Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis

Rachel Gold, Elizabeth Esterberg, Celine Hollombe, Jill Arkind, Patricia A. Vakarcs, Huong Tran, Tim Burdick, Jennifer Devoe, Michael A. Horberg

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

CONTEXT: Guideline-discordant imaging to evaluate incident low back pain is common.

OBJECTIVE: We compared rates of guideline-discordant imaging in patients with low back pain in two care delivery systems with differing abilities to track care through an electronic health record (EHR), and in their patients' insurance status, to measure the association between these factors and rates of ordered low back imaging.

DESIGN: We used data from two Kaiser Permanente (KP) Regions and from OCHIN, a community health center network. We extracted data on imaging performed after index visits for low back pain from June 1, 2011, to May 31, 2012, in these systems. Adjusted logistic regression measured associations between system-level factors and imaging rates.

MAIN OUTCOME MEASURES: Imaging rates for incident low back pain using 2 national quality metrics: Clinical Quality Measure 0052, a measure for assessing Meaningful Use of EHRs, and the Healthcare Effectiveness Data and Information Set measure "Use of Imaging Studies for Low Back Pain."

RESULTS: Among 19,503 KP patients and 2694 OCHIN patients with incident low back pain, ordered imaging was higher among men and whites but did not differ across health care systems. OCHIN's publicly insured patients had higher rates of imaging compared with those with private or no insurance.

CONCLUSION: Rates of ordered imaging to evaluate incident low back pain among uninsured OCHIN patients were lower than in KP overall; among insured OCHIN patients, rates were higher than in KP overall. Research is needed to establish causality and develop interventions.

Original languageEnglish (US)
Pages (from-to)25-33
Number of pages9
JournalThe Permanente journal
Volume20
Issue number2
DOIs
StatePublished - Mar 1 2016

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Systems Analysis
Low Back Pain
Community Networks
Guidelines
Delivery of Health Care
Community Health Centers
Insurance Coverage
Electronic Health Records
Insurance
Causality
Logistic Models
Research

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gold, R., Esterberg, E., Hollombe, C., Arkind, J., Vakarcs, P. A., Tran, H., ... Horberg, M. A. (2016). Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis. The Permanente journal, 20(2), 25-33. https://doi.org/10.7812/TPP/15-081

Low Back Imaging When Not Indicated : A Descriptive Cross-System Analysis. / Gold, Rachel; Esterberg, Elizabeth; Hollombe, Celine; Arkind, Jill; Vakarcs, Patricia A.; Tran, Huong; Burdick, Tim; Devoe, Jennifer; Horberg, Michael A.

In: The Permanente journal, Vol. 20, No. 2, 01.03.2016, p. 25-33.

Research output: Contribution to journalArticle

Gold, R, Esterberg, E, Hollombe, C, Arkind, J, Vakarcs, PA, Tran, H, Burdick, T, Devoe, J & Horberg, MA 2016, 'Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis', The Permanente journal, vol. 20, no. 2, pp. 25-33. https://doi.org/10.7812/TPP/15-081
Gold R, Esterberg E, Hollombe C, Arkind J, Vakarcs PA, Tran H et al. Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis. The Permanente journal. 2016 Mar 1;20(2):25-33. https://doi.org/10.7812/TPP/15-081
Gold, Rachel ; Esterberg, Elizabeth ; Hollombe, Celine ; Arkind, Jill ; Vakarcs, Patricia A. ; Tran, Huong ; Burdick, Tim ; Devoe, Jennifer ; Horberg, Michael A. / Low Back Imaging When Not Indicated : A Descriptive Cross-System Analysis. In: The Permanente journal. 2016 ; Vol. 20, No. 2. pp. 25-33.
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