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Tytuł:
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Assessment of Primary Care Clinician Concordance With Guidelines for Use of Magnetic Resonance Imaging in Patients With Nonspecific Low Back Pain in the Veterans Affairs Health System.
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Autorzy:
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Barnett PG; Veterans Affairs Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
Jacobs JC; Veterans Affairs Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
Jarvik JG; Department of Radiology, University of Washington, Seattle.; Department of Neurological Surgery, University of Washington, Seattle.; Department of Health Services, University of Washington, Seattle.
Chou R; Department of Clinical Epidemiology and Medical Informatics, Oregon Health & Science University, Portland.; Department of Medicine, Oregon Health & Science University, Portland.
Boothroyd D; Quantitative Research Unit, Stanford University Medical School, Stanford, California.
Lo J; Veterans Affairs Health Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, California.
Nevedal A; Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
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Źródło:
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JAMA network open [JAMA Netw Open] 2020 Jul 01; Vol. 3 (7), pp. e2010343. Date of Electronic Publication: 2020 Jul 01.
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Typ publikacji:
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Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
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Język:
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English
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Imprint Name(s):
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Original Publication: Chicago, IL : American Medical Association, [2018]-
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MeSH Terms:
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Guideline Adherence/*statistics & numerical data
Low Back Pain/*diagnostic imaging
Magnetic Resonance Imaging/*statistics & numerical data
Physicians, Primary Care/*statistics & numerical data
United States Department of Veterans Affairs/*statistics & numerical data
Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae/diagnostic imaging ; Magnetic Resonance Imaging/standards ; Male ; Middle Aged ; Retrospective Studies ; United States ; United States Department of Veterans Affairs/standards
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Grant Information:
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I01 HX002016 United States HX HSRD VA
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Entry Date(s):
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Date Created: 20200714 Date Completed: 20201223 Latest Revision: 20210514
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Update Code:
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20240105
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PubMed Central ID:
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PMC7358914
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DOI:
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10.1001/jamanetworkopen.2020.10343
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PMID:
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32658287
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Importance: Magnetic responance imaging (MRI) of the lumbar spine that is not concordant with treatment guidelines for low back pain represents an unnecessary cost for US health plans and may be associated with adverse effects. Use of MRI in the US Department of Veterans Affairs (VA) primary care clinics remains unknown.
Objective: To assess the use of MRI scans during the first 6 weeks (early MRI scans) of episodes of nonspecific low back pain in VA primary care sites and to determine if historical concordance can identify clinicians and sites that are the least concordant with guidelines.
Design, Setting, and Participants: Retrospective cohort study of electronic health records from 944 VA primary care sites from the 3 years ending in 2016. Data were analyzed between January 2017 and August 2019. Participants were patients with new episodes of nonspecific low back pain and the primary care clinicians responsible for their care.
Exposures: MRI scans.
Main Outcomes and Measures: The proportion of early MRI scans at VA primary care clinics was assessed. Clinician concordance with published guidelines over 2 years was used to select clinicians expected to have low concordance in a third year.
Results: A total of 1 285 405 new episodes of nonspecific low back pain from 920 547 patients (mean [SD] age, 56.7 [15.8] years; 93.6% men) were attributed to 9098 clinicians (mean [SD] age, 52.1 [10.1] years; 55.7% women). An early MRI scan of the lumbar spine was performed in 31 132 of the episodes (2.42%; 95% CI, 2.40%-2.45%). Historical concordance was better than a random draw in selecting the 10% of clinicians who were subsequently the least concordant with published guidelines. For primary care clinicians, the area under the receiver operating characteristic curve was 0.683 (95% CI, 0.658-0.701). For primary care sites, the area was under this curve was 0.8035 (95% CI, 0.754-0.855). The 10% of clinicians with the least historical concordance were responsible for just 19.2% of the early MRI scans performed in the follow-up year.
Conclusions and Relevance: VA primary care clinics had low rates of use of early MRI scans. A history of low concordance with imaging guidelines was associated with subsequent low concordance but with limited potential to select clinicians most in need of interventions to implement guidelines.
