TY - JOUR
T1 - Effect of an Individualized Audit and Feedback Intervention on Rates of Musculoskeletal Diagnostic Imaging Requests by Australian General Practitioners: A Randomized Clinical Trial
AU - O'Connor, Denise A
AU - Glasziou, Paul
AU - Maher, Christopher G
AU - McCaffery, Kirsten J
AU - Schram, Dina
AU - Maguire, Brigit
AU - Ma, Robert
AU - Billot, Laurent
AU - Gorelik, Alexandra
AU - Traeger, Adrian C
AU - Albarqouni, Loai
AU - Checketts, Juliet
AU - Vyas, Parima
AU - Clark, Brett
AU - Buchbinder, Rachelle
N1 - Funding Information:
Author Contributions: Mss Maguire and Gorelik had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: O’Connor, Glasziou, Maher, McCaffery, Schram, Maguire, Billot, Traeger, Albarqouni, Checketts, Vyas, Buchbinder. Acquisition, analysis, or interpretation of data: O’Connor, Glasziou, Maher, Schram, Maguire, Ma, Billot, Gorelik, Traeger, Checketts, Vyas, Clark, Buchbinder. Drafting of the manuscript: O’Connor, Gorelik. Critical revision of the manuscript for important intellectual content: O’Connor, Glasziou, Maher, McCaffery, Schram, Maguire, Ma, Billot, Gorelik, Traeger, Albarqouni, Checketts, Vyas, Clark, Buchbinder. Statistical analysis: O’Connor, Maguire, Billot, Gorelik. Obtained funding: Schram, Glasziou, Maher, McCaffery, Buchbinder. Administrative, technical, or material support: Glasziou, Schram, Ma, Albarqouni, Clark. Supervision: O’Connor, Glasziou, Billot. Conflict of Interest Disclosures: Dr Maher reported receipt of nonfinancial support from FlexEze. No other disclosures were reported. Funding/Support: This study was funded by the Australian Government Department of Health and Aged Care and supported by Australian National Health and Medical Research Council (NHMRC) Program Grant APP1113532. Dr O’Connor is supported by an Australian NHMRC Translating Research Into Practice (TRIP) Fellowship (grant APP1168749). Dr Glasziou is supported by an Australian NHMRC Investigator Fellowship (grant APP1155009). Dr Maher is supported by an Australian NHMRC Investigator Fellowship (grant APP1194283). Dr Traeger is supported by an Australian NHMRC Early Career Fellowship (grant APP1144026). Dr Buchbinder is supported by an Australian NHMRC Investigator Fellowship (grant APP1194483).
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PY - 2022/9/6
Y1 - 2022/9/6
N2 - Importance: Audit and feedback can improve professional practice, but few trials have evaluated its effectiveness in reducing potential overuse of musculoskeletal diagnostic imaging in general practice.Objective: To evaluate the effectiveness of audit and feedback for reducing musculoskeletal imaging by high-requesting Australian general practitioners (GPs).Design, Setting, and Participants: This factorial cluster-randomized clinical trial included 2271 general practices with at least 1 GP who was in the top 20% of referrers for 11 imaging tests (of the lumbosacral or cervical spine, shoulder, hip, knee, and ankle/hind foot) and for at least 4 individual tests between January and December 2018. Only high-requesting GPs within participating practices were included. The trial was conducted between November 2019 and May 2021, with final follow-up on May 8, 2021.Interventions: Eligible practices were randomized in a 1:1:1:1:1 ratio to 1 of 4 different individualized written audit and feedback interventions (n = 3055 GPs) that varied factorially by (1) frequency of feedback (once vs twice) and (2) visual display (standard vs enhanced display highlighting highly requested tests) or to a control condition of no intervention (n = 764 GPs). Participants were not masked.Main Outcomes and Measures: The primary outcome was the overall rate of requests for the 11 targeted imaging tests per 1000 patient consultations over 12 months, assessed using routinely collected administrative data. Primary analyses included all randomized GPs who had at least 1 patient consultation during the study period and were performed by statisticians masked to group allocation.Results: A total of 3819 high-requesting GPs from 2271 practices were randomized, and 3660 GPs (95.8%; n = 727 control, n = 2933 intervention) were included in the primary analysis. Audit and feedback led to a statistically significant reduction in the overall rate of imaging requests per 1000 consultations compared with control over 12 months (adjusted mean, 27.7 [95% CI, 27.5-28.0] vs 30.4 [95% CI, 29.8-30.9], respectively; adjusted mean difference, -2.66 [95% CI, -3.24 to -2.07]; P < .001).Conclusions and Relevance: Among Australian general practitioners known to frequently request musculoskeletal diagnostic imaging, an individualized audit and feedback intervention, compared with no intervention, significantly decreased the rate of targeted musculoskeletal imaging tests ordered over 12 months.Trial Registration: ANZCTR Identifier: ACTRN12619001503112.
AB - Importance: Audit and feedback can improve professional practice, but few trials have evaluated its effectiveness in reducing potential overuse of musculoskeletal diagnostic imaging in general practice.Objective: To evaluate the effectiveness of audit and feedback for reducing musculoskeletal imaging by high-requesting Australian general practitioners (GPs).Design, Setting, and Participants: This factorial cluster-randomized clinical trial included 2271 general practices with at least 1 GP who was in the top 20% of referrers for 11 imaging tests (of the lumbosacral or cervical spine, shoulder, hip, knee, and ankle/hind foot) and for at least 4 individual tests between January and December 2018. Only high-requesting GPs within participating practices were included. The trial was conducted between November 2019 and May 2021, with final follow-up on May 8, 2021.Interventions: Eligible practices were randomized in a 1:1:1:1:1 ratio to 1 of 4 different individualized written audit and feedback interventions (n = 3055 GPs) that varied factorially by (1) frequency of feedback (once vs twice) and (2) visual display (standard vs enhanced display highlighting highly requested tests) or to a control condition of no intervention (n = 764 GPs). Participants were not masked.Main Outcomes and Measures: The primary outcome was the overall rate of requests for the 11 targeted imaging tests per 1000 patient consultations over 12 months, assessed using routinely collected administrative data. Primary analyses included all randomized GPs who had at least 1 patient consultation during the study period and were performed by statisticians masked to group allocation.Results: A total of 3819 high-requesting GPs from 2271 practices were randomized, and 3660 GPs (95.8%; n = 727 control, n = 2933 intervention) were included in the primary analysis. Audit and feedback led to a statistically significant reduction in the overall rate of imaging requests per 1000 consultations compared with control over 12 months (adjusted mean, 27.7 [95% CI, 27.5-28.0] vs 30.4 [95% CI, 29.8-30.9], respectively; adjusted mean difference, -2.66 [95% CI, -3.24 to -2.07]; P < .001).Conclusions and Relevance: Among Australian general practitioners known to frequently request musculoskeletal diagnostic imaging, an individualized audit and feedback intervention, compared with no intervention, significantly decreased the rate of targeted musculoskeletal imaging tests ordered over 12 months.Trial Registration: ANZCTR Identifier: ACTRN12619001503112.
UR - http://www.scopus.com/inward/record.url?scp=85137745675&partnerID=8YFLogxK
U2 - 10.1001/jama.2022.14587
DO - 10.1001/jama.2022.14587
M3 - Article
C2 - 36066518
SN - 0098-7484
VL - 328
SP - 850
EP - 860
JO - Journal of the American Medical Association
JF - Journal of the American Medical Association
IS - 9
ER -