Appropriate use criteria and computerized decision support for the pediatric population: background, Pediatric Rapid Response Committee and future direction

Excerpt

Medical imaging contributes to the diagnosis and management of patients of all ages, yet it is increasingly complex — a complexity that has far outpaced the medical school resources devoted to training for its use. Further, this evolution in the complexity and role of medical imaging is so rapid that it renders static educational models obsolete. Yet the potential for appropriately chosen imaging to decrease morbidity and improve outcomes of care delivery is vast, from replacement of routine exploratory laparotomies, to the rapid, accurate and noninvasive diagnosis of treatable conditions such as pyloric stenosis. Similarly, inappropriate imaging can be detrimental, incurring avoidable risks such as unnecessary radiation exposure, complications from contrast media, and detection of confounding and potentially unimportant incidental findings, which sometimes results in increased cost of health care without reciprocal benefit to the health of the individual or the population. This concern is not insignificant. According to a report to the U.S. Congress by the Medicare Payment Advisory Commission in 2011, the volume of physician services per fee-for-service beneficiary rose by 100% between the years 2000 and 2009, with imaging and other tests leading the rise [1]. In a similar report dated 2018, total health care spending as a percentage of gross domestic product was less than 10% in 1975, rising to nearly 18% in 2017; moreover, decisions by health care providers accounted for approximately 80% of these health care expenditures. Unfortunately, these decisions and increased expenditures were found to be largely unaccompanied by improvements in overall quality of health care and outcomes [2]. Clearly, the incorporation of evidence-based and methodologically sound appropriate use criteria to help guide such everyday decision-making is indeed appropriate, and is a directive whose time has come. …