Blog Post

How a new study on inappropriate imaging orders should inform your strategy to curb unnecessary testing

November 6, 2018

    One billion dollars per year—that's how much one study estimates is spent on neuroimaging for headaches in the United States, an exam that is considered low value by Choosing Wisely. Considering that imaging for headache is just one of many Choosing Wisely targets related to imaging, it's clear that reducing unnecessary imaging could significantly affect overall health care spending. However, although the Choosing Wisely campaign launched over six years ago to help reduce unnecessary, low-value medical services, studies have found it's had only limited impact on imaging utilization to date.

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    For instance, low back pain imaging—which was targeted due to its frequency, high cost, and often low value—is one example of unrealized potential. According to a 2017 study, there has only been a 4% reduction in lower back pain imaging since the start of the Choosing Wisely campaign, indicating major untapped opportunity to reduce utilization of this low-value service. 

    Target education efforts to highest utilizers of low-value tests

    When it comes to inflecting change on the utilization of low-value exams, imaging leaders must collaborate with referring providers to drive change. This collaboration can take the form of referrer education, increased use of order checks, and adoption of CDS, but it can be difficult for imaging leaders to provide this education to their entire referrer base.

    According to a new study, however, a large portion of low-value tests may come for a relatively small subgroup of physicians. For the study, researchers examined ordering patterns of primary care providers for four different low-value exams: repeated dual-energy x-ray absorptiometry scans, electrocardiograms, Papanicolaou tests, and chest radiographs. The researchers found that 18.4% of physicians qualified as a "frequent user" of these low-value tests, and this group accounted for 39.2% of all low-value orders—the Pareto principle in action.

    Targeting this subgroup of physicians will likely result in greater return on effort for imaging leaders than a more generalized approach.

    Identifying the highest utilizers

    While identifying which physicians fall into this "frequent user" group may still be a challenge for imaging programs, this study attempted to identify a few common characteristics of these utilizers. Physicians who were male, further removed from medical school, and operated in a fee-for-service model were more likely to order low-value exams.

    As imaging programs continue to invest in initiatives to improve the appropriateness of imaging and implement CDS, they should strategically target educational efforts at those providers who order unnecessary imaging most often.


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