Pradeep Suri1,2,3,4, Eric N Meier1,5, Laura S Gold1,6, Zachary A Marcum7, Sandra K Johnston1,6, Kathryn T James1,6, Brian W Bresnahan6, Michael O'Reilly1,6, Judith A Turner1,2,8, David F Kallmes9, Karen J Sherman10, Richard A Deyo11, Patrick H Luetmer9, Andrew L Avins12, Brent Griffith13, Patrick J Heagerty1,5, Sean D Rundell1,2, Jeffrey G Jarvik1,6,14, Janna L Friedly1,2. 1. Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington, USA. 2. Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA. 3. Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington, USA. 4. Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington, USA. 5. Department of Biostatistics, University of Washington, Seattle, Washington, USA. 6. Department of Radiology, School of Medicine, University of Washington, Seattle, Washington, USA. 7. Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington, USA. 8. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA. 9. Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. 10. Kaiser Permanente Washington, Seattle, Washington, USA. 11. Departments of Family Medicine and Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA. 12. Division of Research (ALA), Kaiser Permanente Northern California, Oakland, California, USA. 13. Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA. 14. Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Abstract
OBJECTIVE: To evaluate the effect of inserting epidemiological information into lumbar spine imaging reports on subsequent nonsurgical and surgical procedures involving the thoracolumbosacral spine and sacroiliac joints. DESIGN: Analysis of secondary outcomes from the Lumbar Imaging with Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized trial. SETTING: Primary care clinics within four integrated health care systems in the United States. SUBJECTS: 238,886 patients ≥18 years of age who received lumbar diagnostic imaging between 2013 and 2016. METHODS: Clinics were randomized to receive text containing age- and modality-specific epidemiological benchmarks indicating the prevalence of common spine imaging findings in people without low back pain, inserted into lumbar spine imaging reports (the "LIRE intervention"). The study outcomes were receiving 1) any nonsurgical lumbosacral or sacroiliac spine procedure (lumbosacral epidural steroid injection, facet joint injection, or facet joint radiofrequency ablation; or sacroiliac joint injection) or 2) any surgical procedure involving the lumbar, sacral, or thoracic spine (decompression surgery or spinal fusion or other spine surgery). RESULTS: The LIRE intervention was not significantly associated with subsequent utilization of nonsurgical lumbosacral or sacroiliac spine procedures (odds ratio [OR] = 1.01, 95% confidence interval [CI] 0.93-1.09; P = 0.79) or any surgical procedure (OR = 0.99, 95 CI 0.91-1.07; P = 0.74) involving the lumbar, sacral, or thoracic spine. The intervention was also not significantly associated with any individual spine procedure. CONCLUSIONS: Inserting epidemiological text into spine imaging reports had no effect on nonsurgical or surgical procedure utilization among patients receiving lumbar diagnostic imaging.
OBJECTIVE: To evaluate the effect of inserting epidemiological information into lumbar spine imaging reports on subsequent nonsurgical and surgical procedures involving the thoracolumbosacral spine and sacroiliac joints. DESIGN: Analysis of secondary outcomes from the Lumbar Imaging with Reporting of Epidemiology (LIRE) pragmatic stepped-wedge randomized trial. SETTING: Primary care clinics within four integrated health care systems in the United States. SUBJECTS: 238,886 patients ≥18 years of age who received lumbar diagnostic imaging between 2013 and 2016. METHODS: Clinics were randomized to receive text containing age- and modality-specific epidemiological benchmarks indicating the prevalence of common spine imaging findings in people without low back pain, inserted into lumbar spine imaging reports (the "LIRE intervention"). The study outcomes were receiving 1) any nonsurgical lumbosacral or sacroiliac spine procedure (lumbosacral epidural steroid injection, facet joint injection, or facet joint radiofrequency ablation; or sacroiliac joint injection) or 2) any surgical procedure involving the lumbar, sacral, or thoracic spine (decompression surgery or spinal fusion or other spine surgery). RESULTS: The LIRE intervention was not significantly associated with subsequent utilization of nonsurgical lumbosacral or sacroiliac spine procedures (odds ratio [OR] = 1.01, 95% confidence interval [CI] 0.93-1.09; P = 0.79) or any surgical procedure (OR = 0.99, 95 CI 0.91-1.07; P = 0.74) involving the lumbar, sacral, or thoracic spine. The intervention was also not significantly associated with any individual spine procedure. CONCLUSIONS: Inserting epidemiological text into spine imaging reports had no effect on nonsurgical or surgical procedure utilization among patients receiving lumbar diagnostic imaging.
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