title: Impact of provider-led, technology-enabled radiology management program on imaging.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02445, USA. iip@partners.org
authors.forename: Ivan K
authors.initials: IK
authors.lastname: Ip
authors.forename: Louise
authors.initials: L
authors.lastname: Schneider
authors.forename: Steven
authors.initials: S
authors.lastname: Seltzer
authors.forename: Allen
authors.initials: A
authors.lastname: Smith
authors.forename: Jessica
authors.initials: J
authors.lastname: Dudley
authors.forename: Andrew
authors.initials: A
authors.lastname: Menard
authors.forename: Ramin
authors.initials: R
authors.lastname: Khorasani
mesh_terms: D000328:Adult; D057791:Cardiac Imaging Techniques / Q000191:economics / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000379:methods; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008490:Medical Informatics / Q000379:methods; D050316:Medical Order Entry Systems; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards*; D011871:Radiology / Q000193:education / Q000379:methods*; D011877:Radionuclide Imaging / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data; D019564:Unnecessary Procedures
keywords: Health information technology; Health policy; Imaging use