Using Decision Support to Curb Unnecessary Imaging

A study looks at whether decision support tools can help save money by cutting back on excessive use of imaging for conditions like migraine and back pain.

Findings from a new study demonstrate that clinical decision support systems can be leveraged to help cut costs by limiting the amount of unnecessary imaging that is being done in the health care setting.

Decision support systems for advanced imaging are being implemented with increased frequency and are mandated under some new government programs, according to the study’s authors. However, although clinical decision support has been identified as a potentially “ideal method for improving the evidence-based use of imaging,” and decision support tools “have the desired properties of being educational, transparent, efficient, practical, and consistent,” data on the effectiveness of these tools in reducing inappropriate imaging utilization is limited.

To that end, investigators from Virginia Mason Medical Center in Seattle, WA, conducted a retrospective cohort study to examine utilization of advanced imaging before and after implementation of a clinical-decision support system of three high-volume procedures: lumbar MRI, brain MRI, and sinus CT. The research team analyzed billing data from a regional health plan and from the institutional radiology information system.

Lead author C. Craig Blackmore, MD, MPH, and colleagues found that there were “clinically and statistically significant decreases in utilization rates for the targeted procedures after the intervention.” According to the study, which is published in the Journal of the American College of Radiology, the rates of imaging after the intervention were 23.4% lower for low back pain lumbar MRI, 23.2% lower for headache head MRI, and 26.8% lower for sinusitis sinus CT.

The peak rate occurred in the year before the intervention for all three imaging procedures, they observed, and the decrease in imaging rate was significant in the multiple regression analysis after adjustment for temporal trend for lumbar MRI, head MRI, and sinus CT, with a non-significant result for the head CT control group.

Following the decline, the rate of MRI of the lumbar spine increased at approximately 3% per year, while there was no evidence of an increase in rate for head MRI imaging.

The authors concluded that “the implementation of imaging clinical decision support for selected high-utilization imaging procedures can have a substantial effect on imaging rate and volume in an integrated multidisciplinary health care network.” Perhaps even more importantly, “the use of such systems can aid the elimination of unnecessary imaging, increasing both patient safety and quality and decreasing health care costs.”

To access the study—Effectiveness of Clinical Decision Support in Controlling Inappropriate Imaging—click here.