Trends in Low-Value Carotid Imaging in the Veterans Health Administration From 2007 to 2016

Anderson, Timothy S.; Leonard, Samuel; Zhang, Alysandra J.; Madden, Erin; Mowery, Danielle L.; Chapman, Wendy W.; Keyhani, Salomeh

doi:10.1001/jamanetworkopen.2020.15250

Cited by 13 publications

(17 citation statements)

References 32 publications

(92 reference statements)

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“…The following were the most frequently reported low-value examinations: imaging in low back pain [ 121 – 131 ] and knee MRI without red flags [ 121 , 141 – 147 ], staging and follow-up in several types of cancer (X-ray, CT, MRI and nuclear medicine) [ 58 , 116 , 172 , 199 – 203 , 209 , 234 – 262 ], abdominal CT in self-limiting episode of suspected urolithiasis [ 190 , 204 – 206 ], chest CTA [ 210 – 216 ] and ultrasound lower limb veins in patients with low risk of thrombosis [ 217 – 221 ] were most prominent among adult populations. When analyzing the extent in use of low-value imaging additional examinations were identified; low interval DEXA screening, echocardiography in patients with low risk of cardiac disease, carotid imaging in syncope, X-ray in rhinosinusitis, and MRI for pain in the hip or upper extremities [ 140 , 157 – 159 , 173 , 277 , 365 , 366 , 369 , 373 , 376 ].…”

Section: Discussionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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Background Inappropriate and wasteful use of health care resources is a common problem, constituting 10–34% of health services spending in the western world. Even though diagnostic imaging is vital for identifying correct diagnoses and administrating the right treatment, low-value imaging—in which the diagnostic test confers little to no clinical benefit—is common and contributes to inappropriate and wasteful use of health care resources. There is a lack of knowledge on the types and extent of low-value imaging. Accordingly, the objective of this study was to identify, characterize, and quantify the extent of low-value diagnostic imaging examinations for adults and children. Methods A scoping review of the published literature was performed. Medline-Ovid, Embase-Ovid, Scopus, and Cochrane Library were searched for studies published from 2010 to September 2020. The search strategy was built from medical subject headings (Mesh) for Diagnostic imaging/Radiology OR Health service misuse/Medical overuse OR Procedures and Techniques Utilization/Facilities and Services Utilization. Articles in English, German, Dutch, Swedish, Danish, or Norwegian were included. Results A total of 39,986 records were identified and, of these, 370 studies were included in the final synthesis. Eighty-four low-value imaging examinations were identified. Imaging of atraumatic pain, routine imaging in minor head injury, trauma, thrombosis, urolithiasis, after thoracic interventions, fracture follow-up and cancer staging/follow-up were the most frequently identified low-value imaging examinations. The proportion of low-value imaging varied between 2 and 100% inappropriate or unnecessary examinations. Conclusions A comprehensive list of identified low-value radiological examinations for both adults and children are presented. Future research should focus on reasons for low-value imaging utilization and interventions to reduce the use of low-value imaging internationally. Systematic review registration: PROSPERO: CRD42020208072.

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Section: Discussionmentioning

confidence: 99%

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

et al. 2022

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“…Prescription habits following publication of guidelines are mainly influenced if supported by multimodal interventions including educational material and awareness campaign and it often takes years for them to shift practice. With awareness campaigns we observed some temporary improvements in mitigating overtreatment 16 , 17 , however, these measures appear insufficient in creating a lasting change 18 , 19 . Following the release of the SSGIM recommendations on RBCTs in May 2016, awareness on the new guidelines was promoted within our hospital network mainly within the department of internal medicine, but not other specialties.…”

Section: Introductionmentioning

confidence: 84%

Differential impact of transfusion guidelines on blood transfusion practices within a health network

