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Medical Appropriateness of Imaging Referrals Analyzed

Review finds 26 percent of primary care physician referrals not supported by evidence-based criteria

TUESDAY, March 2 (HealthDay News) -- A quarter of the primary care physician (PCP) referrals for medical imaging received by the University of Washington/Harborview Medical Center do not meet evidence-based appropriateness criteria, according to a study in the March issue of the Journal of the American College of Radiology.

Bruce E. Lehnert, M.D., and Robert L. Bree, M.D., of the University of Washington/Harborview Medical Center in Seattle conducted a review of records on 459 computed tomography (CT) and magnetic resonance imaging (MRI) studies ordered by PCPs from June 2007 to November 2007. The researchers reviewed patient clinical histories, clinic notes and laboratory results, and applied established appropriateness criteria to determine if the imaging studies were warranted.

The investigators found that 341 (74 percent) of the imaging referrals were appropriate, while 118 (26 percent) were inappropriate, including CT imaging scans for chronic headache, or hematuria during a urinary tract infection, and MRI scans for acute back pain or knee or shoulder osteoarthritis. Of the appropriate imaging scans, 58 percent affected subsequent management, while 24 percent of the inappropriate studies affected management.

"A high percentage of examinations not meeting appropriateness criteria and subsequently yielding negative results suggests a need for tools to help PCPs improve the quality of their imaging decision requests. In the current environment, which stresses cost containment and comparative effectiveness, traditional radiology benefit management tools are being challenged by clinical decision support, with an emphasis on provider education coupled with electronic order entry systems," the authors write.

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