Provider-directed education to reduce unnecessary neuroimaging in uncomplicated headache disorders

More than 1.9 million annual outpatient visits to neurologists in the United States are associated with headache diagnoses. For uncomplicated headache disorders, the evidence-based practice (EBP) guidelines recommend against neuroimaging unless specific neurological signs and symptoms are present; however, neuroimaging rates have only modestly decreased since the guidelines were developed.

We evaluated unnecessary neuroimaging rates in patients with uncomplicated headache at the Emory Department of General Neurology. The rate of unnecessary neuroimaging suggested a provider knowledge gap in the use of neuroimaging in patients with uncomplicated headaches.

A provider-directed educational session was delivered, and outcomes were evaluated 8 weeks after implementation. The postintervention rates of unnecessary neuroimaging were compared with preintervention rates.

A 15-minute educational session on the EBP guidelines for neuroimaging use in uncomplicated headache was presented to all general neurology providers (n = 9). The providers were given an electronic version of the presentation and a pocket-sized EBP algorithm for neuroimaging in this population.

Data collected from the project site's neuroimaging dashboard showed a significantly lower proportion of unnecessary neuroimaging orders in the 8-week posteducational interval (4.2%) compared with the 8-week preeducation interval (7.2%) (t = 2.78, p = .014), a 41.6% reduction.

We found that a provider-directed educational session reviewing the EBP guidelines for neuroimaging in patients with uncomplicated headache disorders was successful in lowering rates of neuroimaging. Implementing similar projects in other departments could further reduce unnecessary neuroimaging use across the organization.