Tigran Avoundjian1, Risha Gidwani2, Dorcas Yao3, Jeanie Lo4, Patricia Sinnott4, Neil Thakur3, Paul G Barnett5. 1. Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California. 2. Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Centers for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California; Division of General Medical Disciplines, Stanford University, Stanford, California. 3. Radiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California. 4. Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California. 5. Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Centers for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Electronic address: paul.barnett@va.gov.
Abstract
PURPOSE: Lumbar spine (LS) MRI overuse may be identified in administrative data, but these data may lack the detailed clinical information needed to correctly assess overuse. The aim of this study was to compare chart review with analysis of administrative data to determine the appropriateness of LS MRI. METHODS: The sensitivity and specificity of the administrative method were determined, with inappropriateness regarded as the positive result, as if chart review determined the true state. Patients were the first 146 veterans who underwent LS MRI in the outpatient setting in fiscal year 2012 at the Veterans Affairs Palo Alto Health Care System. The InterQual criteria for chart review and the method of evaluating administrative data developed by CMS and endorsed by the National Quality Forum were used. Slight modifications were made to each measure to ensure completeness and comparability. RESULTS: Of the 146 scans reviewed, 23% were considered inappropriate by the administrative measure, whereas 59% were considered inappropriate by chart review. Compared with chart review, the administrative measure had specificity of 82% for identifying inappropriate scans and sensitivity of 27% for identifying appropriate scans. CONCLUSIONS: Compared with chart review, analysis of administrative data identified scans that were appropriate but underestimated inappropriate ordering. Contrary to expectations, chart review resulted in more scans being classified as inappropriate. The administrative method is economically feasible for identifying the overuse of LS MRI, but it underestimates the true extent of inappropriate ordering. Published by Elsevier Inc.
PURPOSE: Lumbar spine (LS) MRI overuse may be identified in administrative data, but these data may lack the detailed clinical information needed to correctly assess overuse. The aim of this study was to compare chart review with analysis of administrative data to determine the appropriateness of LS MRI. METHODS: The sensitivity and specificity of the administrative method were determined, with inappropriateness regarded as the positive result, as if chart review determined the true state. Patients were the first 146 veterans who underwent LS MRI in the outpatient setting in fiscal year 2012 at the Veterans Affairs Palo Alto Health Care System. The InterQual criteria for chart review and the method of evaluating administrative data developed by CMS and endorsed by the National Quality Forum were used. Slight modifications were made to each measure to ensure completeness and comparability. RESULTS: Of the 146 scans reviewed, 23% were considered inappropriate by the administrative measure, whereas 59% were considered inappropriate by chart review. Compared with chart review, the administrative measure had specificity of 82% for identifying inappropriate scans and sensitivity of 27% for identifying appropriate scans. CONCLUSIONS: Compared with chart review, analysis of administrative data identified scans that were appropriate but underestimated inappropriate ordering. Contrary to expectations, chart review resulted in more scans being classified as inappropriate. The administrative method is economically feasible for identifying the overuse of LS MRI, but it underestimates the true extent of inappropriate ordering. Published by Elsevier Inc.
Entities:
Keywords:
Low back pain; chart review; claims data; magnetic resonance imaging; quality assessment
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