Including prevalence information about features on lumbar spine images did not affect subsequent health care use but did reduce likelihood of opioid prescription.
Why this matters
The authors argue that this intervention of benchmarking imaging results is simple, inexpensive, and easily implemented and that it may have relevance for other imaging and genetic tests.
- Objective: to evaluate the effect of benchmarking with prevalence data from people without pain as part of routine spinal imaging for back pain on subsequent health care utilization.
- People whose physician had ordered lumbar spinal imaging were randomized to a control group (n=117,455; 57.8% were women) or an intervention group (n=121,431; 57.2% were women).
- The imaging reports for the intervention group included age- and modality-appropriate benchmarks for common findings based on prevalence.
- The primary endpoint was health care use relating to the spine within a year of imaging.
- There was no difference between the control and intervention groups for the primary endpoint of health care use (difference -0.7%, 95% confidence interval [CI] -2.9–1.5%; P=0.54).
- There was a small decrease in the secondary endpoint of likelihood of opioid prescription within a year of imaging (odds ratio 0.95; 95% CI 0.91–1.00; P=0.04).
- The authors concluded that benchmark prevalence information as part of spine imaging reports did not decrease spine-related health care use but did reduce opioid prescriptions.
- Opioid prescribing decreased generally during the course of the study – despite accounting for this in modelling, it remains a potential confound.
- No data collected on functional status, pain, or psychosocial functioning.
- Generalizability of results to healthcare systems with more restrictions on imaging and for-profit hospitals not known.