UH3 Project: Lumbar Imaging with Reporting of Epidemiology (LIRE)
Overview
Principal Investigator:
Sponsoring Institution: University of Washington
Collaborators:
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Kaiser Permanente, Northern California
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Kaiser Permanente Washington Health Research Institute
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Mayo Clinic Health System
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Henry Ford Health System
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Oregon Health and Science University
NIH Institutes Providing Oversight: National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and National Center for Complementary and Integrative Health (NCCIH)
Program Official: Chuck Washabaugh, PhD (NIAMS)
Project Scientist: Robin Boineau, MD, MA (NCCIH)
ClinicalTrials.gov Identifier: NCT02015455
Study Locations: Clinics in California, Michigan, Minnesota, Wisconsin, and Washington
Trial Status: Completed
Trial Summary
Study question and significance: Spine imaging often has incidental findings that can lead to unnecessary tests and treatments. Prior observational research suggested that placing information about the prevalence of common findings in spine imaging reports may help reassure physicians and patients about such findings and reduce subsequent, unnecessary healthcare interventions. The objective of LIRE was to evaluate the impact of including benchmark prevalence data in routine spinal imaging reports on subsequent spine-related healthcare utilization and opioid prescriptions.
Design and setting: Stepped-wedge, cluster randomized trial with 250,401 participants receiving care in 98 primary care clinics in 4 large healthcare systems between October 2013 and September 2016.
Intervention and methods: The control group had standard lumbar spine imaging reports, and the intervention group had reports with age-appropriate prevalence data for common imaging findings in individuals without back pain. The main outcome was healthcare utilization as measured in spine-related relative value units (RVUs) within 365 days of index imaging. A secondary outcome was the number of subsequent opioid prescriptions written by a primary care clinician. Prespecified subgroup analyses examined results by imaging modality.
Findings: The intervention did not reduce spine-related healthcare utilization. In prespecified secondary analyses, the intervention slightly reduced subsequent opioid prescriptions, and patients for whom computed tomography was the imaging modality had lower spine-related healthcare utilization.
Conclusions and relevance: Inserting benchmark prevalence information in lumbar spine imaging reports did not decrease subsequent spine-related RVUs but did reduce subsequent opioid prescriptions. The intervention text was simple, inexpensive, and easily implemented.
Data and Resource Sharing
- LIRE Computable Phenotypes
LIRE Computable Phenotypes
- LIRE Public Use Dataset and Data Dictionary
LIRE Public Use Dataset and Data Dictionary
- LIRE-PilotTestPlan
LIRE Implementation Pilot Test Plan (Final)
- LIRE_Jarvik_UH3 follow-up
LIRE ethics and regulatory documentation - UH3 project updates
- JerryJarvik-PragmaticTrialLumbarImageReportingEpidemiology-LIRE
Minutes from Ethics/Regulatory Call - A Pragmatic Trial of Lumbar Image Reporting with Epidemiology (LIRE)
Featured Interviews
Drs. Jarvik and Heagerty discuss initial results from the Lumbar Imaging with Reporting of Epidemiology (LIRE) NIH Collaboratory Trial.
News and Interviews
- News_Your Pragmatic Trial Has Ended Now What
January 22, 2024: Your Pragmatic Trial Has Ended. Now What?
