Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care
Abstract The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing ev...
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| Veröffentlicht in: | International journal for quality in health care 2023-04, Vol.35 (2) |
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| container_title | International journal for quality in health care |
| container_volume | 35 |
| creator | Tay, Yi Xiang Chan, Ling Ling Than, Shin Ru Lim, Gek Hsiang Tan, Mark Bangwei Mak, May San Hou, Wenlu Wee, Jeremy Choon Peng Ng, Yeong Huei Chen, Robert Chun |
| description | Abstract
The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians’ specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists’ training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of |
| doi_str_mv | 10.1093/intqhc/mzad021 |
| format | Article |
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The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians’ specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists’ training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of <6 weeks duration being the most common indication. Significant differences in inappropriate orders were found (P < .001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in training (27.8%), and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively. Approximately one-third of lumbar spine radiographs performed in the ED were inappropriately ordered by American College of Radiology guidelines; specialists training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce health care costs.</description><identifier>ISSN: 1353-4505</identifier><identifier>EISSN: 1464-3677</identifier><identifier>DOI: 10.1093/intqhc/mzad021</identifier><identifier>PMID: 37043329</identifier><language>eng</language><publisher>UK: Oxford University Press</publisher><subject>Humans ; Low Back Pain - diagnostic imaging ; Lumbar Vertebrae - diagnostic imaging ; Radiography ; Referral and Consultation ; Retrospective Studies ; Unnecessary Procedures</subject><ispartof>International journal for quality in health care, 2023-04, Vol.35 (2)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c324t-563cbef6093ec916b4429932b21e3d6414bdf3cde968c8f815b1af5ae52bd52c3</cites><orcidid>0000-0001-7603-7334 ; 0000-0001-8322-1500</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,1598,27901,27902</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/intqhc/mzad021$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37043329$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tay, Yi Xiang</creatorcontrib><creatorcontrib>Chan, Ling Ling</creatorcontrib><creatorcontrib>Than, Shin Ru</creatorcontrib><creatorcontrib>Lim, Gek Hsiang</creatorcontrib><creatorcontrib>Tan, Mark Bangwei</creatorcontrib><creatorcontrib>Mak, May San</creatorcontrib><creatorcontrib>Hou, Wenlu</creatorcontrib><creatorcontrib>Wee, Jeremy Choon Peng</creatorcontrib><creatorcontrib>Ng, Yeong Huei</creatorcontrib><creatorcontrib>Chen, Robert Chun</creatorcontrib><title>Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care</title><title>International journal for quality in health care</title><addtitle>Int J Qual Health Care</addtitle><description>Abstract
The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians’ specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists’ training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of <6 weeks duration being the most common indication. Significant differences in inappropriate orders were found (P < .001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in training (27.8%), and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively. Approximately one-third of lumbar spine radiographs performed in the ED were inappropriately ordered by American College of Radiology guidelines; specialists training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce health care costs.</description><subject>Humans</subject><subject>Low Back Pain - diagnostic imaging</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Radiography</subject><subject>Referral and Consultation</subject><subject>Retrospective Studies</subject><subject>Unnecessary Procedures</subject><issn>1353-4505</issn><issn>1464-3677</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1u1DAUhS1ERUthyxJ5SRdp_T8Ju6qigFSJDawjx76eGCV2ajuDykPwzHU0A1tW9-j6u0fyOQi9o-Sako7f-FAeR3Mz_9aWMPoCXVChRMPVbveyai55IySR5-h1zj8JoYpL9Qqd8x0RnLPuAv25XZYUl-R1gQA54-jwtM6DTjgvPgBO2vq4T3oZn7AOFjttSkwZ--CmFYLxYY_9rPfbjMlC2sSiS4EU8seqDtuijLAtR1ziL50sPuh63NjkDxDwCHqqT0YneIPOnJ4yvD3NS_Tj_tP3uy_Nw7fPX-9uHxrDmSiNVNwM4FRNAExH1SAE6zrOBkaBWyWoGKzjxkKnWtO6lsqBaic1SDZYyQy_RB-OvvXzjyvk0s8-G5gmHSCuuWdtDUu0O0Uqen1ETYo5J3B9TWvW6amnpN866I8d9KcO6sH7k_c6zGD_4X9Dr8DVEYjr8j-zZ_7olz4</recordid><startdate>20230429</startdate><enddate>20230429</enddate><creator>Tay, Yi