title: Low Back Imaging When Not Indicated: A Descriptive Cross-System Analysis.
abstract: Guideline-discordant imaging to evaluate incident low back pain is common.
  
  
  
  We compared rates of guideline-discordant imaging in patients with low back pain in two care delivery systems with differing abilities to track care through an electronic health record (EHR), and in their patients' insurance status, to measure the association between these factors and rates of ordered low back imaging.
  
  
  
  We used data from two Kaiser Permanente (KP) Regions and from OCHIN, a community health center network. We extracted data on imaging performed after index visits for low back pain from June 1, 2011, to May 31, 2012, in these systems. Adjusted logistic regression measured associations between system-level factors and imaging rates.
  
  
  
  Imaging rates for incident low back pain using 2 national quality metrics: Clinical Quality Measure 0052, a measure for assessing Meaningful Use of EHRs, and the Healthcare Effectiveness Data and Information Set measure "Use of Imaging Studies for Low Back Pain."
  
  
  
  Among 19,503 KP patients and 2694 OCHIN patients with incident low back pain, ordered imaging was higher among men and whites but did not differ across health care systems. OCHIN's publicly insured patients had higher rates of imaging compared with those with private or no insurance.
  
  
  
  Rates of ordered imaging to evaluate incident low back pain among uninsured OCHIN patients were lower than in KP overall; among insured OCHIN patients, rates were higher than in KP overall. Research is needed to establish causality and develop interventions.
authors.affiliation: Investigator in the Science Program at the Center for Health Research and an Investigator for the Practice-Based Research Network for OCHIN, Inc, in Portland, OR. rachel.gold@kpchr.org.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.affiliation: Former Research Analyst in the Science Program at the Center for Health Research in Portland, OR. elizabeth.esterberg@kp.org.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Esterberg
authors.affiliation: Project Manager in the Science Program at the Center for Health Research in Portland, OR. celine.b.hollombe@kpchr.org.
authors.forename: Celine
authors.initials: C
authors.lastname: Hollombe
authors.affiliation: Research Associate for OCHIN, Inc, in Portland, OR. arkindj@ochin.org.
authors.forename: Jill
authors.initials: J
authors.lastname: Arkind
authors.affiliation: Research Analyst for OCHIN, Inc, in Portland, OR. vakarcst@ochin.org.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Vakarcs
authors.affiliation: Research Analyst for Utility of Care Data Analysis for the Kaiser Foundation Health Plan in Oakland, CA. marie.h.tran@kp.org.
authors.forename: Huong
authors.initials: H
authors.lastname: Tran
authors.affiliation: Chief Research Officer for the Practice-Based Research Network for OCHIN, Inc, in Portland, OR. burdickt@ochin.org.
authors.forename: Tim
authors.initials: T
authors.lastname: Burdick
authors.affiliation: Chief Clinical Research Informatics Officer for OCHIN, Inc, and an Associate Professor of Family Medicine at Oregon Health and Science University in Portland, OR. devoej@ohsu.edu.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Devoe
authors.affiliation: Executive Director of Research and Community Benefit for the Mid-Atlantic Permanente Research Institute in Rockville, MD. michael.horberg@kp.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Horberg
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage; D017116:Low Back Pain / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019564:Unnecessary Procedures; D055815:Young Adult