Agreement among measures examining low-value imaging for low back pain

Area of Science:

• Health Services Research
• Medical Informatics
• Radiology

Background:

• Low-value imaging for acute low back pain (LBP) contributes to healthcare overuse.
• Standardized measures are needed to assess and reduce inappropriate imaging.

Purpose of the Study:

• To quantify patient-level agreement among three published measures of low-value imaging for acute LBP.
• To evaluate the consistency of identifying LBP diagnoses, red-flag exclusions, and imaging procedures across these measures.

Main Methods:

• Retrospective cohort study using MarketScan commercial insurance claims data.
• Assessed agreement using percent agreement and Fleiss κ on LBP diagnoses, red-flag exclusions, and imaging procedures.
• Included patients aged 18–64 years with an acute LBP diagnosis in 2014.

Main Results:

• Excellent agreement (99%; κ=0.98) was found for identifying acute LBP and imaging procedures.
• Substantial disagreement (75%; κ=0.61) occurred in excluding red-flag diagnoses.
• This disagreement impacted the accurate identification of the reference population for low-value imaging.

Conclusions:

• Need for consensus on translating guidelines into administrative measures for assessing imaging overuse in acute LBP.
• Particular focus is required on defining patient exclusions for red-flag diagnoses.
• Findings are relevant for other overuse measures that utilize exclusion criteria.