Low Appropriateness of Imaging Orders for Lower Back and Neck Pain
Back and neck pain can make day-to-day activities challenging and miserable. Medical attention is commonly sought in clinics, urgent care centers, and emergency rooms in pursuit of relief from back and neck pain. Imaging studies can help clinicians rule out high risk medical conditions, determine a diagnosis, and provide evidence to proceed with an appropriate treatment plan or further evaluation measures. However, imaging can also be used inappropriately, which can lead to variation of patient care as well as increased healthcare costs and resource utilization in organizations. Imaging studies can increase patient exposure to radiation, and there can be adverse events associated with imaging modalities. Furthermore, findings on an initial imaging can lead to obtaining additional diagnostic studies to further explore abnormal results.
The Journal of the American College of Radiology (ACR)’s recent publication “ACR Appropriateness Criteria Low Back Pain” advises that “imaging is considered in those patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain. It is also considered for those patients presenting with red flags raising suspicion for serious underlying conditions…”¹ Six months of recent imaging order data from three CareSelect Imaging customers and revealed 93% of imaging orders for the indication of low back pain with low ACR appropriateness scores included the reason for exam as “Low back pain, <6 weeks, no red flags.” This suggests there is significant potential to reduce unnecessary imaging orders for low back pain and that enhanced clinical education on current guidelines may be beneficial.
“Neck pain” was among the top three indications listed as a reason for exam for imaging orders with low ACR appropriateness scores placed at these organizations. For one customer, “neck pain” accounted for 17% of the imaging orders placed with low ACR appropriateness scores. There is opportunity to identify clinical scenarios that can lead to imaging orders that may not be necessary, to assess imaging ordering practices, determine drivers of inappropriate imaging order placement, and to plan for improvements. Study findings published in the JACR’s “Screening Cervical Spine CT in the Emergency Department, Phase 3: Increasing Effectiveness of Imaging” depicted that “a clinical education initiative resulted in improved adherence to ACR Appropriateness Criteria and improved clinical effectiveness of the studies by increasing fracture detection rate.” ²
How Can CareSelect Imaging help?
CareSelect Imaging assists clinicians to determine the appropriateness of diagnostic tests for their patients and provides useful information about imaging modalities at the time of order placement. Imaging appropriateness scores from the American College of Radiology’s ACR Select™ Criteria for the chosen reason for exam, cost, and relative radiation level can help clinicians to proceed with determining plans for patient care.
CareSelect Imaging is a decision support tool that healthcare providers can utilize to decide if imaging is clinically indicated and which type of imaging modality is appropriate to pursue for a particular medical condition. In addition, CareSelect Reporting & Analytics tools enable full data collection and analysis of the decision support process, which enables sites to provide continuous education for their clinicians and trainees and to advocate for quality improvement programs.
Next Steps
Appropriate use of diagnostic imaging studies is essential for providing optimal patient care and for reduction of unnecessary costs. Several approaches can be taken in this effort:
- Implement CareSelect Imaging with ACR Select™ to provide enhanced information to clinicians at the point of order, including the appropriateness scores for imaging in relation to the reason for exam, cost, and relative radiation exposure
- Utilize CareSelect Reporting & Analytics tools to identify areas of opportunity, drivers of inappropriate imaging order placements, solutions, and improvement interventions at organizations
- Educate clinicians and clinicians in-training about ACR guidelines for imaging orders and current evidence-based diagnostic guidelines for common medical conditions
- Encourage reassessment of habitual ordering practice amongst healthcare providers
Interested in improving your organization’s quality of patient care while reducing costs from inappropriate imaging?
