Ivan K Ip1, Esteban F Gershanik2, Louise I Schneider2, Ali S Raja3, Wenhong Mar4, Steven Seltzer5, Michael J Healey6, Ramin Khorasani7. 1. Center for Evidence-Based Imaging, Harvard Medical School, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: iip@partners.org. 2. Center for Evidence-Based Imaging, Harvard Medical School, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 3. Center for Evidence-Based Imaging, Harvard Medical School, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Harvard Medical School, Boston, Mass. 4. Center for Evidence-Based Imaging, Harvard Medical School, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass. 5. Department of Radiology, Harvard Medical School, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 6. Department of Medicine, Harvard Medical School, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Brigham and Women's Physician Organization, Harvard Medical School, Boston, Mass. 7. Center for Evidence-Based Imaging, Harvard Medical School, Boston, Mass; Department of Radiology, Harvard Medical School, Boston, Mass; Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
Abstract
BACKGROUND: The purpose of this study was to examine the impact of a multifaceted, clinical decision support (CDS)-enabled intervention on magnetic resonance imaging (MRI) use in adult primary care patients with low back pain. METHODS: After a baseline observation period, we implemented a CDS targeting lumbar-spine MRI use in primary care patients with low back pain through our computerized physician order entry, as well as 2 accountability tools: mandatory peer-to-peer consultation when test utility was uncertain and quarterly practice pattern variation reports to providers. Our primary outcome measure was rate of lumbar-spine MRI use. Secondary measures included utilization of MRI of any body part, comparing it with that of a concurrent national comparison, as well as proportion of lumbar-spine MRI performed in the study cohort that was adherent to evidence-based guideline. Chi-squared, t-tests, and logistic regression were used to assess pre- and postintervention differences. RESULTS: In the study cohort preintervention, 5.3% of low back pain-related primary care visits resulted in lumbar-spine MRI, compared with 3.7% of visits postintervention (P <.0001, adjusted odds ratio 0.68). There was a 30.8% relative decrease (6.5% vs 4.5%, P <.0001, adjusted odds ratio 0.67) in the use of MRI of any body part by the primary care providers in the study cohort. This difference was not detected in the control cohort (5.6% vs 5.3%, P = .712). In the study cohort, adherence to evidence-based guideline in the use of lumbar-spine MRI increased from 78% to 96% (P = .0002). CONCLUSIONS: CDS and associated accountability tools may reduce potentially inappropriate imaging in patients with low back pain.
BACKGROUND: The purpose of this study was to examine the impact of a multifaceted, clinical decision support (CDS)-enabled intervention on magnetic resonance imaging (MRI) use in adult primary care patients with low back pain. METHODS: After a baseline observation period, we implemented a CDS targeting lumbar-spine MRI use in primary care patients with low back pain through our computerized physician order entry, as well as 2 accountability tools: mandatory peer-to-peer consultation when test utility was uncertain and quarterly practice pattern variation reports to providers. Our primary outcome measure was rate of lumbar-spine MRI use. Secondary measures included utilization of MRI of any body part, comparing it with that of a concurrent national comparison, as well as proportion of lumbar-spine MRI performed in the study cohort that was adherent to evidence-based guideline. Chi-squared, t-tests, and logistic regression were used to assess pre- and postintervention differences. RESULTS: In the study cohort preintervention, 5.3% of low back pain-related primary care visits resulted in lumbar-spine MRI, compared with 3.7% of visits postintervention (P <.0001, adjusted odds ratio 0.68). There was a 30.8% relative decrease (6.5% vs 4.5%, P <.0001, adjusted odds ratio 0.67) in the use of MRI of any body part by the primary care providers in the study cohort. This difference was not detected in the control cohort (5.6% vs 5.3%, P = .712). In the study cohort, adherence to evidence-based guideline in the use of lumbar-spine MRI increased from 78% to 96% (P = .0002). CONCLUSIONS: CDS and associated accountability tools may reduce potentially inappropriate imaging in patients with low back pain.
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