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• W4254135036 abstract "You have accessJournal of UrologyProstate Cancer: Staging I (MP62)1 Apr 2020MP62-01 A CLINICAL REMINDER ORDER CHECK (CROC) INTERVENTION TO IMPROVE GUIDELINE-CONCORDANT IMAGING PRACTICES FOR MEN WITH PROSTATE CANCER: A PILOT STUDY Shannon Ciprut, Matthew Kelly, Dawn Walter, Renee Hoffman, Daniel Becker, Stacy Loeb, Erica Sedlander, Craig Tenner, Scott Sherman, Steven Zeliadt, and Danil Makarov* Shannon CiprutShannon Ciprut More articles by this author , Matthew KellyMatthew Kelly More articles by this author , Dawn WalterDawn Walter More articles by this author , Renee HoffmanRenee Hoffman More articles by this author , Daniel BeckerDaniel Becker More articles by this author , Stacy LoebStacy Loeb More articles by this author , Erica SedlanderErica Sedlander More articles by this author , Craig TennerCraig Tenner More articles by this author , Scott ShermanScott Sherman More articles by this author , Steven ZeliadtSteven Zeliadt More articles by this author , and Danil Makarov*Danil Makarov* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000937.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Almost half of US Veterans with low-risk prostate cancer undergo a wasteful imaging workup after diagnosis. EMR-based Clinical Reminder Order Checks (CROC) have been implemented as interventions in other health settings with a moderate amount of success in changing ordering behaviors among providers. We used National Comprehensive Cancer Network’s (NCCN) guidelines to design and implement a CROC that alerts ordering providers of potentially inappropriate imaging orders in real-time based on patient features of men diagnosed with low-risk prostate cancer. METHODS: We implemented the CROC at VA New York Harbor Healthcare System (VANYHHS) from April 2, 2015 to November 15, 2017 in the local Electronic Medical Record (EMR) system. The notification appeared in a pop-up window when an imaging test was ordered for a patient with prostate cancer and PSA < 20 ng/ml. We then used VA administrative claims from the VA’s Corporate Data Warehouse to analyze imaging rates among men with low-risk prostate cancer at VHANYHHS before and after CROC implementation. We also performed a content analysis of the free-form text justifications entered by ordering providers for each override of the notification. RESULTS: 57% (117/205) of Veterans prior to CROC installation and 73% (61/83) of Veterans post-intervention with low-risk prostate cancer were appropriately not imaged. Men with low-risk prostate cancer treated in the post-intervention period were 1.3 times as likely to avoid imaging (thereby receiving guideline-concordant care) compared to those treated prior to the intervention. The most frequent override justification cited by providers were Unclear/None (67%) and Imaging for Non-Prostate Cancer Staging Concern (14.3%). CONCLUSIONS: The EMR-based CROC intervention is associated with moderate improvement in guideline-concordant imaging practices for Veterans with low-risk prostate cancer. Results of this pilot study will help inform intervention implementation across VA Medical Center systems in a national-level trial. Guideline-concordant imaging practices at the VA promote cost-effectiveness and quality of care for Veterans by reducing unnecessary testing. Source of Funding: Funding for this study was provided by the United States Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (VA IIR 15-356). This study is supported by The Prostate Cancer Foundation (PCF), The John and Daria Barry Precision Oncology Center of Excellence of the VANYHHS, and The Edward Blank and Sharon Cosloy–Blank Family Foundation. Dr. Makarov is a Prostate Cancer Foundation Young Investigator awardee. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e945-e945 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shannon Ciprut More articles by this author Matthew Kelly More articles by this author Dawn Walter More articles by this author Renee Hoffman More articles by this author Daniel Becker More articles by this author Stacy Loeb More articles by this author Erica Sedlander More articles by this author Craig Tenner More articles by this author Scott Sherman More articles by this author Steven Zeliadt More articles by this author Danil Makarov* More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W4254135036 title "MP62-01 A CLINICAL REMINDER ORDER CHECK (CROC) INTERVENTION TO IMPROVE GUIDELINE-CONCORDANT IMAGING PRACTICES FOR MEN WITH PROSTATE CANCER: A PILOT STUDY" @default.
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