Changes in Primary Care Health Care Utilization after Inclusion of Epidemiologic Data in Lumbar Spine MR Imaging Reports for Uncomplicated Low Back Pain

Abstract

Purpose To determine whether inclusion of an epidemiologic statement in radiology reports of lumbar magnetic resonance (MR) imaging influences downstream health care utilization in the primary care population. Materials and Methods Beginning July 1, 2013, a validated epidemiologic statement regarding prevalence of common findings in asymptomatic patients was included in all lumbar MR imaging reports at a tertiary academic medical center. Data were collected from July 1, 2012, through June 30, 2014, and retrospective analysis was completed in September 2016. The electronic medical record was reviewed to capture health care utilization rates in patients for 1 year after index MR imaging. Of 4527 eligible adult patients with low back pain referred for lumbar spine MR imaging during the study period, 375 patients had their studies ordered by in-network primary care providers, did not have findings other than degenerative disease, and had at least one follow-up encounter within the system within 1 year of index MR imaging. In the before-and-after study design, a pre-statement-implementation cohort was compared with a post-statement-implementation cohort by using univariate and multivariate statistical models to evaluate treatment utilization rates in these groups. Results Patients in the statement group were 12% less likely to be referred to a spine specialist (137 of 187 [73%] vs 159 of 188 [85%]; P = .007) and were 7% less likely to undergo repeat imaging (seven of 187 [4%] vs 20 of 188 [11%]; P = .01) compared with patients in the nonstatement group. The intervention was not associated with any change in narcotic prescription (53 of 188 [28%] vs 54 of 187 [29%]; P = .88) or with the rate of low back surgery (24 of 188 [13%] vs 16 of 187 [9%]; P = .19). Conclusion In this study, inclusion of a simple epidemiologic statement in lumbar MR imaging reports was associated with decreased utilization in high-cost domains of low back pain management. RSNA, 2018.

Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

“…15,24 This approach has been shown to be promising for lumbar magnetic resonance imaging reports and cardiac testing, with patients being reassured by 'normal results' when relevant epidemiological information is included. 25,26 Second, the practitioners' communication of imaging findings is likely to have a vital impact. Clinicians play an important part in influencing patients' perceptions and subsequent behaviour; therefore, it would be beneficial to carefully consider the language used and the messages delivered when explaining imaging findings to patients.…”

What behaviour change techniques have been used to improve adherence to evidence-based low back pain imaging?

“…Greater than 50% of studies used a BCT that targeted one of the following TDF domains Knowledge ( n = 34 interventions; 27 studies) [ 29 , 32 , 33 , 35 – 37 , 40 – 48 , 50 , 52 , 53 , 55 , 57 – 65 ], Skills ( n = 32 interventions; 27 studies) [ 29 , 31 – 33 , 35 , 36 , 40 – 42 , 44 – 48 , 50 , 52 , 53 , 55 , 57 – 65 ] and Beliefs about capabilities ( n = 32; 27 studies) [ 29 , 31 – 33 , 35 , 36 , 40 – 42 , 44 – 48 , 50 , 52 , 53 , 55 , 57 – 65 ]. Following these, the domains of environmental context and resources ( n = 22 interventions; 21 studies) [ 28 – 30 , 32 , 34 – 36 , 38 , 41 , 44 , 47 , 48 , 51 – 55 , 57 , 59 , 61 , 64 ], social/professional role/identity ( n = 22; 18 studies) [ 29 , 30 , 32 , 35 , …”

Impact of Patient-Reported Symptom Information on Agreement in the MRI Diagnosis of Presumptive Lumbar Spine Pain Generator

“…Because incidental MRI abnormalities are difficult to distinguish from true pain generators, MRI reports can lose value, becoming lists of unprioritized findings and unfocused impressions that fail to provide guidance in therapeutic decision-making [8,12,35,36]. This difficulty reflects the uncertain relationships between MRI abnormalities and symptoms.…”