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Inappropriate wrist MRI: did guidelines have an impact?

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Many wrist MRIs are inappropriate and costly. Following guideline publication, inappropriate MRI use decreased monthly, but further interventions are needed to improve adherence and reduce healthcare expenses.

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Area of Science:

  • Radiology and Health Economics
  • Medical Imaging Appropriateness
  • Clinical Guideline Impact Assessment

Background:

  • Magnetic Resonance Imaging (MRI) is frequently utilized for wrist pain diagnosis.
  • Assessing the appropriateness and associated costs of MRI is crucial for healthcare resource management.

Purpose of the Study:

  • To evaluate the national prevalence and financial burden of inappropriate wrist MRIs.
  • To determine the impact of American College of Radiology (ACR) guidelines on MRI appropriateness.

Main Methods:

  • Analysis of administrative claims data (IBM MarketScan) for adult patients with wrist pain (2016-2019).
  • Assessment of MRI appropriateness based on ACR guidelines.
  • Calculation of total and out-of-pocket costs for inappropriate MRIs.
  • Interrupted time series analysis to evaluate guideline publication impact.

Main Results:

  • A cohort of 867,119 patients was analyzed, with 4.6% undergoing wrist MRI.
  • Over half (52.6%) of wrist MRIs were deemed inappropriate, costing over $44 million in total payments.
  • A 1% monthly decrease in inappropriate MRI odds was observed post-guideline publication.

Conclusions:

  • Inappropriate wrist MRI utilization is prevalent and costly.
  • Published guidelines show a positive but insufficient impact on reducing inappropriate imaging.
  • Interventions like clinical decision support tools are recommended to enhance guideline adherence.