Impact of IT-enabled intervention on MRI use for back pain

Am J Med. 2014 Jun;127(6):512-8.e1. doi: 10.1016/j.amjmed.2014.01.024. Epub 2014 Feb 8.


Background: The purpose of this study was to examine the impact of a multifaceted, clinical decision support (CDS)-enabled intervention on magnetic resonance imaging (MRI) use in adult primary care patients with low back pain.

Methods: After a baseline observation period, we implemented a CDS targeting lumbar-spine MRI use in primary care patients with low back pain through our computerized physician order entry, as well as 2 accountability tools: mandatory peer-to-peer consultation when test utility was uncertain and quarterly practice pattern variation reports to providers. Our primary outcome measure was rate of lumbar-spine MRI use. Secondary measures included utilization of MRI of any body part, comparing it with that of a concurrent national comparison, as well as proportion of lumbar-spine MRI performed in the study cohort that was adherent to evidence-based guideline. Chi-squared, t-tests, and logistic regression were used to assess pre- and postintervention differences.

Results: In the study cohort preintervention, 5.3% of low back pain-related primary care visits resulted in lumbar-spine MRI, compared with 3.7% of visits postintervention (P <.0001, adjusted odds ratio 0.68). There was a 30.8% relative decrease (6.5% vs 4.5%, P <.0001, adjusted odds ratio 0.67) in the use of MRI of any body part by the primary care providers in the study cohort. This difference was not detected in the control cohort (5.6% vs 5.3%, P = .712). In the study cohort, adherence to evidence-based guideline in the use of lumbar-spine MRI increased from 78% to 96% (P = .0002).

Conclusions: CDS and associated accountability tools may reduce potentially inappropriate imaging in patients with low back pain.

Keywords: Clinical decision support; Health information technology; Imaging use.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Decision Support Systems, Clinical*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Logistic Models
  • Low Back Pain / etiology*
  • Lumbar Vertebrae*
  • Magnetic Resonance Imaging / statistics & numerical data*
  • Male
  • Middle Aged
  • Odds Ratio
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data
  • Primary Health Care / methods*
  • Primary Health Care / organization & administration
  • Referral and Consultation
  • Spinal Diseases / complications
  • Spinal Diseases / diagnosis*
  • United States
  • Young Adult