Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial

Eccles, Martin; Steen, Nick; Grimshaw, Jeremy; Thomas, Lois H; McNamee, Paul; Soutter, Jennifer; Wilsdon, John; Matowe, Lloyd; Needham, Gillian; Gilbert, Fiona J.; Bond, Senga

doi:10.1016/s0140-6736(00)04564-5

Cited by 192 publications

(191 citation statements)

References 14 publications

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“…Relatively simple educational reminders can reduce the number of radiograph requests by general practitioners (9,10). However, if ascertaining disease status remains a consideration in some consultations, is there an alternative to sending the patient for a radiograph?…”

Section: Introductionmentioning

confidence: 99%

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

Peat

Thomas

Duncan

et al. 2007

Arthritis & Rheumatism

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Objective. To determine whether clinical information can practically rule in or rule out the presence of radiographic osteoarthritis in older adults with knee pain. Methods. We conducted a cross-sectional diagnostic study involving 695 adults ages >50 years reporting knee pain within the last year identified by postal survey and attending a research clinic. Potential indicators of radiographic osteoarthritis were gathered by self-complete questionnaires, clinical interview, and physical examination. Participants underwent plain radiography (posteroanterior, skyline, and lateral views). Radiographic osteoarthritis was defined as the presence of definite osteophytes in at least 1 joint compartment of the index knee. Results. Independent predictors of radiographic osteoarthritis were age, sex, body mass index, absence of whole leg pain, traumatic onset, difficulty descending stairs, palpable effusion, fixed-flexion deformity, restricted-flexion range of motion, and crepitus. Using this model, 245 participants had a predicted probability >80% (practical rule in), of whom 231 (94%) actually had radiographic osteoarthritis (specificity 93%). Twenty-one participants had a predicted probability <20% (practical rule out), of whom only 2 (10%) had radiographic osteoarthritis (sensitivity 99.6%). The predicted probability of radiographic osteoarthritis for the remaining 429 participants fell into an intermediate category (20 -79%). Conclusion. Simple clinical information can be used to estimate the probability of radiographic osteoarthritis in individual patients. However, for the majority of community-dwelling older adults with knee pain this method enables the presence of radiographic osteoarthritis to be neither confidently ruled in nor ruled out. Prospective validation and updating of these findings in an independent sample is required.

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Section: Introductionmentioning

confidence: 99%

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

Peat

Thomas

Duncan

et al. 2007

Arthritis & Rheumatism

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“…One study 31 was excluded because it reanalyzed the same data as another included study. 7 The characteristics of the included studies are depicted in Table 1. The studies comprised 5 cluster RCTs 7,18-21 and 2 interrupted time series studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…17,24 One trial was performed in a hospital setting 24 with the remainder in primary care. The interventions investigated in the studies were divided into 4 categories: clinical decision support and targeted reminders, 7,24 audit and feedback, 7,20,21 practitioner education 18,19 and postal guideline dissemination. 17 The control groups either had no intervention [19][20][21] or received dissemination of clinical guidelines.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[1][2][3] Despite this, imaging rates remain high, 4,5 which indicates poor concordance with these guidelines. 6,7 Unnecessary imaging for low-back pain has been associated with poorer patient outcomes, increased radiation exposure and higher health care costs. 8 No short-or long-term clinical benefits have been shown with routine imaging of the low back, and the diagnostic value of incidental imaging findings remains uncertain.…”

mentioning

confidence: 99%

“…14 Various interventions have been tried for reducing imaging rates among people with lowback pain. These include strategies targeted at the practitioner such as guideline dissemination, [15][16][17] education workshops, 18,19 audit and feedback of imaging use, 7,20,21 ongoing reminders 7 and clinical decision support. [22][23][24] It is unclear which, if any, of these strategies are effective.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review

Jenkins

Hancock

French

et al. 2015

CMAJ

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Audit and Feedback—Optimizing a Strategy to Reduce Low-Value Care

Korenstein

Gillespie

2022

JAMA

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Despite a decade of attention to the issue of low-value care in the United States and internationally, there has been little change in provision of nonbeneficial health services. 1 The study by O'Connor and colleagues 2 in this issue of JAMA provides important high-quality evidence that a national audit and feedback program might help reduce widespread use of low-value testing.The authors performed a cluster-randomized trial that included 3819 Australian general practitioners (GPs) from 2271 practices who had high request rates for 11 musculoskeletal imaging tests that often represent low-value care: lumbosacral spine x-ray and computed tomography (CT); cervical spine x-ray, CT, and magnetic resonance imaging (MRI); shoulder x-ray and ultrasound; hip x-ray and ultrasound; knee x-ray; and ankle/hind foot ultrasound. Participant physicians were randomized to receive an audit and feedback intervention in the form of a mailed letter from the chief medical officer of the Australian Government Department of Health and Aged Care, or no intervention. The letters used administrative data from the prior year to summarize individual physicians' rates of ordering overall and for each of the 11 individual tests, providing the number of requests per 1000 consultations, and physicians' percentile rankings compared with peers. A 2 × 2 factorial design enabled novel evaluation of 2 variations of the letter, one related to frequency (a 1-time letter compared with 2 letters mailed 1 year apart) and a second related to visual design (with or without "enhancement" via yellow highlighting of tests for which rates were higher than 80% of peers).The study reports a significant relative reduction of about 10% in ordering rates of the 11 imaging tests overall in the intervention groups at 12 months compared with in the control group (adjusted mean, 27.7 [95% CI, 27.5-28.0] tests ordered per 1000 consultations in the audit and feedback intervention groups vs 30.4 [95% CI, 29.8-30.9] in the no-intervention control group; adjusted mean difference, −2.66 [95% CI, −3.24 to −2.07]; P < .001). In prespecified secondary outcome analyses, there were additional marginal but statistically significant reductions from the second letter (with the difference seen at 18 months) and enhanced display interventions compared with a single letter without enhancement. Of note, the initial intervention occurred in late 2019; soon thereafter, rates of imaging decreased precipitously in all groups during the first few months of the COVID-19 pandemic (when stay-at-home orders were active in Australia), but then rebounded, with intervention groups maintaining consistently lower testing rates after return to prepandemic baseline imaging utilization rates.

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Effect of audit and feedback, and reminder messages on primary-care radiology referrals: a randomised trial

Cited by 192 publications

References 14 publications

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

Estimating the probability of radiographic osteoarthritis in the older patient with knee pain

Effectiveness of interventions designed to reduce the use of imaging for low-back pain: a systematic review

Audit and Feedback—Optimizing a Strategy to Reduce Low-Value Care

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