Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.
Identifieur interne : 000209 ( Main/Exploration ); précédent : 000208; suivant : 000210Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.
Auteurs : Andrea L. Nevedal [États-Unis] ; Eleanor T. Lewis [États-Unis] ; Justina Wu [États-Unis] ; Josephine Jacobs [États-Unis] ; Jeffrey G. Jarvik [États-Unis] ; Roger Chou [États-Unis] ; Paul G. Barnett [États-Unis]Source :
- Journal of general internal medicine [ 1525-1497 ] ; 2020.
Abstract
BACKGROUND
Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood.
OBJECTIVE
To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain.
DESIGN
Qualitative study using semi-structured interviews.
PARTICIPANTS
Veterans Affairs PCPs identified from administrative data as having high or low rates of guideline-concordant LS-MRI ordering in 2016.
APPROACH
Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI.
KEY RESULTS
Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low- and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns.
CONCLUSIONS
Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.
DOI: 10.1007/s11606-019-05410-y
PubMed: 31832927
PubMed Central: PMC7174262
Affiliations:
- États-Unis
- Californie, Oregon, Washington (État)
- Portland, Seattle
- Université de Washington, Université des sciences et de la médecine de l'Oregon
Links toward previous steps (curation, corpus...)
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.</title><author><name sortKey="Nevedal, Andrea L" sort="Nevedal, Andrea L" uniqKey="Nevedal A" first="Andrea L" last="Nevedal">Andrea L. Nevedal</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA. Andrea.Nevedal@va.gov.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation></author><author><name sortKey="Lewis, Eleanor T" sort="Lewis, Eleanor T" uniqKey="Lewis E" first="Eleanor T" last="Lewis">Eleanor T. Lewis</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Wu, Justina" sort="Wu, Justina" uniqKey="Wu J" first="Justina" last="Wu">Justina Wu</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation></author><author><name sortKey="Jacobs, Josephine" sort="Jacobs, Josephine" uniqKey="Jacobs J" first="Josephine" last="Jacobs">Josephine Jacobs</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Jarvik, Jeffrey G" sort="Jarvik, Jeffrey G" uniqKey="Jarvik J" first="Jeffrey G" last="Jarvik">Jeffrey G. Jarvik</name><affiliation wicri:level="4"><nlm:affiliation>Departments of Radiology, Neurological Surgery, and Health Services, University of Washington, Seattle, WA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Radiology, Neurological Surgery, and Health Services, University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author><author><name sortKey="Chou, Roger" sort="Chou, Roger" uniqKey="Chou R" first="Roger" last="Chou">Roger Chou</name><affiliation wicri:level="4"><nlm:affiliation>Department of Clinical Epidemiology and Medical Informatics and Department of Medicine, Oregon Health & Science University, Portland, OR, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Clinical Epidemiology and Medical Informatics and Department of Medicine, Oregon Health & Science University, Portland, OR</wicri:regionArea><placeName><region type="state">Oregon</region><settlement type="city">Portland</settlement></placeName><orgName type="university">Université des sciences et de la médecine de l'Oregon</orgName></affiliation></author><author><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:31832927</idno><idno type="pmid">31832927</idno><idno type="doi">10.1007/s11606-019-05410-y</idno><idno type="pmc">PMC7174262</idno><idno type="wicri:Area/Main/Corpus">000313</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000313</idno><idno type="wicri:Area/Main/Curation">000313</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000313</idno><idno type="wicri:Area/Main/Exploration">000313</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.</title><author><name sortKey="Nevedal, Andrea L" sort="Nevedal, Andrea L" uniqKey="Nevedal A" first="Andrea L" last="Nevedal">Andrea L. Nevedal</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA. Andrea.Nevedal@va.gov.