Headache neuroimaging: Routine testing when guidelines recommend against them

Callaghan, Brian C.; Kerber, Kevin A.; Pace, Robert J.; Skolarus, Lesli E.; Cooper, Wade M.; Burke, James F.

doi:10.1177/0333102415572918

Cited by 44 publications

(40 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, Choosing Wisely guidelines have focused on overuse by questioning the use of diagnostic neuroimaging in 2 highly prevalent neurologic conditions: headache and peripheral neuropathy. 2,3 Guideline discordant neuroimaging overuse appears to be common for headache 4,5 and peripheral neuropathy. [6][7][8] At the same time, underuse of neuroimaging in some highrisk headache patients 9 and diagnostic laboratory testing 10 in neuropathy patients likely exists.…”

mentioning

confidence: 99%

“…Understanding the factors that mediate the appropriateness of testing between these 2 large health care systems has the potential to inform future efficiency initiatives. Many differences between the VA and Medicare exist and are potential contributory factors: the fixed resource VA environment, the centrality of primary care in the VA, 4 use of electronic medical records in the VA, 29 provider practice patterns, 30 and provider financial incentives. 31 Understanding which, if any, of these hypotheses account for the differences in appropriateness may inform future quality improvement initiatives.…”

mentioning

confidence: 99%

“…However, if such differences exist, it is unlikely that they would account for the neuroimaging differences between settings as red flags are not strong predictors of receiving neuroimaging. 4 Second, the diagnostic reliability of our ICD-9 algorithms may differ between the VA and HRS-Medicare settings. 32,33 Reassuringly, the primary limitation of these definitions is imperfect sensitivity as opposed to limited specificity.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Neuroimaging overuse is more common in Medicare compared with the VA

et al. 2016

View full text Add to dashboard Cite

Objective: To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.Methods: Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n 5 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n 5 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.Results: For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1% in the VA (p , 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0% in the VA (p , 0.001), and the difference persisted after excluding nontarget conditions. Conclusions:Overuse of neuroimaging is likely less common in the VA than in a Medicare population.Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing. Neurology ® 2016;87:792-798 GLOSSARY HRS 5 Health and Retirement Study; ICD-9 5 International Classification of Diseases-9; NCS 5 nerve conduction studies; SPEP 5 serum protein electrophoresis; VA 5 Veterans Affairs.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Neuroimaging overuse is more common in Medicare compared with the VA

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Recently, we estimated that approximately $1 billion per year is spent on neuroimaging for outpatients for headache in the United States. 5,6 A separate group found similar neuroimaging utilization in headaches. 7 Likewise, high and rising neuroimaging utilization has been reported for patients with low back pain with high resulting costs.…”

Section: Discussionmentioning

confidence: 97%

Neurology Choosing Wisely recommendations

et al. 2015

View full text Add to dashboard Cite

To increase neurologist awareness and inform future efficiency efforts, we identified all neurology-related Choosing Wisely items. Items were categorized by neurologic specialty, disease/symptom, and test/treatment. Of 370 items provided by 65 medical societies, 74 (20%) items were relevant to neurologists. Twelve were duplicated by multiple societies. Items pertaining to 10 neurologic subspecialties were identified, but none for movement disorders and neuromuscular disease. While many recommendations question the use of imaging, few address other high-cost neurologic tests such as EMG/nerve conduction studies and EEG. A rapidly growing number of neurology-related Choosing Wisely recommendations exist including areas of consensus and areas with few recommendations despite high costs. Consensus items should be prioritized for nearterm interventions, while areas with few recommendations represent opportunities for future research.

show abstract

“…To the Editor: In a recent paper published in Cephalalgia, the official journal of the American Headache Society, Callaghan et al [1] reported on information extracted from more than 50 million headache visits in the USA. This indicated that as many as 9.8% of patients with a diagnosis of migraines underwent neuroimaging -either magnetic resonance angiography or computed tomography.…”

Section: Neuroimaging In Migrainementioning

confidence: 99%