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Diagnostic imaging (DI) tests (for example, x-ray tests, ultrasounds, CT scans, or MRIs) are used by health care providers to help diagnose patient illness, but decisions regarding when these tests should be ordered are subjective. As a result, some physicians order these tests more than others. Ordering rates between clinicians seeing similar kinds of patients have been shown to be considerably different, suggesting that many of the tests are unnecessary. DI currently accounts for about 6.6% of Canadian hospital budgets, but this percentage may be much higher in Newfoundland where test ordering rates are almost twice the national average. However, cost is not the only concern. Over-testing can lead to further unnecessary testing to follow-up on harmless findings, and in the case of CT, large doses of potentially harmful radiation. The purpose of this study is to assess DI test-ordering by family physicians across the Eastern Health region, and compare these test ordering rates with those from other jurisdictions. We suspect that many clinicians are not aware that they order more DI tests than their peers. We will therefore develop a "report card" for family physicians in the province that shows them how many tests they are ordering compared to other physicians in the region. We expect that physicians who are over-ordering DI tests will reduce the number of tests they order after receiving their report cards. This is a low-cost way to potentially prevent expensive over-ordering of DI tests that can easily be implemented in the province's other health regions and elsewhere.
The purpose of this trial is to determine if a "report card" for family physicians in the province that shows them how many tests they are ordering compared to other physicians in the region will result in reducing test ordering rates. Family physicians and general practitioners will be stratified (grouped) by community of practice within Eastern Health, then randomized into an intervention "report card" group or into a usual practice "no report card" group. Communities with fewer than five physicians will be grouped with similar communities for stratified randomization purposes. Physicians in the intervention group will be provided a semi-annual (every 6 months) report card outlining the number of CT scans, ultrasounds and plain x-rays they ordered on the patients for whom they were the primary provider. We will assume that the primary provider is the most frequent biller of primary care services. Intervention participants will receive a link to the report card via email from the Newfoundland and Labrador Medical Association (NLMA) by a two-step process: The initial email gives a brief description of the report and contains a link which then redirects the clinician to a secure web page that displays the individual clinician diagnostic imaging utilization in a prior six month period compared to the aggregate of their peers in the same region.
Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Single Blind (Subject), Primary Purpose: Health Services Research
Diagnostic Imaging Utilization
Diagnostic imaging utilization for a prior six-month period
Not yet recruiting
Memorial University of Newfoundland
Published on BioPortfolio: 2016-09-28T23:08:21-0400
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