title: Evaluating Two Measures of Lumbar Spine MRI Overuse: Administrative Data Versus Chart Review.
abstract: OBJECTIVE
  Lumbar spine (LS) MRI overuse may be identified in administrative data, but these data may lack the detailed clinical information needed to correctly assess overuse. The aim of this study was to compare chart review with analysis of administrative data to determine the appropriateness of LS MRI.
  
  
  METHODS
  The sensitivity and specificity of the administrative method were determined, with inappropriateness regarded as the positive result, as if chart review determined the true state. Patients were the first 146 veterans who underwent LS MRI in the outpatient setting in fiscal year 2012 at the Veterans Affairs Palo Alto Health Care System. The InterQual criteria for chart review and the method of evaluating administrative data developed by CMS and endorsed by the National Quality Forum were used. Slight modifications were made to each measure to ensure completeness and comparability.
  
  
  RESULTS
  Of the 146 scans reviewed, 23% were considered inappropriate by the administrative measure, whereas 59% were considered inappropriate by chart review. Compared with chart review, the administrative measure had specificity of 82% for identifying inappropriate scans and sensitivity of 27% for identifying appropriate scans.
  
  
  CONCLUSIONS
  Compared with chart review, analysis of administrative data identified scans that were appropriate but underestimated inappropriate ordering. Contrary to expectations, chart review resulted in more scans being classified as inappropriate. The administrative method is economically feasible for identifying the overuse of LS MRI, but it underestimates the true extent of inappropriate ordering.
authors.affiliation: Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.
authors.forename: Tigran
authors.initials: T
authors.lastname: Avoundjian
authors.affiliation: Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Centers for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California; Division of General Medical Disciplines, Stanford University, Stanford, California.
authors.forename: Risha
authors.initials: R
authors.lastname: Gidwani
authors.affiliation: Radiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
authors.forename: Dorcas
authors.initials: D
authors.lastname: Yao
authors.affiliation: Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.
authors.forename: Jeanie
authors.initials: J
authors.lastname: Lo
authors.affiliation: Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sinnott
authors.affiliation: Radiology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
authors.forename: Neil
authors.initials: N
authors.lastname: Thakur
authors.affiliation: Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Centers for Health Policy/Primary Care and Outcomes Research, Stanford University, Stanford, California; Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Electronic address: paul.barnett@va.gov.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Barnett
mesh_terms: D000067575:Administrative Claims, Healthcare / Q000145:classification / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014600:Utilization Review / Q000379:methods*; D014728:Veterans / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Low back pain; chart review; claims data; magnetic resonance imaging; quality assessment