- News_A Year of New Insights From the NIH Pragmatic Trials Collaboratory
December 12, 2023: A Year of New Insights From the NIH Pragmatic Trials Collaboratory
- News_Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
December 13, 2022: In Our Tenth Year, a Wealth of New Insights From the NIH Pragmatic Trials Collaboratory
- News_A Year of New Insights From the NIH Collaboratory
December 14, 2021: A Year of New Insights From the NIH Collaboratory
- News_A Year of Results and New Insights From the NIH Collaboratory
December 15, 2020: A Year of Results and New Insights From the NIH Collaboratory
- Pilot and Feasibility Testing - The LIRE Example
Pilot and Feasibility Testing: The LIRE Example (Living Textbook Video Module)
- News_LIRE Trial Finds No Change in Healthcare Utilization, Small Drop in Opioid Prescriptions
September 8, 2020: LIRE Trial Finds No Change in Healthcare Utilization, Small Drop in Opioid Prescriptions
- News_Applying PRECIS Ratings to Collaboratory Pragmatic Trials
January 16, 2016: Applying PRECIS Ratings to Collaboratory Pragmatic Trials
- News_PIs of Completed NIH Collaboratory Demonstration Projects Share Accomplishments
July 14, 2020: PIs of Completed NIH Collaboratory Trials Share Accomplishments
- News_ EHR Workshop Grand Rounds Series Continues With Experiences From the Collaboratory PCTs
May 27, 2020: EHR Workshop Grand Rounds Series Continues With Experiences From the Collaboratory PCTs
Publications
- Jujjavarapu et al BMC Med Inform Decis Mak 2023
Predicting decompression surgery by applying multimodal deep learning to patients' structured and unstructured health data
- Gold et al Osteoporos Int 2022
Osteoporosis identification among previously undiagnosed individuals with vertebral fractures
- Jujjavarapu et al Acad Radiol 2022
A comparison of natural language processing methods for the classification of lumbar spine imaging findings related to lower back pain
- Marcum et al J Gen Intern Med 2021
Effects of including epidemiologic data in lumbar spine imaging reports on prescribing non-opioid medications for pain
- Suri et al Pain Med 2021
Providing epidemiological data in lumbar spine imaging reports did not affect subsequent utilization of spine procedures: secondary outcomes from a stepped-wedge randomized controlled trial
- Brinjikji et al AJNR Am J Neuroradiol 2015
MRI findings of disc degeneration are more prevalent in adults with low back pain than in asymptomatic controls: a systematic review and meta-analysis
- Gold et al J Am Board Fam Med 2021
Patient, provider, and clinic characteristics associated with opioid and non-opioid pain prescriptions for patients receiving low back imaging in primary care
- Richesson et al J Am Med Inform Assoc 2021
Enhancing the use of EHR systems for pragmatic embedded research: lessons from the NIH Health Care Systems Research Collaboratory
- LIRE Study Snapshot
LIRE Study Snapshot
- Jarvik et al JAMA Netw Open 2020
LIRE Main Outcome Paper
- Living Textbook Chapter_Which PCTs Should Have a DMC
Living Textbook Chapter: Which PCTs Should Have a DMC?
- Living Textbook_The Embedded Pragmatic Trials Ecosystem
Living Textbook: The Embedded Pragmatic Clinical Trial Ecosystem
- Living Textbook Chapter_Monitoring Intervention and Fidelity Adaptions
Living Textbook Chapter: Monitoring Intervention and Fidelity Adaptions: Intervention Adaptation Strategies and Examples
- Living Textbook Chapter_Data Sharing and Embedded Research
Living Textbook Chapter: Data Sharing Solutions for Embedded Research
- Tan et al Acad Radiol 2018
Comparison of natural language processing rules-based and machine-learning systems to identify lumbar spine imaging findings related to low back pain
- Huhdanpaa et al J Digit Imaging 2018
Using natural language processing of free-text radiology reports to identify type 1 Modic endplate changes
- LIRE 2017-Snapshot
LIRE Study Snapshot
- Phenotype Case Study-LIRE
Phenotyping in Pragmatic Clinical Trials: LIRE Case Study
- Living Textbook Chapter_Stepped Wedge Designs
Living Textbook Chapter: Dissemination and Implementation: Stepped Wedge Designs
