Session Information
Date: Sunday, November 8, 2015
Title: Education
Session Type: ACR Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose:
The US Department of Veterans Affairs (VA) has developed a national continuing professional development program to train primary care providers (PCPs) in the evaluation and management of patients with common musculoskeletal (MSK) conditions. Although the initial phase of this project emphasized the development of providers’ proficiency to perform joint injections, the appropriate use of advanced imaging technology (e.g., magnetic resonance imaging (MRI)) in evaluating knee pain is an important additional objective of this national educational initiative. The aim of this study was to investigate the impact of this educational program on providers’ utilization of MRI in the evaluation of knee pain.
Methods:
Twenty-six PCPs from the Salt Lake City VA Health Care System participated in the MSK “Mini-Residency between April 2012 and October 2014. All orders for knee MRIs submitted by these providers over the 12-months prior to their participation in the mini-residency (pre-training) were reviewed, as well as all orders submitted over the 12-months following their participation (post-training). MRIs were categorized as follows:
“Inappropriate”: No prior weight-bearing x-rays done within the preceding 12 months
“Probably inappropriate”: Findings of OA described on x-ray report
“Possibly appropriate”: No findings of OA described on x-ray report
The number of MRIs in each category was recorded for the pre-training and post-training period specific to each provider, and the number of MRIs in each category was tallied. Differences in the numbers of MRIs that were ordered post-training as compared to pre-training for each of the three categories were evaluated using Student’s t-test (2—tailed).
Results:
|
|
Pre-training |
Post-training |
Change (n, % of change; p) |
|
Completed MRIs (n, % of total) |
114 (100%) |
62 (100%) |
-52 (-54.4%; p < 0.001) |
|
Inappropriate |
70 (61.4%) |
33 (53.2%) |
-37 (-47.1%; p = 0.03) |
|
Probably Inappropriate |
30 (26.3%) |
16 (25.8%) |
-14 (-53.3%; p = 0.03) |
|
Possibly Appropriate |
14 (12.3%) |
13 (21%) |
-1 (-7.1%; p = NS) |
Conclusion:
Following participation in the MSK Mini-Residency program, the overall number of MRI orders decreased by over 50%. The reduction in total number of MRIs is completely attributable to a decrease in orders that were categorized as either inappropriate or probably inappropriate. The number of MRIs that were categorized as possibly appropriate did not change. These findings suggest that the cost effectiveness of the MSK mini-residency program is even greater than earlier estimates, which did not consider cost savings due to more appropriate use of imaging.
To cite this abstract in AMA style:
Call M, Barker AM, Cannon GW, Lawrence P, Battistone MJ. Impact of a Musculoskeletal “Mini-Residency” Continuing Professional Education Program on Knee MRI Orders By Primary Care Providers [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/impact-of-a-musculoskeletal-aeoemini-residencyae%ef%bf%bd-continuing-professional-education-program-on-knee-mri-orders-by-primary-care-providers/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-a-musculoskeletal-aeoemini-residencyae%ef%bf%bd-continuing-professional-education-program-on-knee-mri-orders-by-primary-care-providers/