Family-med practices take a bite out of inappropriate low-back MRI

In Harris County, Texas, three outpatient family-medicine affiliates of Baylor College of Medicine have slashed their unnecessary orders of lumbar-spine MRIs—and improved the appropriateness ratings of those they did order—by attending educational sessions and using the American College of Radiology’s R-SCAN program.

Kevin Yuqi Wang, MD, and colleagues describe the success story in an article published online Sept. 29 in the Journal of the American College of Radiology.

The team accessed the R-SCAN (which stands for Radiology Support, Communication and Alignment Network) web portal to design and run a project specifically aimed at cutting inappropriate lumbar MRI referrals from the clinics for uncomplicated low-back pain.

Collectively the clinics comprised 43 physicians plus several physician assistants and nurse practitioners.

The research team used order-entry data to track lumbar MRI orders placed from the clinics over two 10-month periods: before and after the clinicians attended presentations highlighting published imaging guidelines.

They also peeled off a subset of these orders to gauge them, in both time windows, by ACR Appropriateness Criteria.

On analysis, they found that the average per-month MRI order count from the three clinics dropped significantly, from 10.0 prior to the sessions to 6.3 after (P = .009).

Meanwhile, the combined average ACR Appropriateness Criteria rating at all three clinics was 5.8 after the sessions. This was significantly higher than their combined rating of 4.7 before the presentations (P = .014).

In their discussion, Wang and colleagues note that their findings are consistent with those published in a previous study focused on order counts and appropriateness—again, pre- and post-education—of CT angiograms for pulmonary emboli in emergency departments.

“The approach in fostering change in referral patterns with the use of educational sessions is not unique, but nevertheless fomented a decreased inappropriateness and imaging utilization rate, and may be largely due to the intentional design of R-SCAN to foster a concerted and collaborative effort between radiologists and referring clinicians in which both groups possess similar objectives and commitment to the reduction in imaging inappropriateness,” the authors write of their present research.

They add that, in the “volume to value” transition currently reshaping healthcare economics in the U.S., R-SCAN “allows referring physicians to become more familiar with the concept of clinical decision support and allows radiologists to satisfy one of the Merit-Based Incentive Payment System performance measures under the new quality-based payment system.”

The ACR has posted an hourlong webinar on the Baylor project featuring insights from several of the study co-authors.