6 success factors for reducing low-value medical imaging

There are six potential success factors that health systems should keep in mind when working to reduce low-value medical imaging, according to new research published Wednesday.

Healthcare overuse is common problem, with radiology services one potential target. Norway has worked to address unnecessary imaging in its public healthcare system, sharing lessons learned in the journal Current Problems in Diagnostic Radiology. Interventions to curtail inappropriate imaging use are “rarely successful,” but experts believe they’ve found some answers.

“Every intervention to reduce low-value imaging is special, but general lessons can be learned from specific implementations,” Bjørn Hofmann with the Centre for Medical Ethics at the University of Oslo, Norway, and co-authors wrote Aug. 14. “This study from Norway provides valuable insights for future projects to improve the quality, safety, and efficiency of care by reducing low-value imaging.”

For the study, Hofmann and colleagues analyzed international literature, gathered national data related to outpatient imaging, and conducted interviews with stakeholders. They also used meeting agendas, notes, and reports from an expert group and advisory board to compile the study. The review provided a list of about 90 low-value imaging procedures, with a focus on three specific examinations. Those included MRIs for lower-back pain without red flags, uncomplicated headache, and anterior lateral knee pain without mechanical symptoms or effusion.

Norwegian imaging experts reviewed potential interventions to cut use of these three exams, among them, clinical decision support, hand-outs, financial incentives, education, and guidelines. They further conducted interviews with key stakeholders to pinpoint which interventions would work best in Norway.

“The selected imaging procedures were provided in high volumes by private imaging providers,” the authors noted. “Given the time constraint of 3 years a multi-component intervention directed at both imaging staff assessing referrals and practitioners referring the three selected examinations was developed in close cooperation with the medical directors of two private imaging providers.”

The intervention consisted of four components—a standard procedure for returning inappropriate imaging referrals, a letter template to address these referrals, information to the public about why these scans are low-value, and further data for general practitioners and their patients.

Norway implemented these interventions in a local catchment area as a pilot study from May to October 2022. It later spread to the rest of the country, lasting until the end of June 2023. Hofmann and co-authors plan to offer details on how much they were able to reduce low-value imaging in a future study. However, they did offer six lessons learned from the project so far:

1. “Acknowledge complexity: Managing complexity through advanced knowledge synthesis, competence of the context, and broad and strong stakeholder involvement is crucial.
2. Clear consensus-based criteria for selecting low-value imaging procedures are key.
3. Having a clear target group is important.
4. Stakeholder engagement is crucial to ascertain intervention relevance and compliance.
5. Active and well-motivated intervention collaborators is a necessary but not sufficient condition.
6. It is crucial to pay close attention to the mechanisms of low-value imaging and the barriers to reduce it.”

“Clearly, we do not claim that the success factors identified in the Norwegian context can be transferred to all healthcare systems,” the authors wrote. “In particular, they are less relevant for corporatized and privatized healthcare systems, such as the USA. However, they are in line with crucial insights in implementation science and demonstrate how they play out in an imaging context. Therefore, we hope that the lessons learned in Norway can be valuable well beyond this specific setting.”

Read more in CPDR at the link below.