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Evaluation of Policy to Require the Use of Evidence-Based Guidelines for Advanced Imaging (MRI) Utilization for Workers’ Compensation Claimants with Low Back Pain Coalition

University of Washington – $23,003

This research evaluates change in healthcare utilization associated with a 2011 Washington State policy change requiring the use of evidence-based guidelines for advanced imaging following acute low back pain.

Abstract

Background: The Washington Legislature passed a new law in 2009 (ESHB 2105/Chapter 258, Laws of 2009), which required an Advanced Imaging Management Work Group to identify evidence-based best practice guidelines for advanced imaging. State agencies, such as the Department of Labor and Industries (DLI), were directed to implement evidence-based checklists for high-cost, high-use imaging studies, as recommended by the Work Group. On June 1, 2010, DLI implemented these evidence-based guidelines, whereby prior authorization is required for all Washington State Workers’ Compensation (WC) State Fund claims involving MRI scans of the spine and upper and lower extremities, and CT and MRI scans for headache.

The evaluation of this policy will assess factors such as changes in service patterns, disability, and cost outcomes. Prior to June 1, 2010, providers treating WC claimants were not required to follow specific guidelines or send referrals for review prior to treatment. Instituting the requirement of guideline adherence and prior authorization may have resulted in a reduction in the unnecessary use of MRI for low back pain (LBP), which is a common and costly advanced imaging procedure for WC claimants (lumbar MRI).The purpose of this research is to evaluate the change in utilization by considering trends in MRI use for LBP from January 2006 through June 2014. This research will assess potentially associated changes in the utilization of other health care services, such as office visits, prescriptions of narcotics for pain, and lumbar surgeries.

Deliverables: In this subcontract, a background literature search, data analysis, presentation of results to the Occupational Epidemiology and Health Outcomes program, and a final report will be completed.

Primary Investigators

Janessa Graves
Janessa Graves, PhD