Balafas

Gagliano

Serio

et al. 2023

Sci Rep

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Whether clinical practice guidelines have a significant impact on practice is unclear. The effect of guideline recommendations on clinical practice often a lags behind the date of publication. We evaluated by means of a data-driven approach if and when the guidelines on red blood cell transfusions (RBCTs) issued by Swiss Smarter Medicine in 2016 had an impact on RBCTs practice within a hospital network, where awareness of guidelines was promoted mainly among internal medicine specialties. Data on RBCTs performed in a Swiss hospital network from January 2014 to April 2021 were analyzed by hospital site and specialty to assess whether guidelines led to a decrease in inappropriate RBCTs. RBCTs were defined as “inappropriate” if patients had a hemoglobin level ≥ 70 g/L without or ≥ 80 g/L with significant cardiovascular comorbidities. Changes in the rate of inappropriate transfusions were analyzed with an advanced statistical approach that included generalized additive models. Overall prior to March 2017 there were more inappropriate than appropriate RBCTs, but after October 2017 the opposite could be observed. A change-point in the time trend was estimated from transfusion data to occur in the time interval between March and October 2017. This change was mainly driven by practice changes in the medical wards, while no significant change was observed in the critical care, surgical and oncology wards. Change in practice varied by hospital site. In conclusion, our results show that a significant change in the RBCTs practice at the hospital level occurred approximately 18 months after national guidelines were issued.

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“…Nineteen studies focused on the CW initiative and one study 34 focused on the NICE reminders. Evidence-based recommendations from wide-ranging specialties were explored, including cardiology, 30,44,45 geriatrics, 31 gynecology, 34 hematology, 35 nephrology, 30,45 obstetrics, 34 oncology, 36,38,40,42,43,46,47,49 primary care, 30,37,41,45 radiology, 31,39,45 and urology. 33,34,48 Most studies only targeted one recommendation of a specialty, with 3 studies 30,34,45 investigated multiple recommendations across different specialties and another 3 studies 37,42,43 explored various recommendations within one specialty.…”

Section: Study Characteristicsmentioning

confidence: 99%

The Effectiveness of Public Awareness Initiatives Aimed at Encouraging the Use of Evidence-Based Recommendations by Health Professionals: A Systematic Review

Tian,

Nguyen,

Chung

et al. 2024

J Patient Saf

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Objectives Public awareness initiatives have attracted growing attention globally, as a strategy to reduce low-value care and disinformation. However, knowledge gap remains in determining their effects. The aim of this systematic review was to summarize existing evidence to date on global effectiveness of public awareness initiatives. Methods Primary quantitative studies focusing on passive delivery of public awareness initiatives that targeted health professionals were included. Eligible studies were identified through search of MEDLINE, Embase, Emcare, the Cochrane Library, PsycINFO, Business Source Complete, Emerald Insight, and Google (initially on December 19, 2018, followed by updated search between July 8–10, 2019, and then between March 8–9, 2022) and the reference list of relevant studies. Methodological quality of included studies was assessed using modified McMaster critical appraisal tool. A narrative synthesis of the study outcomes was conducted. Results Twenty studies from United States, United Kingdom, Canada, Australia, and multicountry were included. Nineteen studies focused on Choosing Wisely initiative and one focused on National Institute of Clinical Excellence reminders. Most studies investigated one recommendation of a specialty. The findings showed conflicting evidence on the effectiveness of public awareness initiatives, suggesting passive delivery has limited success in reducing low-value care among health professionals. Conclusions This review highlights the complexity of change in an established practice pattern in health care. As passive delivery of public awareness initiatives has limited potential to initiate and sustain change, wide-ranging intervention components need to be integrated for a successful implementation.

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Trends in Low-Value Carotid Imaging in the Veterans Health Administration From 2007 to 2016

Cited by 13 publications

References 32 publications

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Characterizing and quantifying low-value diagnostic imaging internationally: a scoping review

Differential impact of transfusion guidelines on blood transfusion practices within a health network

The Effectiveness of Public Awareness Initiatives Aimed at Encouraging the Use of Evidence-Based Recommendations by Health Professionals: A Systematic Review

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