TY - JOUR
T1 - Diagnostic Imaging Use for the Initial Evaluation of Low Back Pain by Primary Care Providers in the United States
T2 - 2011-2016
AU - Pakpoor, Jina
AU - Raad, Micheal
AU - Harris, Andrew
AU - Puvanesarajah, Varun
AU - Canner, Joseph K.
AU - Nadgir, Rohini
AU - Jain, Amit
N1 - Publisher Copyright:
© 2019 American College of Radiology
PY - 2019/11
Y1 - 2019/11
N2 - Objective: High-value care guidelines from multiple medical societies recommend against imaging for the initial evaluation of low back pain in the absence of red flag symptoms. We aimed to determine the current temporal and geographic landscape of imaging ordering patterns for this indication among US primary care providers. Methods: Using a national commercial insurance claims database, we identified patients between 18 and 64 years old who presented to a primary care provider for an initial evaluation of low back pain between 2011 and 2016. Patients were identified via International Classification of Diseases codes, and the use of diagnostic imaging was identified by Current Procedural Terminology codes. Geographic regions were based on the location of patient residence. Results: Overall, 627,118 encounters met inclusion criteria. Imaging acquisitions increased over time, from 14% of encounters in 2011 to 16% in 2016 (P < .01). Radiographs represented 96% of ordered imaging, CT 2%, and MRI 3%. The likelihood of having any imaging for low back pain varied significantly by US census region and by US state (P < .01). The greatest use of imaging was in the Midwest (13.9%) and the South (18.5%), and lowest in the Northeast and West (6.2% and 13.6%). Discussion: Imaging utilization for the initial evaluation of low back pain by primary care providers has increased on a national level from 2011 to 2016, largely represented by radiographs. Significant regional variation also exists. Encouragingly, the use of advanced imaging has remained at a low level in the primary care setting (<1.0%).
AB - Objective: High-value care guidelines from multiple medical societies recommend against imaging for the initial evaluation of low back pain in the absence of red flag symptoms. We aimed to determine the current temporal and geographic landscape of imaging ordering patterns for this indication among US primary care providers. Methods: Using a national commercial insurance claims database, we identified patients between 18 and 64 years old who presented to a primary care provider for an initial evaluation of low back pain between 2011 and 2016. Patients were identified via International Classification of Diseases codes, and the use of diagnostic imaging was identified by Current Procedural Terminology codes. Geographic regions were based on the location of patient residence. Results: Overall, 627,118 encounters met inclusion criteria. Imaging acquisitions increased over time, from 14% of encounters in 2011 to 16% in 2016 (P < .01). Radiographs represented 96% of ordered imaging, CT 2%, and MRI 3%. The likelihood of having any imaging for low back pain varied significantly by US census region and by US state (P < .01). The greatest use of imaging was in the Midwest (13.9%) and the South (18.5%), and lowest in the Northeast and West (6.2% and 13.6%). Discussion: Imaging utilization for the initial evaluation of low back pain by primary care providers has increased on a national level from 2011 to 2016, largely represented by radiographs. Significant regional variation also exists. Encouragingly, the use of advanced imaging has remained at a low level in the primary care setting (<1.0%).
KW - Health services research
KW - high value care
KW - imaging utilization
KW - low back pain
KW - trends analysis.
UR - http://www.scopus.com/inward/record.url?scp=85068254015&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068254015&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2019.04.015
DO - 10.1016/j.jacr.2019.04.015
M3 - Article
C2 - 31125539
AN - SCOPUS:85068254015
SN - 1546-1440
VL - 16
SP - 1522
EP - 1527
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 11
ER -