Background & Objective
Improving imaging appropriateness requires a strategic plan that includes collaboration across specialties, educational campaigns, clinical decision support for point of care guidance, and provider feedback reports. At the core of these initiatives are the ACR Appropriateness Criteria® (AC), evidence-based guidelines that indicate the relative utility of various imaging tests for more than 1,080 clinical indications. Evidence shows that education about ACR AC® reduces utilization and costs.
However, formal training in appropriate imaging ordering practices in both undergraduate and graduate medical education is lacking, with reports that only 10-20% of medical students are aware of ACR AC®. Furthermore, attending level providers who order imaging examinations have not fully embraced this resource. Radiologists are best equipped to educate providers about best practice for selecting the most appropriate imaging. Accordingly, we created a targeted educational program to educate providers about imaging appropriateness
A Google forms survey was sent to all ordering providers at a single large academic institution. The primary question allowed providers to select (multiple) from 30 of the most common clinical indications for imaging. Additional queries included the participant’s specialty/subspecialty and whether he or she would you attend a continuing medical education (CME) course on these topics. Results were tabulated automatically by Google and exported for further analysis in Microsoft Excel. The IRB of our institution acknowledged this as exempt and approved publication as a quality improvement initiative.
A total of 51 ordering providers completed the survey with 246 responses for clinical indications that providers considered a need for imaging guidance. Most (47/51) of those who responded also indicated their specialty: internal medicine physicians (21/47; 45%), 13% family medicine, 11% pediatrics, 11% surgery or surgical subspecialty, 9% OB-GYN physicians, 4% cardiology, 2% gastroenterology, and 6% other. Nearly half (45%) were interested in attending a CME course on radiology appropriateness. The top clinical indications where guidance would be most valued were abdominal pain, incidental findings, headache, low back pain, Nuclear Medicine: When & Why, TIA, coronary artery screening, flank pain, indeterminate kidney or liver lesion, breast imaging and pelvic pain.
Pursuant to the results, a CME course was designed for non-radiology faculty, delivered by subspecialty trained faculty in our radiology department. The program Is approved to deliver both AMA PRA Category 1 CreditsTM and ABIM MOC Credits. In 2017, 80 providers attended; evaluations revealed that 96% rated the program as excellent (72%) or very good (24%). Strengths included wide variety of topics, speaker knowledge, practical review, focus on appropriate use, short presentations, great speakers and radiology specialist lecturers.
For the 2018 conference, >200 have registered to participate and the program has been expanded to include high value ordering and prescribing for hospital medicine (Figure). Additionally, we have posted the lectures from the preceding year online as a free educational resource, at orderwisely.org/free-online-le....
To ensure that ACR standards for quality and safety are maintained while imaging exams are targeted for reduction, high value imaging needs to be defined and directed by radiologists. Dedicated CME courses on imaging appropriateness led by radiologists to educate providers about appropriate exam selection are integral to improving quality and safety of patient care and reducing unnecessary imaging.
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