Referral quality and justification rate in MRI for the lower back: evaluation of an intervention to reduce imaging og low value

BackgroundLower back magnetic resonance imaging (MRI) is a common imaging procedure; however, it often has low value in patients with uncomplicated back pain. Measures to reduce low-value procedures are necessary for a sustainable imaging service.PurposeTo evaluate the outcomes of the national intervention implemented in imaging centers by assessing referral quality and justification rate of lower back MRI in private imaging centers in Norway.Material and MethodsThis study used a before-after design to assess referrals retrospectively for justification and information quality to evaluate the intervention's effect. Four radiologists and four radiographers, all experienced in the field, assessed 360 referrals, half from before and half after the intervention. Descriptive, comparative, and Kappa statistics were used to analyze the data.ResultsThe rate of justified referrals increased from 60% to 65% when comparing before and after the implementation. The rate of unjustified referrals was reduced from 24% before to 19% after. The rate of referrals that lacked information was unchanged. Further, referral quality slightly increased after the intervention; still, 88% of the referrals were considered low quality. Radiologists were stricter in their assessment of referrals compared to radiographers. The interrater agreement was moderate in justification assessment and very good in referral quality assessment.ConclusionThe intervention slightly improved referral quality and justification rate. However, with a 20% unjustified rate after the intervention, further measures are needed to increase service quality and reduce wait times.