A research paper titled “Discordance in Clinical Recommendations Regarding the Use of Imaging” has been published online by the American Journal of Medical Quality. This study reviews the literature on comparisons of clinical recommendations regarding medical imaging, highlighting the challenges that arise when different entities disseminate divergent Appropriate Use Criteria (AUC) or clinical guidelines on the same topic.
The objectives of this study were to summarize the nature of the differences found in the literature, the reasons for those differences, and how the differences may in some cases impact clinical decision making.
The research team was led by Adam C. Powell, Ph.D. of HealthHelp and Teresa L. Rogstad, MPH of Humana, under the supervision of Vijay M. Rao, MD, former President of the Radiological Society of North America. The team identified and analyzed 406 articles obtained from the PubMed database that matched the purpose of this study. Of the 406 articles identified, 15 met the selection criteria: eight qualitative and seven quantitative. Reasons for discordance varied, with lack of scientific evidence often cited. Quantitative studiesoften found that different decisions would be reached depending upon the clinical recommendation followed. Nonetheless, quantitative studies also tended not to consider one set of recommendations superior to another.
Based upon the findings of this study, the authors concluded that different organizations seeking to address similar clinical issues often developed discordant clinical recommendations, primarily due to lack of scientific evidence. Quantitative analyses have shown that different approaches to characterizing clinical scenarios, differences in reliance on imaging versus pathological evidence, and different objectives (e.g. having high sensitivity versus specificity) have led to different clinical decisions.
An awareness of these differences and their consequences could help clinicians seek guidance more thoughtfully and could inform the integration of guidelines and AUC into quality improvement programs and clinical decision support systems. By creating a better understanding of how discordance in clinical recommendations is impacting outcomes, it will be possible to improve the quality of care.
In response to the findings of the study, Dr. Powell remarked, “As a consequence of the Protecting Access to Medicare Act, the Centers for Medicare & Medicaid Services have authorized a number of Provider-led Entities (PLEs) to develop appropriate use criteria for advanced diagnostic imaging. In the years ahead, we will likely need to increasingly consider how we wish to handle discordance in clinical recommendations, as PLEs can create conflicting recommendations for the same clinical scenarios.”
To read this study in its entirety, please click here: https://journals.sagepub.com/doi/full/10.1177/1062860619851561