Several clinician characteristics, including clinician specialty, imaging for the prior patient, ownership of imaging equipment and high rates of low-value imaging, are strong predictors of low-value imaging for back pain and headache, and can be used to guide interventions to enhance patient care, according to findings published in JAMA Internal Medicine.
“Clinicians who order unnecessary radiographic imaging may cause financial harm to patients who have increasing levels of cost sharing,” Arthur S. Hong, MD, MPH, from the department of internal medicine at the University of Texas Southwestern Medical Center, Dallas, and colleagues wrote. “Clinician predictors of low-value imaging are largely unknown.”
Therefore, Hong and colleagues sought to determine the clinician predictors associated with low-value imaging. They performed multivariate logistic regression modeling of imaging rates after acute uncomplicated back pain and headache using commercial claims and demographic data between January 2010 and December 2014 from OptumInsight.
The researchers documented whether recruited clinicians (n = 100,977) — including primary care physicians, specialist physicians and chiropractors — owned imaging equipment and had a prior patient who received imaging, and whether associations varied by physician specialty. High rates of low-value back imaging were used as a predictor for low-value headache imaging.
Clinicians oversaw 1,007,392 visits for acute uncomplicated low-back pain from 878,720 patients aged between 18 and 64 years. Overall, 57,859 PCPs saw a median of seven acute uncomplicated back pain visits; 27,583 chiropractors saw a median of 10 visits; and 15,535 specialists saw a median of five visits. A total of 52,876 PCPs saw 417,010 patients for 492,804 acute uncomplicated headache visits (median visits, 7), whereas 34,190 PCPs saw 344,991 participants with both conditions for a median of nine headache visits and at least four back pain visits.
Results showed that if a PCP’s prior patient received low-value back imaging, the patient was 1.81 (95% CI, 1.77-1.85) times more likely to have low-value imaging; this effect was greater for chiropractors (OR = 2.80; 95% CI, 2.74-2.86) and specialists (OR = 2.98; 95% CI, 2.88-3.07). Patients with a prior low-value head image for headache were two times more likely to have a subsequent head imagining order (95% CI, 1.95-2.06).
Across clinician type and imaging scenario, clinician ownership of imaging equipment was consistently predictive of low-value imaging (OR = 1.65-7.76). PCPs were 1.53 (95% CI, 1.45-1.61) times more likely to order low-value headache imaging if they had the highest rates of low-value back imaging.
“Clinician characteristics such as ordering low-value imaging on a prior patient, high rates of low-value imaging in another clinical scenario and ownership of imaging equipment are strong predictors of low-value back and headache imaging,” Hong and colleagues concluded. “Findings should inform policies that target potentially unnecessary and financially burdensome care.” – by Alaina Tedesco
Disclosures: The authors report no relevant financial disclosures.