A rule of thumb has emerged that only 14% of medical research findings survive a tortuous 17-year journey and become translated into standard healthcare practices.
Imaging treatment can be a pain
This month, however, there may have been a case where the research has caught up to a practice. And, while it didn't take 17 years for this to occur, I found the American College of Physicians' Feb. 1 declaration that advanced imaging for patients with low back pain is “not associated with clinically meaningful benefits” to be a little behind the times.
Research presented last week at the American Academy of Orthopaedic Surgeons annual conference in San Diego noted how 38.7% of magnetic resonance imaging tests reviewed in a study were ordered for defensive medicine purposes. But research I have seen reported at healthcare conferences involves how Seattle's Virginia Mason Medical Center worked with Aetna and some of the region's largest employers to identify high-priority conditions linked to high healthcare costs and absenteeism.
The conditions studied included cardiac arrhythmias, gastroesophageal reflux disease, lower back pain and migraine headaches. Of these, the back pain initiative has received the most attention. Perhaps this is due in part because “back pain” is much easier to spell than “arrhythmia” and “gastroesophageal.” It may also be because it provided a real-world example of how improving healthcare efficiency and quality led to lower profits as it was discovered that MRIs prescribed for back pain treatment were beneficial to the hospital's bottom line but had little value in healing the patient's lower back.
Virginia Mason reports that it reduced the number of lower-back MRIs it performed by almost 31% from 1,886 to in 2004 to 1,308 in 2007; and—at $1,000 a pop—losing some $578,000 in the process.
At the same time, it sped up patient flow by freeing up the imaging equipment for patients for whom the test was more valuable and it created a “new back pain pathway,” which apparently was well received. Virginia Mason reported that, in the fourth quarter of 2007, 100 patients were asked about their level of satisfaction. The hospital reported that the average rating was 4.9 on a five-point scale.
The Center for Health Care Solutions at Virginia Mason reported that only one MRI of questionable value was performed on an Aetna-covered patient seen at the hospital's spine clinic in 2007.
Carrying on the effort, Virginia Mason developed a set of “evidence-based decision rules” for advanced imaging that are posted on its website for the whole world to use. In a retrospective study, published in the January issue of the Journal of the American College of Radiology, Virginia Mason researchers said the guidelines resulted in a 23.2% reduction in the rate of MRIs for low back pain, a 23.2% reduction for headache, and a 26.8% reduction in CT scans for sinusitis.
No word yet on a follow-up study for 2028.
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