Rapidity and Modality of Imaging for Acute Low Back Pain in Elderly Patients

In this study, researchers found that almost one in three elderly Medicare patients received imaging service within a month of low-back pain diagnosis despite well-established guidelines stating patients with low-back pain do not require imaging until after a month of therapy.

While most quality measures focus on underuse of services, few focus on overuse of services, which can lead to exposure to potential procedural harm and waste of health care resources. This article investigates associations between patient and primary care physician characteristics and the rapidity and modality of imaging for acute low-back pain in elderly patients. The study of low-back pain patients provides researchers with an opportunity to more carefully assess how these patient and primary care physician characteristics influence potential overuse.

Researchers examined claims data for Medicare fee-for-service beneficiaries treated by physicians responding to either the 2000–2001 or 2004–2005 Community Tracking Study—a group of 35,039 patients. Ordered logit models assessed the associations. The data showed that 28.8 percent of beneficiaries with low-back pain underwent imaging within 28 days of diagnoses. Of those patients, 88.2 percent received radiography and 11.8 percent received CT/MRI.

Medicaid patients received slower or less advanced imaging compared to other patients. White patients were more likely to receive CT/MRI or rapid imaging than minority patients. Incentives, including satisfaction measures, resulted in both more rapid and advanced imaging; clinical quality-based incentives were associated with less advanced imaging.