Imaging utilization and the appropriateness of the imaging in the specific clinical scenario is a main focus of health policy discussions today. On April 1, 2014, President Obama signed a patch to the specific growth rate which included a requirement for decision support to be used for imaging by 2017. Computerized Provider Order Entry (CPOE) and decision support have been shown to decrease utilization of imaging . Yet, decision support requires ongoing clinical research be peer reviewed and published as well as reviewed and incorporated into the decision-making algorithms where appropriate.
In this issue of Academic Radiology , we look at the radiology literature and how it can be used to make clinical decisions and inform health policy. The Radiology Alliance for Health Services Research/Association of Clinical Educators in Radiology course at 2013 Association of University Radiologists (AUR) focused on the standards on how to report and critically appraise studies in the clinical literature. Highlights from this symposium are presented in two articles in this issue . The first of these articles reviews the internationally accepted standards on how to report the results of research studies based on the study type . The second article reviews the accepted techniques for critical appraisal or review of specific research study types . By standardizing both how clinical research studies are reported and how they are appraised, the quality of clinical evidence will improve. More recently, an emphasis has been placed on engaging the patient in their own care both in decision making and setting specific goal. Unfortunately, there are no accepted guidelines on how to report or review patient-reported outcome literature . Nor are there standards for reporting benefit–risk analysis studies .
The type of research studies and metrics needed and published in radiology is changing and presents opportunities for academic radiology to impact patient outcomes. Publications in this issue include a protocol IMpact of Platelet Rich plasma OVer alternative therapies with lateral Epicondylitis (IMPROVE) . Peer review of protocols lends credibility and places the protocol to be in the literature before the collection and analysis of the data. An article by Lee and Jarvik describes the pragmatic trial—a research study design that merges qualitative and quantitative data which allows comparative effectiveness of imaging-based versus non–imaging-based diagnostic tests . Another line of research will seek to predict outcomes, so interventions can occur earlier. Stojanovska et al. assess the ability to use multidetector computed tomography as a biomarker to assess whether left atrial measurements (volume, function, and diameter) can be an accurate predictor of the presence and chronicity of atrial fibrillation . Not only does evidence inform policy but policy can change patient behavior. New research tools will allow access to big data sets such as Internet searches. Dehkordy et al. present an article using Google Trends to determine the correlation of Web browser searches for “breast density” and the corresponding state’s breast density legislative agenda .
The literature can be incorporated into clinical care by individuals in their daily clinical decision making and by professional societies. The American College of Radiology (ACR) has used Delphi consensus panel of radiologists and nonradiologist to develop the ACR appropriateness criteria. These are built into decision support tools in CPOE systems. Decision support offers the ability to rapidly disseminate new discoveries and the best practices with changes in practices potentially on a national level. The opportunity for academic radiologists and their research to impact patient outcomes has never been greater. The quality of evidence must be of the highest caliber and relevant to the clinical questions being asked by all stakeholders in health care. This will require an expansion of existing health service research and recognizing the paradigm shift in what constitutes a contribution to the peer-reviewed literature.
References
1. Thrall James: Appropriateness and imaging utilization: Computerized Provider Order Entry and Decision Support. Acad Radiol 2014; 21: pp. 1083-1087.
2. Cronin Paul, Rawson James V., Heilbrun Marta E., et. al.: How to report a research study. Acad Radiol 2014; 21: pp. 1088-1116.
3. Cronin Paul, Rawson James V., Heilbrun Marta E., et. al.: How to critically appraise the clinical literature. Acad Radiol 2014; 21: pp. 1117-1128.
4. Bresnahan Brian W.: Including patient-reported outcomes and patient-reported resource-use questionnaires in studies. Acad Radiol 2014; 21: pp. 1129-1137.
5. Agapova Maria, Devine Beth, Bresnahan Brian W., et. al.: Applying quantitative benefit-risk analysis to aid regulatory decision-making in diagnostic imaging: methods, challenges, and opportunities. Acad Radiol 2014; 21: pp. 1138-1143.
6. Mary M Chiavaras, Jon A Jacobson, Ruth Carlos, Eugene Maida, Todd Bentley, Nicole Simunovic, Marilyn Swinton, Mohit Bhandari. IMpact of Platelet Rich plasma OVer alternative therapies in patients with lateral Epicondylitis (IMPROVE): protocol for a multicenter randomized controlled study. Acad Radiol 2014; 21:1144–1155.
7. Lee Christoph I., Jarvik Jerry: Patient-centered outcomes research in radiology. Acad Radiol 2014; 21: pp. 1156-1161.
8. Jadranka Stojanovska, Paul Cronin, Barry H Gross, Alex Tsodikov, Luba Frank, Ella A Kazerooni, Hakan Oral. Left atrial function and maximum volume as determined by MDCT are independently associated with atrial fibrillation. Acad Radiol 2014; 21:1162–1171.
9. Soudabeh Fazeli Dehkordy, Ruth Carlos, Vanessa Dalton, Kelli Hall. Novel data sources for women’s health research: mapping breast screening information seeking through Google Trends. Acad Radiol 2014; 21:1172–1176.