Michael A Bruno1, Joseph S Fotos2, Marika Pitot3, Ana M Franceschi4, Janet A Neutze2, Mark H Willis5, Emily Wasserman6, Bethany L Snyder6, Giuseppe Cruciata7, Heather L Stuckey8, Max Wintermark9. 1. Vice-Chair for Radiology Quality & Safety and Chief of Emergency Radiology, Department of Radiology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine and Penn State Health, Hershey, Pennsylvania. Electronic address: mbruno@pennstatehealth.psu.edu. 2. Department of Radiology, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine and Penn State Health, Hershey, Pennsylvania. 3. Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota. 4. Department of Radiology, Neuroradiology Section, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Manhasset, New York. 5. Associate Chair for Radiology Quality Improvement, Department of Radiology, Stanford University and Stanford Medical Center, Stanford, California. 6. Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania. 7. Stony Brook University Medical Center, Stony Brook, New York. 8. Department of Medicine, Penn State Health, Hershey, Pennsylvania. 9. Chief of Neuroradiology, Department of Radiology, Stanford University and Stanford Medical Center, Stanford, California.
Abstract
PURPOSE: The effectiveness of evidence-based guidelines (EBGs) and clinical decision support (CDS) is significantly hampered by widespread clinician resistance to it. Our study was designed to better understand the reasons for this resistance to CDS and explore the factors that drive it. METHODS: We used a mixed-methods approach to explore and identify the drivers of resistance for CDS among clinicians, including a web-based multispecialty survey exploring clinicians' impressions of the strengths and weaknesses of CDS, two clinician focus groups, and several one-on-one focused clinician interviews in which individual participants were asked to comment on their rationale for choosing imaging utilization that might not be supported by EBGs. Additionally, a unique electronic learning and assessment module known as Amplifire was used to probe clinician knowledge gaps regarding EBGs and CDS. RESULTS: In both the quantitative and qualitative portions of the study, the primary factor driving resistance to CDS was a desire to order studies not supported by EBGs, primarily for the purpose of reducing the clinician's diagnostic uncertainty. CONCLUSIONS: Our results suggest that to enhance the effectiveness of CDS, we must first address the issue of clinician discomfort with diagnostic uncertainty and the role of imaging via educational outreach and ongoing radiologist consultation.
PURPOSE: The effectiveness of evidence-based guidelines (EBGs) and clinical decision support (CDS) is significantly hampered by widespread clinician resistance to it. Our study was designed to better understand the reasons for this resistance to CDS and explore the factors that drive it. METHODS: We used a mixed-methods approach to explore and identify the drivers of resistance for CDS among clinicians, including a web-based multispecialty survey exploring clinicians' impressions of the strengths and weaknesses of CDS, two clinician focus groups, and several one-on-one focused clinician interviews in which individual participants were asked to comment on their rationale for choosing imaging utilization that might not be supported by EBGs. Additionally, a unique electronic learning and assessment module known as Amplifire was used to probe clinician knowledge gaps regarding EBGs and CDS. RESULTS: In both the quantitative and qualitative portions of the study, the primary factor driving resistance to CDS was a desire to order studies not supported by EBGs, primarily for the purpose of reducing the clinician's diagnostic uncertainty. CONCLUSIONS: Our results suggest that to enhance the effectiveness of CDS, we must first address the issue of clinician discomfort with diagnostic uncertainty and the role of imaging via educational outreach and ongoing radiologist consultation.