A Simulation-Based Diagnostic Stewardship Framework for Imaging Utilization in Primary Care: A Model Using 100 Common...

Area of Science:

• Health Services Research
• Medical Informatics
• Diagnostic Imaging

Background:

• Increasing diagnostic imaging use raises concerns about overuse, radiation exposure, and cascading diagnostic tests.
• Primary care physicians are key to influencing system-level healthcare resource utilization.
• Diagnostic stewardship is crucial for optimizing healthcare resource allocation.

Purpose of the Study:

• To develop and evaluate a conceptual diagnostic stewardship framework for primary care.
• To assess the framework's impact on imaging utilization, radiation burden, and diagnostic cascades using simulation.
• To provide a data-driven hypothesis for real-world validation.

Main Methods:

• Developed a synthetic dataset of 100 common primary care conditions with diagnostic attributes.
• Created a simulation model for one million hypothetical primary care visits.
• Estimated imaging utilization, radiation burden, and diagnostic cascades under baseline and framework-guided scenarios.

Main Results:

• The framework-guided scenario showed a 37% reduction in imaging examinations (258,000 vs. 412,000).
• Modeled reductions of 37% in radiation burden index and significant decreases in diagnostic cascades were observed.
• Sensitivity analyses confirmed the robustness of the findings.

Conclusions:

• The proposed diagnostic stewardship framework effectively reduces modeled imaging utilization and associated downstream consequences.
• This simulation highlights the potential of structured diagnostic stewardship in primary care.
• Findings support further validation with real-world clinical data to confirm impact.