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation></author><author><name sortKey="Lewis, Eleanor T" sort="Lewis, Eleanor T" uniqKey="Lewis E" first="Eleanor T" last="Lewis">Eleanor T. Lewis</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Wu, Justina" sort="Wu, Justina" uniqKey="Wu J" first="Justina" last="Wu">Justina Wu</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation></author><author><name sortKey="Jacobs, Josephine" sort="Jacobs, Josephine" uniqKey="Jacobs J" first="Josephine" last="Jacobs">Josephine Jacobs</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Jarvik, Jeffrey G" sort="Jarvik, Jeffrey G" uniqKey="Jarvik J" first="Jeffrey G" last="Jarvik">Jeffrey G. Jarvik</name><affiliation wicri:level="4"><nlm:affiliation>Departments of Radiology, Neurological Surgery, and Health Services, University of Washington, Seattle, WA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Departments of Radiology, Neurological Surgery, and Health Services, University of Washington, Seattle, WA</wicri:regionArea><placeName><region type="state">Washington (État)</region><settlement type="city">Seattle</settlement></placeName><orgName type="university">Université de Washington</orgName></affiliation></author><author><name sortKey="Chou, Roger" sort="Chou, Roger" uniqKey="Chou R" first="Roger" last="Chou">Roger Chou</name><affiliation wicri:level="4"><nlm:affiliation>Department of Clinical Epidemiology and Medical Informatics and Department of Medicine, Oregon Health & Science University, Portland, OR, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Clinical Epidemiology and Medical Informatics and Department of Medicine, Oregon Health & Science University, Portland, OR</wicri:regionArea><placeName><region type="state">Oregon</region><settlement type="city">Portland</settlement></placeName><orgName type="university">Université des sciences et de la médecine de l'Oregon</orgName></affiliation></author><author><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><affiliation wicri:level="1"><nlm:affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025</wicri:regionArea><wicri:noRegion>94025</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:affiliation>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author></analytic><series><title level="j">Journal of general internal medicine</title><idno type="eISSN">1525-1497</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b></p><p>Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood.</p></div><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain.</p></div><div type="abstract" xml:lang="en"><p><b>DESIGN</b></p><p>Qualitative study using semi-structured interviews.</p></div><div type="abstract" xml:lang="en"><p><b>PARTICIPANTS</b></p><p>Veterans Affairs PCPs identified from administrative data as having high or low rates of guideline-concordant LS-MRI ordering in 2016.</p></div><div type="abstract" xml:lang="en"><p><b>APPROACH</b></p><p>Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI.</p></div><div type="abstract" xml:lang="en"><p><b>KEY RESULTS</b></p><p>Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low- and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.</p></div></front></TEI><pubmed><MedlineCitation Status="In-Data-Review" Owner="NLM"><PMID Version="1">31832927</PMID><DateRevised><Year>2020</Year><Month>04</Month><Day>24</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1525-1497</ISSN><JournalIssue CitedMedium="Internet"><Volume>35</Volume><Issue>4</Issue><PubDate><Year>2020</Year><Month>Apr</Month></PubDate></JournalIssue><Title>Journal of general internal medicine</Title><ISOAbbreviation>J Gen Intern Med</ISOAbbreviation></Journal><ArticleTitle>Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.</ArticleTitle><Pagination><MedlinePgn>1044-1051</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s11606-019-05410-y</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">Clinical practice guidelines suggest that magnetic resonance imaging of the lumbar spine (LS-MRI) is unneeded during the first 6 weeks of acute, uncomplicated low-back pain. Unneeded LS-MRIs do not improve patient outcomes, lead to unnecessary surgeries and procedures, and cost the US healthcare system about $300 million dollars per year. However, why primary care providers (PCPs) order unneeded LS-MRI for acute, uncomplicated low-back pain is poorly understood.</AbstractText><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">To characterize and explain the factors contributing to PCPs ordering unneeded LS-MRI for acute, uncomplicated low-back pain.