Reinitiation of Withdrawn or Modified Neuroimaging Requests After Collaborative Consultation

This study explored four common sequences of interaction between providers and a collaborative, nondenial model preauthorization program to assess the extent to which the collaborative consultation impacted care delivered to a patient in the 30 days after a neuroimaging consult. In each of the sequences examined, providers interacted with the preauthorization program's consulting radiologist and modified their imaging study requests during the interaction. If providers did not subsequently reinitiate the original study requests, then it suggests that the study resulting from the collaborative consultation fulfilled the providers' clinical objective.

Four years of retrospective authorization and clinical data were analyzed to determine the rate at which requests modified through peer-to-peer consultation were reinitiated in the following four sequences: 1) request for head computed tomography (CT) modified to head magnetic resonance imaging (MRI), 2) request for both head CT and intracranial CT angiography (CTA) or both head MRI and intracranial MRA modified to a request for a single study, 3) request for both a CT of the head and sinuses modified to a request for a single study, and 4) request for an MRI of the head and orbits modified to a request for a single study.

In three of the sequences, no provider reinitiated a study within 30 days. In the fourth sequence, only 4 of 64 (6%) withdrawn requests for head CT/MRI or head CTA/MRA were reinitiated within 30 days.

Modifications after collaborative consultations rarely lead to repeat imaging requests, confirming the utility of the consultations.