The book provides a systematic framework for understanding the best imaging choices for patient care. Chapters highlight key points that support the clinical applications, allowing fast access to pertinent information. Topics include patient selection, imaging strategies, test performance, cost-effectiveness, and applicability. This Revised Edition adds ten new chapters to the material from the original, hardcover edition, covering radiation risk in medical imaging, the economic and regulatory impact of evidence-based imaging in the new healthcare reform environment in the United States, and new topics on common disorders.
Improving Pediatric Care: Evidence-Based Solutions to Support Better Patient Outcomes
By offering a clear understanding of the science behind the evidence, the book fills a void for radiologists, clinicians, residents, and others with an interest in medical imaging and a desire to implement an evidence-based approach. Santiago Medina joined Miami Children's Hospital as a neuroradiologist and pediatric radiologist in He is a member of several professional committees and gives multiple lectures on evidence-based medicine and central nervous system imaging.
Santiago Medina has published numerous articles in national and international peer review journals. He is bi-lingual in English and Spanish.
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Rent the eBook. Spending on diagnostic imaging is rapidly increasing, and some patients receive unnecessary radiation exposure that can lead to adverse health impacts . Inappropriate imaging falls into 3 broad categories: imaging that does not conform to clinical guidelines, imaging that is contraindicated due to an allergy or implantable medical device, and imaging that might be clinically indicated but is duplicative of prior imaging services.
Clinical decision support CDS functionality supports health care improvement initiatives to narrow the gap between evidence-based practices and routine care . CDS merges patient-specific clinical information with relevant information about evidence-based practices, providing health care providers with timely information to guide decisions at the point of care .
Decision support is most commonly delivered in the form of alerts and reminders .
CDS can be effective in reducing adverse drug events , sepsis [8,9], and other conditions in hospital [10—12] and ambulatory settings [13,14]. For the evaluation of suspected appendicitis in children, ultrasound is the preferred initial consideration for imaging examination .
2 The Diagnostic Process | Improving Diagnosis in Health Care | The National Academies Press
Evidence suggests that CDS can increase the use of ultrasound for suspected pediatric appendicitis [16,17] and has affirmed the utility of ultrasound as a first-line diagnostic tool for suspected appendicitis [18,19]. In the Choosing Wisely campaign, the American College of Surgeons and the American College of Radiology have both endorsed ultrasound as an option to consider prior to conducting a CT scan to evaluate suspected appendicitis in children .
Banner Health, a large health system headquartered in Phoenix, Arizona, implemented a health care improvement initiative using CDS functionality to encourage providers to use ultrasound instead of CT as a first-line diagnostic tool for suspected pediatric appendicitis. We conducted a site visit to Banner Health, an organization who had had attained a high score on the EMR Adoption Model  to examine their implementation process.
We sought to build on previous research examining the use of health information technology to improve performance in large health systems [21—23]. Banner Health is a large not-for-profit health system that is comprised of 24 acute care hospitals across several states, as well as ambulatory medical practices, behavioral health, home care, and ambulatory surgery centers [24,25].
The health system is the largest employer in Arizona and one of the largest in the United States with over 50, employees. Banner Health has been nationally recognized for clinical quality , an innovative leadership team , and using health IT to improve quality . The first 2 authors conducted a 2-day site visit to the Banner Health headquarters in Phoenix, Arizona in November The team conducted discussions with over 20 individuals, including health system leadership, frontline clinicians in several units of an acute care hospital, staff members in 2 telehealth hubs—including a tele-ICU hub—and trainers in a simulation facility that is used for staff training.
CDS and Referral Guidelines
The discussions were conducted with groups of staff or on an individual basis, as appropriate. At the outset of the project, an environmental scan of relevant grey and peer-reviewed literature was conducted under contract on behalf of the authors to guide data collection and analysis . An interview protocol was created to guide the discussions. The protocol contained modules that were used during each discussion, if relevant. The modules addressed topics such as technical issues with designing and deploying health information technology functionalities such as clinical decision support systems, the organizational processes and structures needed to launch health care improvement initiatives, and using health information technology care coordination.
- 6. Standards for paediatric imaging;
- Improving the Quality of Imaging in the Emergency Department.
- Tai-Pan (Asian Saga - Book 2).
- Summary of the proceedings of the International Forum 2018: “Value-based radiology”.
- Evidence-Based Imaging.
Within each module, questions probed about the challenges that arose and the solutions to these challenges, with a focus on the four phases of implementing a health information technology intervention: functionality planning, software customization and workflow design, training and user support, and optimization. To assist with interpreting the qualitative findings, an evolving outline of the findings was maintained.
Salient themes and conceptual categories were tracked, which helped the researchers organize, synthesize, and interpret the information collected during the site visit.
Once the authors chose to focus on clinical decision support, summary notes from the discussions were reviewed for relevant information, and this information was compiled and organized under the rubric of the four implementation phases. The findings and key themes from the discussion notes were distilled into key lessons for the field.