</AbstractText><AbstractText Label="DESIGN" NlmCategory="METHODS">Qualitative study using semi-structured interviews.</AbstractText><AbstractText Label="PARTICIPANTS" NlmCategory="METHODS">Veterans Affairs PCPs identified from administrative data as having high or low rates of guideline-concordant LS-MRI ordering in 2016.</AbstractText><AbstractText Label="APPROACH" NlmCategory="METHODS">Providers were interviewed about their use of LS-MRI for acute, uncomplicated low-back pain and factors contributing to their decision-making. Directed content analysis of transcripts was conducted to identify and compare environmental-, patient-, and provider-level factors contributing to unneeded LS-MRI.</AbstractText><AbstractText Label="KEY RESULTS" NlmCategory="RESULTS">Fifty-five PCPs participated (8.6% response rate). Both low (n = 33) and high (n = 22) guideline-concordant providers reported that LS-MRIs were required for specialty care referrals, but they differed in how other environmental factors (stringency of radiology utilization review, management of patient travel burden, and time constraints) contributed to LS-MRI ordering patterns. Low- and high-guideline-concordant providers reported similar patient factors (beliefs in value of imaging and pressure on providers). However, provider groups differed in how provider-level factors (guideline familiarity and agreement, the extent to which they acquiesced to patients, and belief in the value of LS-MRI) contributed to LS-MRI ordering patterns.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Results describe how diverse environmental, patient, and provider factors contribute to unneeded LS-MRI for acute, uncomplicated low-back pain. Prior research using a single intervention to reduce unneeded LS-MRI has been ineffective. Results suggest that multifaceted de-implementation strategies may be required to reduce unneeded LS-MRI.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Nevedal</LastName><ForeName>Andrea L</ForeName><Initials>AL</Initials><Identifier Source="ORCID">http://orcid.org/0000-0003-3859-8493</Identifier><AffiliationInfo><Affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA. Andrea.Nevedal@va.gov.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lewis</LastName><ForeName>Eleanor T</ForeName><Initials>ET</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Program Evaluation and Resource Center, VA Office of Mental Health and Suicide Prevention, Menlo Park, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Wu</LastName><ForeName>Justina</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jacobs</LastName><ForeName>Josephine</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Jarvik</LastName><ForeName>Jeffrey G</ForeName><Initials>JG</Initials><AffiliationInfo><Affiliation>Departments of Radiology, Neurological Surgery, and Health Services, University of Washington, Seattle, WA, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Chou</LastName><ForeName>Roger</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Clinical Epidemiology and Medical Informatics and Department of Medicine, Oregon Health & Science University, Portland, OR, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Barnett</LastName><ForeName>Paul G</ForeName><Initials>PG</Initials><AffiliationInfo><Affiliation>Center for Innovation to Implementation, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Health Economics Resource Center, VA Palo Alto Healthcare System, Menlo Park, CA, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>1 I01 HX002016-01A1.</GrantID><Agency>Department of Veterans Affairs Health Services and Research Development Program</Agency><Country></Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2019</Year><Month>12</Month><Day>12</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>J Gen Intern Med</MedlineTA><NlmUniqueID>8605834</NlmUniqueID><ISSNLinking>0884-8734</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">de-implementation</Keyword><Keyword MajorTopicYN="N">low-back pain</Keyword><Keyword MajorTopicYN="N">magnetic resonance imaging</Keyword><Keyword MajorTopicYN="N">primary care providers</Keyword><Keyword MajorTopicYN="N">qualitative