CDS-generated report cards help reduce imaging orders for lower back pain

Using clinical decision support (CDS) to send primary care providers (PCPs) personalized “report cards” evaluating their ordering decisions can reduce outpatient lumbar spine (LS) MRI orders for lower back pain (LBP), according to a new study published in the American Journal of Roentgenology.  

Guidelines for LS MRI use for LBP were issued in 2007 by the American College of Physicians and American Pain Society. The authors examined how different types of guideline adherence feedback—no feedback at all, CDS-generated report cards comparing practices to their peers and CDS alerts as orders are being entered—impacted eight different PCP practices.

“Report cards compared the number and proportion of LS MRI orders that were adherent, nonadherent, uncertain, or not covered for that individual provider to aggregate all-provider data,” wrote Hanna M. Zafar, MD, of the University of Pennsylvania in Philadelphia. “To provide clinical context, each provider's report card included the proportion of adherent and nonadherent LS MRI orders relative to all their LS MRI orders and the proportion of LBP visits with finalized LS MRI orders among all their visits.”

Overall, the CDS-generated report cards resulted in PCPs having a lower likelihood of LS MRI orders a full month after the visit than when no feedback was provided at all. The real-time CDS alerts, however, were not associated with such a change in the likelihood of LS MRI orders.

“Our results suggest that health information technology tools can promote high-value cost-conscious health care through high-quality provider report cards presenting evidence-based diagnostic imaging guideline adherence to PCPs based on data entered into a CDS system within the context of relevant clinic visits,” the authors wrote. “Our data further suggest that turning off real-time CDS alerts does not influence PCP guideline adherence. The effect of report cards was likely optimized by report card content, frequency, and the trustworthiness of the evidence source.”