Tay YX, Chan LL, Than SR, Lim GH, Tan MB, Mak MS, Hou W, Wee JCP, Ng YH, Chen RC. Appropriateness of lumbar spine radiography and factors influencing imaging ordering patterns: paving the path towards value-driven healthcare.
Int J Qual Health Care 2023;
35:7116072. [PMID:
37043329 DOI:
10.1093/intqhc/mzad021]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/02/2023] [Accepted: 04/11/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND
The demand for diagnostic imaging continues to rise. Against the backdrop of rising healthcare costs and finite resources, this has prompted a paradigm shift towards value-driven patient care. Inappropriate imaging is a barrier towards achieving this goal, which runs counter to prevailing evidence-based guidelines and contributes to rising healthcare costs. Our objective was to evaluate the appropriateness of lumbar spine X-rays in a tertiary referral emergency department and assess whether physician specialization and years of experience influence appropriateness.
METHODS
Retrospective review of 1030 lumbar spine radiographs performed in an emergency department of an academic medical centre over a consecutive 3-month period. Referral indications were reviewed for adherence to 2021 American College of Radiology (ACR) appropriateness guidelines for low back pain, and referral pattern evaluated among physician groups based on specialist training and years in practice.
RESULTS
63.8% of lumbar spine radiograph were appropriate, with trauma being the most common indication. 36.2% orders were inappropriate, with low back pain of less than 6 weeks duration being the most common indication. Significant differences in inappropriate orders was found (p<0.001) across physician groups: qualified Emergency Medicine specialists (20.9% inappropriate orders), specialists in-training (27.8%) and non-specialists with ≥3 (60.0%) and <3 (36.9%) years in practice, respectively.
CONCLUSION
Approximately a third of lumbar spine radiography performed in the emergency room were inappropriately ordered by ACR guidelines; specialist training and years in practice affected referral patterns. Integrating evidence-based appropriateness guidelines into the physician order workflow and targeting older non-specialists may promote more judicious imaging and reduce healthcare costs.
Collapse