Evaluating Two Measures of Lumbar Spine MRI Overuse: Administrative Data Versus Chart Review

Avoundjian, Tigran; Gidwani, Risha; Yao, Dorcas C.; Lo, Jeanie; Sinnott, Patricia L.; Thakur, Neil; Barnett, Paul G.

doi:10.1016/j.jacr.2016.04.013

Cited by 21 publications

(14 citation statements)

References 24 publications

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“…This is a common issue when measuring low-value care in routinely collected data [ 20 ]. Validation studies using clinical chart review have, however, suggested either reasonable agreement or a conservative estimate of low-value care using the routine data approach [ 21 – 23 ].…”

Section: Limitationsmentioning

confidence: 99%

Developing indicators for measuring low-value care: mapping Choosing Wisely recommendations to hospital data

et al. 2018

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ObjectiveLow-value health care refers to interventions where the risk of harm or costs exceeds the likely benefit for a patient. We aimed to develop indicators of low-value care, based on selected Choosing Wisely (CW) recommendations, applicable to routinely collected, hospital claims data.ResultsWe assessed 824 recommendations from the United States, Canada, Australia and the United Kingdom CW lists regarding their capacity to be measured in administrative hospital admissions datasets. We selected recommendations if they met the following criteria: the service occurred in the hospital setting (observable in setting); a claim recorded the use of the service (record of service); the appropriate/inappropriate use of the service could be mapped to information within the hospital claim (indication); and the service is consistently recorded in the claims (consistent documentation). We identified 17 recommendations (15 services) as measurable. We then developed low-value care indicators for two hospital datasets based on the selected recommendations, previously published indicators, and clinical input.

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Section: Limitationsmentioning

confidence: 99%

Developing indicators for measuring low-value care: mapping Choosing Wisely recommendations to hospital data

et al. 2018

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“…However, comparisons of indicators of inappropriate care based on administrative data (like we have done) versus chart reviews suggest the former yield conservative or indicative estimates of low-value care. These comparisons have only been done for a few services and administrative data sets,30–32 and further research and validation work on these indicators would be useful 29…”

Section: Discussionmentioning

confidence: 99%

Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010–2014)

et al. 2019

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ObjectiveTo examine the prevalence, costs and trends (2010–2014) for 21 low-value inpatient procedures in a privately insured Australian patient cohort.DesignWe developed indicators for 21 low-value procedures from evidence-based lists such as Choosing Wisely, and applied them to a claims data set of hospital admissions. We used narrow and broad indicators where multiple low-value procedure definitions exist.Setting and participantsA cohort of 376 354 patients who claimed for an inpatient service from any of 13 insurance funds in calendar years 2010–2014; approximately 7% of the privately insured Australian population.Main outcome measuresCounts and proportions of low-value procedures in 2014, and relative change between 2010 and 2014. We also report both the Medicare (Australian government) and the private insurance financial contributions to these low-value admissions.ResultsOf the 14 662 patients with admissions for at least 1 of the 21 procedures in 2014, 20.8%–32.0% were low-value using the narrow and broad indicators, respectively. Of the 21 procedures, admissions for knee arthroscopy were highest in both the volume and the proportion that were low-value (1607–2956; 44.4%–81.7%).Seven low-value procedures decreased in use between 2010 and 2014, while admissions for low-value percutaneous coronary interventions and inpatient intravitreal injections increased (51% and 8%, respectively).For this sample, we estimated 2014 Medicare contributions for admissions with low-value procedures to be between $A1.8 and $A2.9 million, and total charges between $A12.4 and $A22.7 million.ConclusionsThe Australian federal government is currently reviewing low-value healthcare covered by Medicare and private health insurers. Estimates from this study can provide crucial baseline data and inform design and assessment of policy strategies within the Australian private healthcare sector aimed at curtailing the high volume and/or proportions of low-value procedures.

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“…11 Prior research found approximately 29% of LS-MRIs in the private sector are unneeded, 12,13 with a 22.5% average annual prevalence of this practice nationwide, 14 and 11% of older patients with acute, uncomplicated LPB receiving unneeded advanced imaging. 15 Unneeded LS-MRI may be a particular concern for patients seen by the Veterans Health Administration (VA), as more than 10% of patients seen in VA are diagnosed with LBP each year, 16 and studies using different methods 17,18 have found between 30 and 66% of LS-MRI ordered by VA providers were unneeded.…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Primary Care Providers’ Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study

Nevedal

Lewis

et al. 2019

J GEN INTERN MED

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BACKGROUND: Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood. OBJECTIVE: To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain. DESIGN: Qualitative study using semi-structured interviews. PARTICIPANTS: Veterans Affairs PCPs identified from administrative data as having high or low rates of guidelineconcordant LS-MRI ordering in 2016. APPROACH: Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI. KEY RESULTS: Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low-and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns. CONCLUSIONS: Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.

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Evaluating Two Measures of Lumbar Spine MRI Overuse: Administrative Data Versus Chart Review

Cited by 21 publications

References 24 publications

Developing indicators for measuring low-value care: mapping Choosing Wisely recommendations to hospital data

Developing indicators for measuring low-value care: mapping Choosing Wisely recommendations to hospital data

Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010–2014)

Factors Influencing Primary Care Providers’ Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study

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