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Reducing Imaging Utilization in Primary Care Through Implementation of a Peer Comparison Dashboard.

David J Halpern1,2, Adrian Clark-Randall3, Jonathan Woodall3

  • 1Duke University, Durham, NC, USA. david.halpern@duke.edu.

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Summary

Peer comparison feedback significantly reduced radiology ordering variation in a primary care network. This low-cost intervention decreased overall imaging rates by 17.3% and costly advanced imaging use.

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Area of Science:

  • Health Services Research
  • Clinical Practice Improvement
  • Medical Informatics

Background:

  • High clinical variation impacts care quality, costs, and patient satisfaction.
  • Implementing interventions to standardize care is crucial for healthcare networks.

Purpose of the Study:

  • To evaluate existing variation in radiology ordering within a primary care network.
  • To determine if peer comparison feedback reduces this variation and alters practice patterns.

Main Methods:

  • Retrospective analysis of radiology ordering data from 159 providers over 3 years.
  • Monthly sharing of a utilization dashboard with providers for peer comparison.
  • Pre- and post-intervention imaging rates were analyzed.

Main Results:

  • Significant pre-intervention variation observed, with top decile providers ordering 4.2x more than the lowest.
  • Post-intervention, median imaging rates decreased by 17.3% (p<0.001).
  • Ordering of costly cross-sectional imaging (CT, MRI, nuclear medicine) reduced by 20-42%.

Conclusions:

  • Peer comparison feedback effectively influences provider imaging behavior without explicit targets.
  • This intervention is low-cost and low-touch, applicable to other clinical areas.
  • Standardizing radiology ordering improves efficiency and potentially reduces healthcare costs.