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Physician, Patient Traits Affect Back Pain Imaging in Elderly

Last Updated: May 29, 2009.

Quality metrics that focus on overuse as well as underuse of services may be helpful in improving the quality of diagnostic services for elderly patients presenting with acute low back pain, according to a study in the May 25 Archives of Internal Medicine.

FRIDAY, May 29 (HealthDay News) -- Quality metrics that focus on overuse as well as underuse of services may be helpful in improving the quality of diagnostic services for elderly patients presenting with acute low back pain (LBP), according to a study in the May 25 Archives of Internal Medicine.

Hoangmai H. Pham, M.D., of the Center for Studying Health System Change in Washington, D.C., and colleagues analyzed data from 35,039 Medicare beneficiaries with acute LBP. The data was assessed for rapidity of testing at less than 28 days, 28 to 180 days, or more than 180 days, and also for the type of imaging used, classified as computed tomography or MRI, radiograph, or no imaging.

Imaging was conducted within 28 days for 28.8 percent of the patients, and between 28 and 180 days for 4.6 percent, with radiography most commonly used and accounting for 88.2 percent of imaging, the researchers discovered. Physicians who were given clinical quality-based incentives were less likely to order advanced imaging within 28 days, but those given incentive combinations, including satisfaction measures, were more likely to order rapid and more advanced imaging tests. In addition, Medicaid patients received less rapid or advanced imaging than other patients and white patients had higher levels of imaging than patients of other races.

"Rapidity and modality of imaging for LBP is associated with patient and physician characteristics, but the directionality of associations with desirable care processes is opposite of associations for measures targeting underuse," the authors write.

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