Provider Feedback about Imaging Appropriateness by Using Scores from Order Entry Decision Support: Raw Rates...

Area of Science:

• Radiology and Imaging
• Health Services Research
• Medical Informatics

Background:

• Low-utility advanced imaging examinations contribute to healthcare costs and potential patient harm.
• Order entry systems with appropriateness feedback aim to mitigate unnecessary imaging.
• Understanding factors influencing ordering decisions is crucial for optimizing imaging utilization.

Purpose of the Study:

• To identify physician and practice-related factors associated with ordering low-utility advanced imaging examinations.
• To quantify the contribution of individual providers and practice settings to imaging low utility.

Main Methods:

• Retrospective analysis of ~250,000 outpatient advanced imaging orders (CT, MRI, nuclear medicine) from 2008-2012.
• Hierarchical logistic regression model to predict low-utility imaging (score 1-3/9).
• Estimation of physician- and practice-specific random effects to measure interphysician variation.

Main Results:

• Examination type, order cancellation, ordering status, and clinician order volume predicted low-utility imaging.
• Patient demographics (age, sex) and study year did not influence low-utility rates.
• Moderate interphysician variation (22% ICC) and low practice variation (5% ICC) were observed.

Conclusions:

• Ordering providers account for 22% of the variation in low-utility imaging rates.
• Practice specialty or clinic setting explains 5% of the variation.
• Physician-specific effects are sufficiently reliable for identifying outlier ordering patterns.