Imaging Wisely Campaign: Initiative to Reduce Imaging for Low Back Pain Across a Large Safety Net System

Area of Science:

• Health Services Research
• Quality Improvement
• Medical Imaging

Background:

• Low back pain is a frequent reason for costly and potentially harmful medical imaging.
• Overutilization of imaging for low back pain can lead to unnecessary procedures and patient harm.
• A safety net system initiative aimed to curb unnecessary imaging for low back pain.

Purpose of the Study:

• To implement and evaluate an initiative to reduce lumbar imaging orders within a safety net healthcare system.
• To assess the impact of electronic health record (EHR) nudges on ordering lumbar radiography, CT, and MRI.

Main Methods:

• A quality improvement study involving 70 ambulatory clinics and 11 teaching hospitals.
• Implementation of three EHR-based nudges for lumbar radiography (x-ray), CT, and MRI orders.
• Primary outcome measured was the rate of imaging orders per 1,000 patient-days or encounters.

Main Results:

• Statistically significant decreases in lumbar x-ray orders across inpatient (-52.9%), ambulatory (-23.7%), and ED (-17.3%) settings.
• Lumbar CT orders decreased in inpatient and ambulatory settings but increased in ED-only encounters.
• No significant change observed in lumbar MRI ordering rates.

Conclusions:

• The EHR-based nudging intervention effectively reduced lumbar radiography orders across all clinical settings.
• The initiative also led to a reduction in lumbar CT orders in specific settings, indicating success in curbing some unnecessary imaging.
• Further strategies may be needed to address lumbar MRI ordering and specific indications for CT scans.