Lasser E C, Pfoh E R, Chang H Y, Chan K S, Bailey J C, Kharrazi H, Weiner J P, Dy S M
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, 21205, USA.
Johns Hopkins Center for Population Health IT, Baltimore, MD, USA.
Osteoporos Int. 2016 Jul;27(7):2311-2316. doi: 10.1007/s00198-016-3511-0. Epub 2016 Feb 9.
Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue. We evaluated trends in DXA ordering before and after Choosing Wisely recommendations were released. We found no significant difference in ordering trends suggesting that other initiatives are needed to change behavior.
Reducing overuse of tests such as dual-energy X-ray absorptiometry (DXA) scans in younger women is an important quality issue, but trends in care are difficult to change. We evaluated (1) trends in DXA ordering before and after the Choosing Wisely recommendation release and (2) patterns of key characteristics that indicate a potentially appropriate DXA scan order.
We performed a retrospective longitudinal analysis of electronic health record data at a multi-specialty, ambulatory care network of 34 practices across Maryland and Washington, DC. Since the Choosing Wisely DXA recommendation was released April 2012, the study periods were April-December 2011 (pre-initiative) and April-December 2012 (post-initiative). Women between 50 and 64 years with primary care encounters, and primary care providers who saw ten or more women in the study population in both pre and post periods were included.
For 42,320 eligible patients, the mean provider ordering rate was 2.6 % pre-initiative and 2.0 % post-initiative; there was no significant difference in trend over time. Over 70 % of the population had no characteristics associated with potentially appropriate DXA ordering. Low body mass index, current smoker status, and osteopenia were the most common characteristics indicating potentially appropriate DXA orders. Patients with any of these three characteristics had DXA ordering rates between 3-20 %.
The trend in provider ordering rates of DXA scans did not decrease after the release of the DXA Choosing Wisely recommendation. Targeted initiatives addressing providers with high ordering rates will be needed to change behavior.
减少年轻女性双能X线吸收测定法（DXA）扫描等检查的过度使用是一个重要的质量问题。我们评估了“明智选择”建议发布前后DXA检查开具的趋势。我们发现开具趋势没有显著差异，这表明需要采取其他举措来改变行为。
减少年轻女性双能X线吸收测定法（DXA）扫描等检查的过度使用是一个重要的质量问题，但医疗护理趋势难以改变。我们评估了（1）“明智选择”建议发布前后DXA检查开具的趋势，以及（2）表明DXA扫描开具可能合适的关键特征模式。
我们对马里兰州和华盛顿特区34家医疗机构组成的多专科门诊护理网络的电子健康记录数据进行了回顾性纵向分析。自2012年4月发布“明智选择”DXA建议以来，研究时间段为2011年4月至12月（倡议前）和2012年4月至12月（倡议后）。纳入了年龄在50至64岁之间有初级保健就诊经历的女性，以及在倡议前后两个时间段内诊治了10名或更多研究人群中女性的初级保健提供者。
对于42320名符合条件的患者，倡议前提供者的平均开具率为2.6%，倡议后为2.0%；随时间推移趋势无显著差异。超过70%的人群没有与DXA开具可能合适相关的特征。低体重指数、当前吸烟状态和骨质减少是表明DXA开具可能合适的最常见特征。具有这三个特征中任何一个的患者DXA开具率在3%至20%之间。
“明智选择”DXA建议发布后，提供者DXA扫描开具率的趋势并未下降。需要针对开具率高的提供者采取有针对性的举措来改变行为。
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