Tan Alai, Zhou Jie, Kuo Yong-Fang, Goodwin James S
Institute for Translational Sciences, University of Texas Medical Branch, Galveston, TX, USA.
Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, USA.
J Gen Intern Med. 2016 Feb;31(2):156-163. doi: 10.1007/s11606-015-3475-3. Epub 2015 Jul 28.
Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain.
To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain.
Retrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with non-specific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs.
We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use.
Among patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time.
PCPs vary substantially in the use of imaging for non-specific acute low back pain. Provider-level measures can be employed to provide feedback to physicians in an effort to modify imaging use.
不建议在非特异性急性腰痛的评估和管理中使用诊断性影像学检查。
评估初级保健提供者（PCP）对老年非特异性急性腰痛患者使用诊断性影像学检查的差异。
使用100%的德克萨斯医疗保险索赔数据进行回顾性队列研究。我们确定了2007年1月1日至2011年11月30日期间，由3297名PCP照料的145320名66岁及以上的非特异性急性腰痛患者。
我们跟踪每位患者在初次就诊后4周内是否接受了腰椎成像检查（X线摄影、计算机断层扫描[CT]或磁共振成像[MRI]）。使用多水平逻辑回归模型来估计医生层面在成像检查使用上的差异。
在腰痛初次就诊后4周内，27.2%的患者接受了X线摄影，11.1%的患者接受了CT或MRI检查。PCP在影像学检查的使用上差异很大。最高十分位数的PCP在4周内进行X线摄影的平均比例为53.9%，而最低十分位数的PCP为6.1%。最高和最低十分位数的PCP在4周内进行CT/MRI检查的平均比例分别为18.5%和3.2%。患者所看的具体医生占成像检查是否进行的变异性的25%，而仅有0.44%的变异是由于测量的患者特征，1.4%是由于已知的医生特征。个体医生的成像检查使用随时间保持稳定。
PCP在非特异性急性腰痛的影像学检查使用上差异很大。可以采用提供者层面的措施向医生提供反馈，以努力改变影像学检查的使用。
