Several strong clinician predictors of low-value imaging, such as ordering low-value imaging on a prior patient, high rates of low-value imaging in another clinical scenario, and ownership of imaging equipment, can help guide intervention targets to improve the value of care for patients, according to a study from JAMA Internal Medicine.

Arthur S. Hong, MD, MPH, from the Department of Internal Medicine at the University of Texas Southwestern Medical Center in Dallas, and colleagues examined clinician characteristics as predictors for 2 common low-value services: inappropriate back pain and headache imaging. Clinicians were recruited from a medical claims data set from a large commercial health insurer from January 2010 to December 2014. Participants included 100,977 clinicians: primary care clinicians, specialist physicians, and chiropractors.

Imaging after acute uncomplicated back pain and headache visits was recorded. The authors identified whether the clinician’s prior patient received imaging, whether the clinician was an owner of imaging equipment, and the impact by clinician specialty. The authors then used high rates of low-value back imaging as a predictor for low-value headache imaging.

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Clinicians conducted 1,007,392 visits for 878,720 adults aged 18 to 64 years with acute uncomplicated back pain; 52,876 primary care clinicians conducted visits for 492,805 adults with acute uncomplicated headache; 34,190 primary care clinicians conducted 405,721 visits for 344,991 adults with headache and had also conducted at least 4 visits from patients with back pain.

The authors found that if a primary care clinician’s patient previously received low-value back imaging, the patient had 1.81 higher odds of low-value imaging. This effect was stronger for chiropractors (odds ratio [OR], 2.80) and specialists (OR, 2.98). For headache, a prior low-value head image led to 2.00 higher odds of a subsequent head imaging order.

Clinician ownership of imaging equipment was seen as an independent predictor of low-value imaging (OR, 1.65-7.76) across clinician type and imaging scenario. Primary care clinicians with the highest rates of low-value back imaging also had 1.53 higher odds of ordering low-value headache imaging.

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”Among commercially insured patients, strong predictors of low-value back pain and headache imaging included a clinician’s history of ordering low-value imaging, a high rate of imaging in another low-value clinical scenario, and clinician ownership of imaging equipment,” the authors concluded.


Hong AS, Ross-Degnan D, Zhang F, Wharam JF. Clinician-level predictors for ordering low-value imaging. JAMA Intern Med. 25 Sept 2017. doi:10.1001/jamainternmed.2017.4888