Clinician-Level Predictors for Ordering Low-Value Imaging.

Area of Science:

• Health Services Research
• Medical Economics
• Clinical Practice Patterns

Background:

• Unnecessary radiographic imaging leads to significant financial burdens for patients due to rising cost-sharing.
• Predictors of low-value imaging practices among clinicians remain largely uncharacterized.
• Understanding these predictors is crucial for developing targeted interventions.

Purpose of the Study:

• To identify clinician-specific predictors of low-value imaging for acute uncomplicated back pain and headache.
• To examine the influence of prior patient imaging history and clinician equipment ownership on imaging orders.
• To assess if high rates of low-value imaging in one condition predict such practices in another.

Main Methods:

• Analysis of commercial insurance claims data from January 2010 to December 2014.
• Inclusion of 100,977 clinicians (primary care physicians, specialists, chiropractors) and their patient visits.
• Multivariate logistic regression to model imaging rates and identify significant predictors.

Main Results:

• A prior low-value back imaging order increased odds of subsequent low-value imaging by 81% for primary care physicians, and even more for chiropractors and specialists.
• A prior low-value headache imaging order increased subsequent headache imaging odds by 100%.
• Clinician ownership of imaging equipment consistently predicted higher rates of low-value imaging across all scenarios.

Conclusions:

• Clinician factors, including prior patient imaging patterns, high imaging rates in other conditions, and equipment ownership, are strong predictors of low-value imaging for back pain and headache.
• These findings highlight the need for policies addressing clinician behavior and financial incentives to curb unnecessary imaging.
• Interventions targeting these predictors could reduce patient financial harm and healthcare costs.