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Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging
Author(s) -
Kanzaria Hemal K.,
Hoffman Jerome R.,
Probst Marc A.,
Caloyeras John P.,
Berry Sandra H.,
Brook Robert H.
Publication year - 2015
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.12625
Subject(s) - medicine , descriptive statistics , family medicine , malpractice , health care , focus group , medical imaging , emergency department , diagnostic test , medical emergency , medical physics , emergency medicine , radiology , nursing , statistics , business , mathematics , marketing , political science , law , economics , economic growth
Objectives The objective was to determine emergency physician ( EP ) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice. Methods As part of a larger study to engage physicians in the delivery of high‐value health care, two multispecialty focus groups were conducted to explore the topic of decision‐making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot‐tested and refined for emergency medicine ( EM ) to focus on advanced diagnostic imaging (i.e., computed tomography [ CT ] or magnetic resonance imaging [ MRI ]). The survey was then administered to a national, purposive sample of EP s and EM trainees. Simple descriptive statistics to summarize physician responses are presented. Results In this study, 478 EP s were approached, of whom 435 (91%) completed the survey; 68% of respondents were board‐certified, and roughly half worked in academic emergency departments ( ED s). Over 85% of respondents believe too many diagnostic tests are ordered in their own ED s, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low‐probability diagnosis and fear of litigation. Solutions most commonly felt to be “extremely” or “very” helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision‐making (56%), feedback to physicians on test‐ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Conclusions Overordering of advanced imaging may be a systemic problem, as many EP s believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high‐yield solutions that must be addressed simultaneously to curb overimaging.