Speakers
Jeffrey (Jerry) G. Jarvik MD MPH
Professor, Radiology, Neurological Surgery and Health Services
Adjunct Professor, Pharmacy and Orthopedics & Sports Medicine
University of Washington
Patrick Heagerty, PhD
Professor and Chair
Department of Biostatistics
University of Washington
Topic
Lumbar Imaging with Reporting of Epidemiology: Initial Results and Some Lessons Learned
Keywords
Embedded pragmatic clinical trials; Radiology imaging; LIRE; Stepped-wedge; Cluster randomization; Epidemiology; Back pain
Key Points
- The LIRE NIH Collaboratory Trial evaluated whether prevalence benchmark data inserted into lumbar spine imaging reports would reduce overall spine-related healthcare utilization for patients referred from primary care.
- The inserted intervention text urges caution when interpreting the presence of certain findings that are common in normal, pain-free volunteers.
- While the study team found no decrease in spine-related healthcare utilization for the overall cohort, there was a small but potentially important effect on reducing opioid prescriptions.
Discussion Themes
A characteristic of stepped-wedge study design is that it yields two comparisons: between-group comparisons (clinic A vs clinic B) and within-group comparisons. But temporal trends can have an impact and must be adjusted for in the analysis.
For what type of intervention would a stepped-wedge design be suitable?
The hope is for a wider dissemination about interventions where radiologic testing is done and incidental findings are common.
Read more about the LIRE NIH Collaboratory Trial.
Tags
#pctGR, #PragmaticTrials, @Collaboratory1