UH3 Project: Lumbar Imaging with Reporting of Epidemiology (LIRE)

UH3 Project: Lumbar Imaging with Reporting of Epidemiology (LIRE)

 

Principal Investigator: Jeffrey Jarvik, MD, MPH

Sponsoring Institution: University of Washington

Collaborators:

  • Kaiser Permanente, Northern California

  • Kaiser Permanente Washington Health Research Institute

  • Mayo Clinic Health System

  • Henry Ford Health System

  • Oregon Health and Science University

NIH Institutes Providing Oversight:

Program Official: Chuck Washabaugh (NIAMS)

Project Scientist: Robin Boineau (NCCIH)

ClinicalTrials.gov Identifier: NCT02015455

Study Locations: Clinics in California, Michigan, Minnesota, Wisconsin, and Washington

Trial Status: Completed

Low back pain is an Institute of Medicine priority condition for comparative effectiveness research and 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.

LIRE is a large pragmatic, cluster-randomized controlled trial testing the effectiveness of a simple and inexpensive intervention: inserting epidemiologic benchmarks into lumbar spine imaging reports. The goal of the trial is to reduce subsequent tests and treatments, including cross-sectional imaging (such as magnetic resonance and computed tomography), opioid prescriptions, spinal injections, or surgery. The LIRE trial has the potential to demonstrate the feasibility of randomly assigning clinics within large health systems to receive a clinical decision support-type intervention as well as the feasibility of passively collecting outcomes data up to 2 years after enrollment using the robust electronic medical record systems available at each health system.

NIH Project Information

Presentation

5/1/2019: Presentation to NIH Collaboratory Steering Committee (slides)

Interviews

6/8/2015: Interview with principal investigator Dr. Jerry Jarvik and Dr. Eric Larson (video)

4/20/2015: Interview with principal investigator Dr. Jerry Jarvik (PDF)

4/10/2014: Interview with principal investigator Dr. Jerry Jarvik (video)

Supplementary Material

Phenotype Case Study: LIRE

Regulatory and Ethics Support Documentation

Implementation Pilot Test Plan

Publications

Comparison of natural language processing rules-based and machine-learning systems to identify lumbar spine imaging findings related to low back pain. Acad Radiol. 2018;25(11):1422-1432.

Using natural language processing of free-text radiology reports to identify type 1 Modic endplate changes. J Digit Imaging. 2018;31(1):84-90.

Lumbar Imaging With Reporting Of Epidemiology (LIRE)--protocol for a pragmatic cluster randomized trial. Contemp Clin Trials. 2015;45(Pt B):157-163.

Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.

Presentations

5/1/2019: Presentation to NIH Collaboratory Steering Committee (slides)

5/14/2018: Presentation to NIH Collaboratory Steering Committee (slides)

1/26/2018: PCT Grand Rounds: "The Lumbar Imaging with Reporting of Epidemiology (LIRE) Trial: Subsequent Cross-Sectional Imaging Through 90 Days—Preliminary Results" (videoslides)

5/23/2017: Presentation on Top Barriers/Challenges and Recent Generalizable Lessons Learned to NIH Collaboratory Steering Committee (slides)

11/18/16: PCT Grand Rounds: "Lumbar Imaging with Reporting of Epidemiology (LIRE): The Beginning of the End (or The End of the Beginning?)" (video; slides)

5/9/2016: Presentation on Data Governance and Data Sharing to NIH Collaboratory Steering Committee (slides)

5/9/2016: Presentation on Generalizable Lessons Learned to NIH Collaboratory Steering Committee (slides)

11/6/2015: PCT Grand Rounds: "Lumbar Imaging with Reporting of Epidemiology (LIRE): Lessons Learned" (video; slides)

4/21/2015: Presentation to NIH Collaboratory Steering Committee (slides)

10/10/2014: PCT Grand Rounds (video; slides)

2/24/2014: Presentation on Data Sharing to NIH Collaboratory Steering Committee (slides)

7/19/2013: PCT Grand Rounds: "Back Pain Outcomes Using Longitudinal Data (BOLD)—Lessons for LIRE and Other Pragmatic Trials" (video; slides)

1/25/2013: PCT Grand Rounds: "Lumbar Imaging with Reporting of Epidemiology (LIRE)" (video; slides)

 

 

 

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Citation:

Demonstration Projects: UH3 Project: Lumbar Imaging with Reporting of Epidemiology (LIRE). In: Rethinking Clinical Trials: A Living Textbook of Pragmatic Clinical Trials. Bethesda, MD: NIH Health Care Systems Research Collaboratory. Available at: https://rethinkingclinicaltrials.org/demonstration-projects/uh3-project-lumbar-imaging-with-reporting-of-epidemiology-lire/. Updated January 10, 2020.