Modification and Reinitiation of Lower Back Imaging Orders After Evidence-Based Collaborative Consultation

Area of Science:

• Radiology and Imaging
• Health Services Research
• Clinical Practice Guidelines

Background:

• Practice guidelines recommend delaying imaging for low back pain onset for at least 28 days.
• Nondenial prior authorization programs aim to align imaging orders with clinical guidelines.

Purpose of the Study:

• To evaluate the effectiveness of a nondenial prior authorization program in modifying low back imaging orders.
• To assess the rate of reinitiation for modified imaging orders.

Main Methods:

• Analysis of prior authorization and claims data from 2014-2017.
• Evaluation of computed tomography (CT) and magnetic resonance imaging (MRI) order modifications and reinitiations.
• Use of chi-square tests to identify factors associated with modification and reinitiation.

Main Results:

• Over 533,000 orders resulted in 1380 modifications and 224 reinitiations.
• Modified orders were reinitiated 7.1%-20.6% of the time.
• Primary care physician orders were more likely to be modified; urban orders were more likely to be reinitiated.

Conclusions:

• Low back imaging orders modified by the program were rarely reinitiated within 28 days.
• The program appears successful in promoting adherence to evidence-based imaging practices for low back pain.