Xiang</creator><creator>Chan, Ling Ling</creator><creator>Than, Shin Ru</creator><creator>Lim, Gek Hsiang</creator><creator>Tan, Mark Bangwei</creator><creator>Mak, May San</creator><creator>Hou, Wenlu</creator><creator>Wee, Jeremy Choon Peng</creator><creator>Ng, Yeong Huei</creator><creator>Chen, Robert Chun</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7603-7334</orcidid><orcidid>https://orcid.org/0000-0001-8322-1500</orcidid></search><sort><creationdate>20230429</creationdate><title>Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care</title><author>Tay, Yi Xiang ; Chan, Ling Ling ; Than, Shin Ru ; Lim, Gek Hsiang ; Tan, Mark Bangwei ; Mak, May San ; Hou, Wenlu ; Wee, Jeremy Choon Peng ; Ng, Yeong Huei ; Chen, Robert Chun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c324t-563cbef6093ec916b4429932b21e3d6414bdf3cde968c8f815b1af5ae52bd52c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Humans</topic><topic>Low Back Pain - diagnostic imaging</topic><topic>Lumbar Vertebrae - diagnostic imaging</topic><topic>Radiography</topic><topic>Referral and Consultation</topic><topic>Retrospective Studies</topic><topic>Unnecessary Procedures</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tay, Yi Xiang</creatorcontrib><creatorcontrib>Chan, Ling Ling</creatorcontrib><creatorcontrib>Than, Shin Ru</creatorcontrib><creatorcontrib>Lim, Gek Hsiang</creatorcontrib><creatorcontrib>Tan, Mark Bangwei</creatorcontrib><creatorcontrib>Mak, May San</creatorcontrib><creatorcontrib>Hou, Wenlu</creatorcontrib><creatorcontrib>Wee, Jeremy Choon Peng</creatorcontrib><creatorcontrib>Ng, Yeong Huei</creatorcontrib><creatorcontrib>Chen, Robert Chun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal for quality in health care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Tay, Yi Xiang</au><au>Chan, Ling Ling</au><au>Than, Shin Ru</au><au>Lim, Gek Hsiang</au><au>Tan, Mark Bangwei</au><au>Mak, May San</au><au>Hou, Wenlu</au><au>Wee, Jeremy Choon Peng</au><au>Ng, Yeong Huei</au><au>Chen, Robert Chun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care</atitle><jtitle>International journal for quality in health care</jtitle><addtitle>Int J Qual Health Care</addtitle><date>2023-04-29</date><risdate>2023</risdate><volume>35</volume><issue>2</issue><issn>1353-4505</issn><eissn>1464-3677</eissn><abstract>Abstract
The demand for diagnostic imaging continues to rise. Against the backdrop of rising health care costs and finite resources, this has prompted a paradigm shift toward value-driven patient care. Inappropriate imaging is a barrier toward achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral Emergency Department (ED) and assess whether physicians’ specialization and years of experience influence appropriateness. A total of 1030 lumbar spine radiographs performed in the ED of an academic medical center over a consecutive 3-month period were reviewed retrospectively. Referral indications were reviewed for adherence to 2021 American College of Radiology appropriateness guidelines for lower back pain, and referral patterns were evaluated among physician groups based on specialists’ training and years in practice. 63.8% of lumbar spine radiographs were appropriate, with trauma being the most common indication. 36.2% of orders were inappropriate, with lower back pain of <6 weeks duration being the most common indication. Significant differences in inappropriate orders were found (P < .001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in training (27.8%), and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively. Approximately one-third of lumbar spine radiographs performed in the ED were inappropriately ordered by American College of Radiology guidelines; specialists training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce health care costs.</abstract><cop>UK</cop><pub>Oxford University Press</pub><pmid>37043329</pmid><doi>10.1093/intqhc/mzad021</doi><orcidid>https://orcid.org/0000-0001-7603-7334</orcidid><orcidid>https://orcid.org/0000-0001-8322-1500</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Oxford Journals Open Access Collection |
| subjects | Humans Low Back Pain - diagnostic imaging Lumbar Vertebrae - diagnostic imaging Radiography Referral and Consultation Retrospective Studies Unnecessary Procedures |
| title | Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path toward value-driven health care |
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