Retrospective Chart Review: Analyzing unnecessary imaging for Low Back Pain in Nebraska

Background: Excessive amounts of money in healthcare are wasted due to duplicated or unnecessary health screenings. For example, an estimated four million dollars was spent on wasteful or likely wasteful imaging for low back pain, a commonly treated condition within healthcare. 2 Research shows that two-thirds of people will present with low back pain at some point throughout their lifetime, but 20-50% of high-tech imaging procedures fail to provide information that improves the patient’s condition, representing unnecessary services. 1

Purpose: The purpose of this study was to evaluate the existence of redundant healthcare expenditures on imaging for low back pain throughout healthcare systems in Nebraska. 

Methods: This study was a retrospective chart review of de-identified healthcare records focused on procedures related to imaging for low back pain extracted from Nebraska Health Information Exchange managed by the Nebraska Health Information Initiative (NeHII). The sample included 937 deidentified patients with a diagnosis of low back pain who received imaging in the state of Nebraska and whose health record was recorded in the Nebraska Health Information Exchange. To determine redundancy, records were categorized in three areas including necessary imaging, likely wasteful imaging, or wasteful imaging based on the criteria from the “First, Do No Harm” study conducted by the Washington Health Alliance. 

Results: Results revealed a total of 51% of low back pain imaging was considered wasteful, 35% likely wasteful, and 14% necessary. 

Conclusion: Based on these results, further research is warranted to determine specific demographics related to necessary, likely wasteful, and wasteful imaging and the purpose for performing these expensive imaging procedures. The findings also support research regarding incongruencies that exists in the healthcare system as it relates to expenditure.  

Reflections: Results from this research inform healthcare policy to address reimbursement and make necessary changes that would improve cost savings through the involvement of EHRs and health information exchanges (HIE). The Quadruple Aim guides healthcare to improve patient and clinical experience, create better outcomes, and lower costs. Interprofessional collaboration between healthcare professionals and use of HIEs could decrease unnecessary procedures, which would lead to better care and better value for our patients while saving costs. Health care teams would have access to a more holistic view of patients with EHRs in place, allowing them to provide care that addresses all the patient’s needs.

References upon request.