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

下腰痛，医学研究所比较有效性研究的优先条件，是 对公共卫生具有重大意义。这是就诊的最常见原因之一，也是 导致功能受限和残疾的重要原因。成像通常作为 诊断性评估，是背痛护理费用的重要贡献者，背痛护理费用总计超过 2005年为860亿美元。众所周知，即使没有背部疼痛，磁共振(MR)成像 腰椎经常表现为椎间盘干燥或鼓起。患者和他们的提供者 可能会对这些发现给予更多的重视，这些发现往往与年龄有关，因为 他们没有一个适当的参照系来解释调查结果。这些都是偶然的 这些发现可能会引发一连串的事件，甚至可能导致手术，而不会改善患者的病情 结果。 我们提出了一项务实的随机对照试验(RCT)来确定 在影像报告中插入流行病学基准，以减少后续检查和治疗。 我们的理由是为医生和患者提供一个更好地解释成像结果的背景 可能会减少对偶然发现的担忧，并减少不必要的进一步诊断测试和 治疗。我们的干预措施简单、廉价且易于部署。我们提出了一种高效、新颖、 集群随机设计，称为阶梯式楔形设计，允许纵向比较 同时控制时间趋势。根据申请请求中的要求，我们计划被动地 使用Robust收集干预前和干预后的医疗保健利用的主要结果衡量标准 在我们的参与网站上提供电子病历。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，包括磁共振和CT，阿片类药物处方， 脊椎注射和手术。其基本原理是，流行病学数据可能会为两者提供一个背景 医生和患者更好地解释成像结果。长期的公共卫生意义是很高的。 这种简单、廉价的干预不仅可以大大减少不必要和昂贵的护理 背部疼痛；这种干预可以很容易地推广到所有诊断测试，并可能成为 交流诊断信息的主导模式。

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.