title: With "big data" comes big responsibility: outreach to North Carolina Medicaid patients with 10 or more computed tomography scans in 12 months.
abstract: BACKGROUND
  Patients are being exposed to increasing levels of ionizing radiation, much of it from computed tomography (CT) scans.
  
  
  METHODS
  Adults without a cancer diagnosis who received 10 or more CT scans in 2010 were identified from North Carolina Medicaid claims data and were sent a letter in July 2011 informing them of their radiation exposure; those who had undergone 20 or more CT scans in 2010 were also telephoned. The CT scan exposure of these high-exposure patients during the 12 months following these interventions was compared with that of adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population.
  
  
  RESULTS
  The average number of CT scans per month for the high-exposure population decreased over time, but most of that reduction occurred 6-9 months before our interventions took place. At about the same time, the number of CT scans per month also decreased in adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population.
  
  
  CONCLUSIONS
  Our data do not include information about CT scans that may have been performed during times when patients were not covered by Medicaid. Some of our letters may not have been received or understood. Some high-exposure patients were unintentionally excluded from our study because organization of data on Medicaid claims varies by setting of care.
  
  
  CONCLUSIONS
  Our patient education intervention was not temporally associated with significant decreases in subsequent CT exposure. Effecting behavior change to reduce exposure to ionizing radiation requires more than an educational letter or telephone call.
authors.affiliation: Community Care of North Carolina, Raleigh, NC, USA; Lincoln Community Health Center, Durham, NC, USA.holly.biola@duke.edu>
authors.forename: Holly
authors.initials: H
authors.lastname: Biola
authors.affiliation: Division of Medical Assistance, North Carolina Department of Health and Human Services, Raleigh, NC, USA; Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Randall M
authors.initials: RM
authors.lastname: Best
authors.affiliation: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Rita M
authors.initials: RM
authors.lastname: Lahlou
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Burke
authors.affiliation: Community Care of North Carolina, Raleigh, NC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Dewar
authors.affiliation: North Carolina Community Care Networks, Inc, Raleigh, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Carlos T
authors.initials: CT
authors.lastname: Jackson
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Broder
authors.affiliation: OptumInsight, Raleigh, NC, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Grey
authors.affiliation: Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Semelka
authors.affiliation: Community Care of North Carolina, Raleigh, NC, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Dobson
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009657:North Carolina; D010353:Patient Education as Topic / Q000379:methods*; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000706:statistics & numerical data; D014481:United States; D055815:Young Adult