- Living Textbook Chapter_Non-disclosure of Research Activities
Living Textbook Chapter: Consent, Disclosure, and Non-disclosure: Non-disclosure of Research Activities
- Living Textbook Chapter_Randomization Methods
Living Textbook Chapter: Experimental Designs and Randomization Schemes: Randomization Methods
- Living Textbook Chapter_Assessing Feasibility
Living Textbook Chapter: Assessing Feasibility: Spotlight of Four NIH Collaboratory Trials
- Jarvik et al Contemp Clin Trials 2015
LIRE Study Design Paper
- Brinjikji et al AJNR Am J Neuroadiol 2015
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations
Presentations
- 2022 NIH Workshop_Panel 1
2022 NIH Workshop Panel 1 Presentation
- GR-Video-05-29-20
EHR Core Workshop: Experiences from the Collaboratory PCTs (GR Video 2020)
- GR-Slides-05-29-20
EHR Core Workshop: Experiences from the Collaboratory PCTs (GR Slides 2020)
- Presentations at the April 2020 SC Meeting
Presentations at the April 2020 SC Meeting
- GR-Video-11-08-19
Lumbar Imaging with Reporting of Epidemiology: Initial Results and Some Lessons Learned (GR Video 2019)
- GR-Slides-11-08-19
Lumbar Imaging with Reporting of Epidemiology: Initial Results and Some Lessons Learned (GR Slides 2019)
- SC-2019-Barriers-LIRE
Barriers and Challenges-Lire
- LIRE Collaboratory update Data Sharing 2016-05-9v2
LIRE Collaboratory update Data Sharing 2016-05-9v2
- Workshop Design and Analysis of PCT_Panel 3_Choosing a Parallel Group or Stepped-Wedge Design
Workshop Design and Analysis of PCT: Panel 3: Choosing a Parallel Group or Stepped-Wedge Design
- Poster_LIRE_AcaemyHealth_2018_2_c
A Natural Language Processing System to Identify Lumbar Spine Imaging Findings Related to Low Back Pain from Radiology Reports (AcademyHealth 2018)
- Presentation_LIRE_RSNA_2018_2_c
Osteoporosis Identification and Treatment among Previously Undiagnosed Patients With Vertebral Fractures (RSNA 2018)
- Presentation_LIRE_DCRI_2018_c
Please Call Them Lessons Learned and Not Screw-ups: LIRE, a Pragmatic Randomized Trial (DCRI 2018)
- Presentation_LIRE_AAMPR_2018_c
Accuracy of NLP for Identifying Spondyloarthropathy in Primary Care Patients Receiving Lumbar Spine Imaging (AAPM&R 2018)
- Poster_LIRE_AcaemyHealth_2018_c
Low Back Pain and Cancer: Are We Imaging in a Timely Manner? (AcademyHealth 2018)
- Presentation_LIRE_CERT_Webinar_2018_c
Designing the Scientific Approach (CERT 2018)
- Presentation_LIRE_CERT_2018_c
Study Design, Power Analysis and Sample Size (RSNA 2018)
- Presentation_LIRE_ASNR_2018_c
Low Back Pain and Cancer: Are We Imaging in a Timely Manner? (ASN 2018)
- 12.-Jarvik_LIRE-Collaboratory-Top-Barrier-and-Lesson-REVISED-2018-05
Lumbar Imaging with Reporting of Epidemiology (LIRE): Barriers/Lessons Learned
- Presentation_LIRE_AUR_2018_2_c
Different Study Designs - Pros and Cons (AUR 2018)
- Presentation_LIRE_AUR_2018_c
How Do I Get Funding to Get Started Doing CER? (AUR 2018)
- Presentation_LIRE_UTSW_2018_c
From Explanatory to PCTs: A New Era for Effectiveness Research (UTSW 2018)
- GR-Slides-1-26-18
The Lumbar Imaging with Reporting of Epidemiology (LIRE) Trial: Subsequent Cross-Sectional Imaging Through 90 Days—Preliminary Results (GR Slides 2018)
- GR-Video-01-26-18
The Lumbar Imaging with Reporting of Epidemiology (LIRE) Trial: Subsequent Cross-Sectional Imaging Through 90 Days—Preliminary Results (GR Video 2018)
- Presentation_LIRE_RSNA_2018_c
MRI for Low Back Pain: Comparative Effectiveness Research and PCTs (RSNA 2018)
- Presentation_LIRE_RSNA_2017_c
From Efficacy to Effectiveness: The PCT (RSNA 2017)
- Jarvik-SC-May-2017
Lumbar Imaging with Reporting of Epidemiology (LIRE): Top Barrier and Lesson Learned
- GR-Slides-11-18-16
Lumbar Imaging with Reporting of Epidemiology (LIRE): The Beginning of the End (or The End of the Beginning?) (GR Slides 2016)
- GR-Video-11-18-16
Lumbar Imaging with Reporting of Epidemiology (LIRE): The Beginning of the End (or The End of the Beginning?) (GR Video 2016)
- Presentation_LIRE_PMR_2018_c
Lumbar Spine Imaging: When to Order and What the Results Mean (2018)
- LIRE Collaboratory update Lessons Learned 2016-05-9v4
LIRE Collaboratory update Lessons Learned 2016-05-9v4