Impact of provider-led, technology-enabled radiology management program on imaging.
OBJECTIVE
The study objective was to assess the impact of a provider-led, technology-enabled radiology medical management program on high-cost imaging use.


METHODS
This study was performed in the ambulatory setting of an integrated healthcare system. After negotiating a risk contract with a major commercial payer, we created a physician-led radiology medical management program to help address potentially inappropriate high-cost imaging use. The radiology medical management program was enabled by a computerized physician order entry system with integrated clinical decision support and accountability tools, including (1) mandatory peer-to-peer consultation with radiologists before order completion when test utility was uncertain on the basis of order requisition; (2) quarterly practice pattern variation reports to providers; and (3) academic detailing for targeted outliers. The primary outcome measure was intensity of high-cost imaging, defined as the number of outpatient computed tomography (CT), magnetic resonance imaging (MRI), and nuclear cardiology studies per 1000 patient-months in the payer's panel. Chi-square test was used to assess trends.


RESULTS
In 1.8 million patient-months from January 2004 to December 2009, 50,336 eligible studies were performed (54.1% CT, 40.3% MRI, 5.6% nuclear cardiology). There was a 12.0% sustained reduction in high-cost imaging intensity over the 5-year period (P < .001). The number of CT studies performed decreased from 17.5 per 1000 patient-months to 14.5 (P < .01); nuclear cardiology examinations decreased from 2.4 to 1.4 (P < .01) per 1000 patient-months. The MRI rate remained unchanged at 11 studies per 1000 patient-months.


CONCLUSION
A provider-led radiology medical management program enabled through health information technology and accountability tools may produce a significant reduction in high-cost imaging use.
['Ip|Ivan K|IK|', 'Schneider|Louise|L|', 'Seltzer|Steven|S|', 'Smith|Allen|A|', 'Dudley|Jessica|J|', 'Menard|Andrew|A|', 'Khorasani|Ramin|R|']
D000328:Adult D057791:Cardiac Imaging Techniques D019033:Delivery of Health Care, Integrated D003952:Diagnostic Imaging D005260:Female D006801:Humans D008279:Magnetic Resonance Imaging D008297:Male D008490:Medical Informatics D050316:Medical Order Entry Systems D010818:Practice Patterns, Physicians' D011871:Radiology D011877:Radionuclide Imaging D012017:Referral and Consultation D014057:Tomography, X-Ray Computed D019564:Unnecessary Procedures
Imaging use Health information technology Health policy