A Pragmatic Trial of Lumbar Image Reporting with Epidemiology (LIRE)

下背痛是医学研究所进行比较有效性研究的优先条件， 对公众健康至关重要。这是医生就诊的最常见原因之一， 功能限制和残疾的重要原因。成像经常作为 诊断评估，是一个重要的贡献者，背部疼痛护理的成本，其中总额超过 2005年为860亿美元。众所周知，即使没有背痛， 腰椎经常显示的结果，如椎间盘干燥或隆起。患者及其提供者 可能会把这些发现（通常与年龄有关）的重要性归因于它们，因为 他们没有一个适当的参考框架来解释调查结果。这些 附带 这些发现可能引发一系列事件，甚至可能导致手术，而不会改善患者的病情。 结果。 我们提出了一个实用的，随机对照试验（RCT），以确定的有效性， 在影像学报告中插入流行病学基准，以减少后续检查和治疗。 我们的基本原理是，为医生和患者提供一个更好地解释成像结果的背景 可以减少对偶然发现的担忧，减少不必要的进一步诊断测试， 治疗。我们的干预措施简单、廉价、易于部署。我们提出了一种高效，新颖， 群集随机化设计，称为 阶梯楔 设计，允许纵向比较 同时控制时间趋势。正如申请书中所要求的，我们计划被动地 收集干预前和干预后医疗保健利用的主要结局指标， 在我们的参与研究中心提供电子病历。我们假设，对于初级保健的患者， 提供者，在腰椎成像报告中插入流行病学基准将减少 随后的诊断和治疗干预，包括MR和CT，阿片类药物处方， 脊柱注射和手术。基本原理是流行病学数据可以为这两种情况提供背景 医生和患者更好地解释成像结果。长期公共卫生意义重大。 这种简单、廉价的干预不仅可以大大减少不必要的和昂贵的护理， 背痛;这种干预可以很容易地推广到所有的诊断测试，并可能成为 沟通诊断信息的主要范例。

Low back pain, an Institute of Medicine priority condition for comparative effectiveness research, is of major public health importance. It is one of the most common reasons for physician visits and an important cause of functional limitation and disability. Imaging is frequently performed as part of the diagnostic evaluation and is an important contributor to the cost of back pain care, which totaled more than $86 billion in 2005. It is well known that, even without back pain, magnetic resonance (MR) imaging of the lumbar spine frequently reveals findings such as disc desiccation or bulging. Patients and their providers may attribute greater importance to these findings, which are often age-related, than they should, because they do not have an appropriate frame of reference in which to interpret the findings. These incidental findings may initiate a cascade of events leading possibly even to surgery, without improving patient outcomes. We propose a pragmatic, randomized controlled trial (RCT) to determine the effectiveness of inserting epidemiological benchmarks into imaging reports at reducing subsequent tests and treatments. Our rationale is that providing a context for both physicians and patients to better interpret imaging findings may reduce concern about incidental findings and reduce unnecessary further diagnostic tests and treatments. Our intervention is simple, inexpensive and easy to deploy. We propose an efficient, novel, cluster randomized design referred to as a stepped wedge design, permitting longitudinal comparisons while controlling for temporal trends. As called for in the Request for Applications, we plan to passively collect primary outcome measures of healthcare utilization both pre- and post-intervention, using robust electronic medical records at our participating sites. We hypothesize that for patients of primary care providers, inserting epidemiological benchmarks in lumbar spine imaging reports will reduce subsequent diagnostic and therapeutic interventions, including MR and CT, opioid prescriptions, spinal injections and surgery. The rationale is that the epidemiologic data may provide a context for both physicians and patients to better interpret imaging findings. The long-term public health significance is high. Not only may this simple, inexpensive intervention substantially reduce unnecessary and expensive care for back pain; thee intervention can easily be generalized to all diagnostic tests, and could become the dominant paradigm for communicating diagnostic information.