Study: Reinitiation of Imaging for Low Back Pain after Collaborative Consult

June 11, 2018

A poster titled “Reinitiation of Imaging for Low Back Pain after Collaborative Consult” has been presented at the American College of Radiology’s 2018 Annual Meeting, which was held from May 19 through 23, 2018, in Washington, DC.

The study’s lead author, Adam C. Powell, Ph.D., and his team sought to assess the extent to which collaborative consultation impacted decisions to perform imaging for low back pain. A Centers for Medicare & Medicaid Services quality measure and the Choosing Wisely guidelines of the American Academy of Family Physicians, the American Society of Anesthesiologists, and the North American Spine Society suggest that in most cases, physicians should wait at least 28 days after a patient has experienced the onset of low back pain before ordering imaging. The study explored four interaction sequences between ordering and consulting physicians in a non-denial prior authorization program. Ordering physicians were asked to modify orders during a consultation with a board-certified physician if their orders did not appear to meet best practice guidelines. If the original orders were not reinitiated, it could imply that the modified orders met clinical objectives.

Prior authorization data and claims data from 2014 to 2017 were analyzed to determine the rate at which computed tomography and magnetic resonance imaging orders changed or withdrawn during consultation were reinitiated within 28 days. The study calculated reinitiation rates for each sequence of interaction examined.

Across the four sequences, 533,768 orders were placed, leading to 6,855 consultations, 1,380 modifications, and 224 reinitiations. The rate at which modification led to reinitiation for the various sequences ranged from 7.1 percent to 20.6 percent, with an average rate of 16.2 percent. The majority of low back pain imaging orders modified were not reinitiated within 28 days. Reinitiation of imaging orders within 28 days of their withdrawal may have sometimes been consistent with evidence-based practice, since sufficient time may have elapsed so that imaging actually was at least 28 days after the initial onset of pain.

Per Dr. Powell, “This study showed that when ordering physicians agreed to modify their use of imaging as a part of a collaborative, non-denial prior authorization consultation, they infrequently conducted the imaging studies originally ordered. This finding suggests that collaborative consultation may improve the patient experience by reducing exposure to unnecessary imaging.”

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