Impact of IT-enabled Intervention on MRI Use for Back Pain - 22/05/14
, Esteban F. Gershanik, MD, MPH, MMSc a, b, c, d, Louise I. Schneider, MD a, b, c, d, Ali S. Raja, MD, MPH, MBA a, b, d, e, Wenhong Mar, MSc a, b, Steven Seltzer, MD b, d, Michael J. Healey, MD c, d, f, Ramin Khorasani, MD, MPH a, b, dAbstract |
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.
El texto completo de este artículo está disponible en PDF.Keywords : Clinical decision support, Health information technology, Imaging use
Esquema
| Funding: This study was funded in part by Grant 1UC4EB012952-01 from the National Institute of Biomedical Imaging and Bioengineering. |
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| Conflict of Interest: RK is a consultant to Medicalis Corporation. RK is named on US Patent 6,029,138 held by Brigham and Women's Hospital on Clinical Decision Support-related software licensed to Medicalis Corporation in the year 2000. As the result of this licensing, Brigham and Women's Hospital and its parent organization, Partners Healthcare Inc., have equity and royalty interests in Medicalis. SS is President of Brigham Radiology Research and Education Foundation, which has been an equity holder in Medicalis Corporation. SS has been the recipient of research grants from Siemens, GE, and Toshiba, and is on the Board of Directors of the Association of University Radiologists, Society of Chairs of Academic Radiology Departments, and the Academy of Radiology Research. EFG is a stockholder in Amgen, Eli Lilly and Company, General Electric Company, Johnson & Johnson, and Pfizer, Inc. |
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| Authorship: All authors had access to the data and played a role in writing the manuscript. |
Vol 127 - N° 6
P. 512 - juin 2014 Regresar al número
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