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Clinician-Level Predictors for Ordering Low-Value Imaging.

Publication ,  Journal Article
Hong, AS; Ross-Degnan, D; Zhang, F; Wharam, JF
Published in: JAMA Intern Med
November 1, 2017

IMPORTANCE: Clinicians who order unnecessary radiographic imaging may cause financial harm to patients who have increasing levels of cost sharing. Clinician predictors of low-value imaging are largely unknown. OBJECTIVE: To characterize clinician predictors of low-value imaging for acute uncomplicated back pain and headache, including clinicians who saw both conditions. DESIGN, SETTING, AND PARTICIPANTS: Multivariate logistic regression modeling of imaging rates after acute uncomplicated back pain and headache visits as indicated by January 2010 to December 2014 commercial insurance claims and demographic data from a large US health insurer. Participants included 100 977 clinicians (primary care physicians, specialist physicians, and chiropractors). MAIN OUTCOMES AND MEASURES: Imaging after acute uncomplicated back pain and headache visits was recorded. We identified whether the clinician's prior patient received imaging, whether the clinician was an owner of imaging equipment, and the varying impact by clinician specialty. We then used high rates of low-value back imaging as a predictor for low-value headache imaging. RESULTS: Clinicians conducted 1 007 392 visits for 878 720 adults ages 18 to 64 years with acute uncomplicated back pain; 52 876 primary care physicians conducted visits for 492 805 adults ages 18 to 64 years with acute uncomplicated headache; 34 190 primary care clinicians conducted 405 721 visits for 344 991 adults ages 18 to 64 years with headache and had also conducted at least 4 visits from patients with back pain. If a primary care physician's prior patient received low-value back imaging, the patient had 1.81 higher odds of low-value imaging (95% CI, 1.77-1.85). This practice effect was larger for chiropractors (odds ratio [OR], 2.80; 95% CI, 2.74-2.86) and specialists (OR, 2.98; 95% CI, 2.88-3.07). For headache, a prior low-value head image predicted 2.00 higher odds of a subsequent head imaging order (95% CI, 1.95-2.06). Clinician ownership of imaging equipment was a consistent independent predictor of low-value imaging (OR, 1.65-7.76) across clinician type and imaging scenario. Primary care physicians with the highest rates of low-value back imaging also had 1.53 (95% CI, 1.45-1.61) higher odds of ordering low-value headache imaging. CONCLUSIONS AND RELEVANCE: 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. Findings should inform policies that target potentially unnecessary and financially burdensome care.

Duke Scholars

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Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

November 1, 2017

Volume

177

Issue

11

Start / End Page

1577 / 1585

Location

United States

Related Subject Headings

  • United States
  • Quality Improvement
  • Practice Patterns, Physicians'
  • Middle Aged
  • Male
  • Low Back Pain
  • Humans
  • Headache
  • Female
  • Diagnostic Imaging
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Hong, A. S., Ross-Degnan, D., Zhang, F., & Wharam, J. F. (2017). Clinician-Level Predictors for Ordering Low-Value Imaging. JAMA Intern Med, 177(11), 1577–1585. https://doi.org/10.1001/jamainternmed.2017.4888
Hong, Arthur S., Dennis Ross-Degnan, Fang Zhang, and J Frank Wharam. “Clinician-Level Predictors for Ordering Low-Value Imaging.JAMA Intern Med 177, no. 11 (November 1, 2017): 1577–85. https://doi.org/10.1001/jamainternmed.2017.4888.
Hong AS, Ross-Degnan D, Zhang F, Wharam JF. Clinician-Level Predictors for Ordering Low-Value Imaging. JAMA Intern Med. 2017 Nov 1;177(11):1577–85.
Hong, Arthur S., et al. “Clinician-Level Predictors for Ordering Low-Value Imaging.JAMA Intern Med, vol. 177, no. 11, Nov. 2017, pp. 1577–85. Pubmed, doi:10.1001/jamainternmed.2017.4888.
Hong AS, Ross-Degnan D, Zhang F, Wharam JF. Clinician-Level Predictors for Ordering Low-Value Imaging. JAMA Intern Med. 2017 Nov 1;177(11):1577–1585.

Published In

JAMA Intern Med

DOI

EISSN

2168-6114

Publication Date

November 1, 2017

Volume

177

Issue

11

Start / End Page

1577 / 1585

Location

United States

Related Subject Headings

  • United States
  • Quality Improvement
  • Practice Patterns, Physicians'
  • Middle Aged
  • Male
  • Low Back Pain
  • Humans
  • Headache
  • Female
  • Diagnostic Imaging