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Am J Med. 2013 Aug;126(8):687-92. doi: 10.1016/j.amjmed.2012.11.034. Epub 2013 Jun 17.

Impact of provider-led, technology-enabled radiology management program on imaging.

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Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02445, USA.



The study objective was to assess the impact of a provider-led, technology-enabled radiology medical management program on high-cost imaging use.


This study was performed in the ambulatory setting of an integrated healthcare system. After negotiating a risk contract with a major commercial payer, we created a physician-led radiology medical management program to help address potentially inappropriate high-cost imaging use. The radiology medical management program was enabled by a computerized physician order entry system with integrated clinical decision support and accountability tools, including (1) mandatory peer-to-peer consultation with radiologists before order completion when test utility was uncertain on the basis of order requisition; (2) quarterly practice pattern variation reports to providers; and (3) academic detailing for targeted outliers. The primary outcome measure was intensity of high-cost imaging, defined as the number of outpatient computed tomography (CT), magnetic resonance imaging (MRI), and nuclear cardiology studies per 1000 patient-months in the payer's panel. Chi-square test was used to assess trends.


In 1.8 million patient-months from January 2004 to December 2009, 50,336 eligible studies were performed (54.1% CT, 40.3% MRI, 5.6% nuclear cardiology). There was a 12.0% sustained reduction in high-cost imaging intensity over the 5-year period (P < .001). The number of CT studies performed decreased from 17.5 per 1000 patient-months to 14.5 (P < .01); nuclear cardiology examinations decreased from 2.4 to 1.4 (P < .01) per 1000 patient-months. The MRI rate remained unchanged at 11 studies per 1000 patient-months.


A provider-led radiology medical management program enabled through health information technology and accountability tools may produce a significant reduction in high-cost imaging use.


Health information technology; Health policy; Imaging use

[Indexed for MEDLINE]

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