Reducing inappropriate diagnostic practice through education and decision support

Bairstow, Phillip J.; Persaud, Jennifer; Mendelson, Richard; Nguyen, Long

doi:10.1093/intqhc/mzq016

Cited by 48 publications

(37 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, a seminal study conducted by Brenner and Hall (13) warns against its bad effects (particularly for children) due to the radiation exposure associated with CT. Independent CT imaging studies (12, 14, 15) advocate the adoption of a comprehensive approach that targets physicians’ education to decrease the over-reliance on CT imaging for those suffering from brain disease. Therefore, to reduce the harmfulness of CT, it can be beneficial to use data mining methods specially, NBN as a predictor.…”

Section: Resultsmentioning

confidence: 99%

Applying Naive Bayesian Networks to Disease Prediction: a Systematic Review

2016

View full text Add to dashboard Cite

Introduction:Naive Bayesian networks (NBNs) are one of the most effective and simplest Bayesian networks for prediction.Objective:This paper aims to review published evidence about the application of NBNs in predicting disease and it tries to show NBNs as the fundamental algorithm for the best performance in comparison with other algorithms.Methods:PubMed was electronically checked for articles published between 2005 and 2015. For characterizing eligible articles, a comprehensive electronic searching method was conducted. Inclusion criteria were determined based on NBN and its effects on disease prediction. A total of 99 articles were found. After excluding the duplicates (n= 5), the titles and abstracts of 94 articles were skimmed according to the inclusion criteria. Finally, 38 articles remained. They were reviewed in full text and 15 articles were excluded. Eventually, 23 articles were selected which met our eligibility criteria and were included in this study.Result:In this article, the use of NBN in predicting diseases was described. Finally, the results were reported in terms of Accuracy, Sensitivity, Specificity and Area under ROC curve (AUC). The last column in Table 2 shows the differences between NBNs and other algorithms.Discussion:This systematic review (23 studies, 53,725 patients) indicates that predicting diseases based on a NBN had the best performance in most diseases in comparison with the other algorithms. Finally in most cases NBN works better than other algorithms based on the reported accuracy.Conclusion:The method, termed NBNs is proposed and can efficiently construct a prediction model for disease.

show abstract

Section: Resultsmentioning

confidence: 99%

Applying Naive Bayesian Networks to Disease Prediction: a Systematic Review

2016

View full text Add to dashboard Cite

show abstract

“…Several studies have found as much as 30% of all imaging tests are inappropriate in some fashion [38–40]. In some instances no imaging test is warranted at all, but more often are the situations where an alternative modality could have been utilised with lower or no radiation burden such as ultrasound, a plain radiograph or, MRI imaging.…”

Section: Discussionmentioning

confidence: 99%

Cohort study of Western Australia computed tomography utilisation patterns and their policy implications

Gibson

Moorin

Holman

2014

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundComputed tomography (CT) scanning is a relatively high radiation dose diagnostic imaging modality with increasing concerns about radiation exposure burden at the population level in scientific literature. This study examined the epidemiology of adult CT utilisation in Western Australia (WA) in both the public hospital and private practice settings, and the policy implications.MethodsRetrospective cohort design using aggregate adult CT data from WA public hospitals and Medical Benefits Schedule (MBS) (mid-2006 to mid-2012). CT scanning trends by sex, age, provider setting and anatomical areas were explored using crude CT scanning rates, age-standardised CT scanning rates and Poisson regression modelling.ResultsFrom mid-2006 to mid-2012 the WA adult CT scanning rate was 129 scans per 1,000 person-years (PY). Females were consistently scanned at a higher rate than males. Patients over 65 years presented the highest scanning rates (over 300 scans per 1,000 PY). Private practice accounted for 73% of adult CT scans, comprising the majority in every anatomical area. In the private setting females predominately held higher age-standardised CT scanning rates than males. This trend reversed in the public hospital setting. Patients over 85 years in the public hospital setting were the most likely age group CT scanned in nine of ten anatomical areas. Patients in the private practice setting aged 85+ years were relatively less prominent across every anatomical area, and the least likely age group scanned in facial bones and multiple areas CT scans.ConclusionIn comparison to the public hospital setting, the MBS subsidised private sector tended to service females and relatively younger patients with a more diverse range of anatomical areas, constituting the majority of CT scans performed in WA. Patient risk and subsequent burden is greater for females, lower ages and some anatomical areas. In the context of a national health system, Australia has various avenues to monitor radiation exposure levels, improve physician training and modify funding mechanisms to ensure individual and population medical radiation exposure is as low as reasonably achievable.

show abstract

“…The clinical features of VTE are variable; many patients remain asymptomatic, while others present with non‐specific illness, for which further investigation is required, particularly when pulmonary embolism (PE) is suspected. Diagnostic management of patients with suspected VTE is often inappropriate and does not always conform to recommended guidelines 1 , 2 . The use of structured diagnostic algorithms and decision‐support tools improves the accuracy of clinical assessment and the appropriateness of referral of patients with suspected VTE; however, these resources are seldom used by referring clinicians, in spite of evidence that adherence to guidelines significantly improves clinical outcomes 1 .…”

mentioning

confidence: 99%

“…Such structured assessment has now become standard practice in Western Australian teaching hospital emergency departments, where an online decision‐support tool has been available since 2001 1 , 6 . There is a widespread perception among imaging specialists in public hospitals in WA that, in spite of the availability of structured assessments and decision support, the volume of referrals for VTE investigations has increased over recent years, and that many may be inappropriate 2 . We aimed to document trends in referrals for VTE‐related imaging within WA teaching hospitals to see whether this perception is valid and what impact any increase in testing may have had on the incidence of deaths related to PE.…”

mentioning

confidence: 99%