research</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2019</Year><Month>05</Month><Day>14</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2019</Year><Month>09</Month><Day>20</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2019</Year><Month>12</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2019</Year><Month>12</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2019</Year><Month>12</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">31832927</ArticleId><ArticleId IdType="doi">10.1007/s11606-019-05410-y</ArticleId><ArticleId IdType="pii">10.1007/s11606-019-05410-y</ArticleId><ArticleId IdType="pmc">PMC7174262</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>JAMA. 2015 Mar 17;313(11):1143-53</Citation><ArticleIdList><ArticleId IdType="pubmed">25781443</ArticleId></ArticleIdList></Reference><Reference><Citation>N Engl J Med. 2001 Feb 1;344(5):363-70</Citation><ArticleIdList><ArticleId IdType="pubmed">11172169</ArticleId></ArticleIdList></Reference><Reference><Citation>J Neurotrauma. 2016 Aug 15;33(16):1554-60</Citation><ArticleIdList><ArticleId IdType="pubmed">26760283</ArticleId></ArticleIdList></Reference><Reference><Citation>AJR Am J Roentgenol. 2012 Jun;198(6):1375-9</Citation><ArticleIdList><ArticleId IdType="pubmed">22623551</ArticleId></ArticleIdList></Reference><Reference><Citation>Am J Manag Care. 2002 Jan;8(1):27-35</Citation><ArticleIdList><ArticleId IdType="pubmed">11814170</ArticleId></ArticleIdList></Reference><Reference><Citation>J Gen Intern Med. 2019 Nov 25;:</Citation><ArticleIdList><ArticleId IdType="pubmed">31768907</ArticleId></ArticleIdList></Reference><Reference><Citation>Qual Health Res. 2005 Nov;15(9):1277-88</Citation><ArticleIdList><ArticleId IdType="pubmed">16204405</ArticleId></ArticleIdList></Reference><Reference><Citation>Spine (Phila Pa 1976). 2006 Nov 1;31(23):2724-7</Citation><ArticleIdList><ArticleId IdType="pubmed">17077742</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2016 Dec 1;176(12):1866-1868</Citation><ArticleIdList><ArticleId IdType="pubmed">27749950</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2013 May 13;173(9):823-5</Citation><ArticleIdList><ArticleId IdType="pubmed">23529302</ArticleId></ArticleIdList></Reference><Reference><Citation>J Gen Intern Med. 1997 Oct;12(10):619-25</Citation><ArticleIdList><ArticleId IdType="pubmed">9346458</ArticleId></ArticleIdList></Reference><Reference><Citation>Am J Manag Care. 2016 Feb 01;22(2):e68-76</Citation><ArticleIdList><ArticleId IdType="pubmed">26881322</ArticleId></ArticleIdList></Reference><Reference><Citation>J Gen Intern Med. 2017 Feb;32(2):210-217</Citation><ArticleIdList><ArticleId IdType="pubmed">27599491</ArticleId></ArticleIdList></Reference><Reference><Citation>Ann Intern Med. 2011 Feb 1;154(3):181-9</Citation><ArticleIdList><ArticleId IdType="pubmed">21282698</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2016 Feb;176(2):198</Citation><ArticleIdList><ArticleId IdType="pubmed">26641734</ArticleId></ArticleIdList></Reference><Reference><Citation>Arch Intern Med. 2009 May 25;169(10):972-81</Citation><ArticleIdList><ArticleId IdType="pubmed">19468091</ArticleId></ArticleIdList></Reference><Reference><Citation>Ann Intern Med. 2015 Apr 21;162(8):557-65</Citation><ArticleIdList><ArticleId IdType="pubmed">25894025</ArticleId></ArticleIdList></Reference><Reference><Citation>Healthcare (Basel). 2016 Jun 29;4(3):</Citation><ArticleIdList><ArticleId IdType="pubmed">27417624</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2015 May;175(5):733-43</Citation><ArticleIdList><ArticleId IdType="pubmed">25799308</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2019 Jan 1;179(1):16-25</Citation><ArticleIdList><ArticleId IdType="pubmed">30508010</ArticleId></ArticleIdList></Reference><Reference><Citation>J Gen Intern Med. 2015 Feb;30(2):221-8</Citation><ArticleIdList><ArticleId IdType="pubmed">25373832</ArticleId></ArticleIdList></Reference><Reference><Citation>J Gen Intern Med. 2018 Sep;33(9):1469-1477</Citation><ArticleIdList><ArticleId IdType="pubmed">29943109</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA. 1999 Oct 20;282(15):1458-65</Citation><ArticleIdList><ArticleId IdType="pubmed">10535437</ArticleId></ArticleIdList></Reference><Reference><Citation>Med Care Res Rev. 2003 Sep;60(3 Suppl):146S-167S</Citation><ArticleIdList><ArticleId IdType="pubmed">15095551</ArticleId></ArticleIdList></Reference><Reference><Citation>J Gen Intern Med. 2019 Jul;34(7):1192-1199</Citation><ArticleIdList><ArticleId IdType="pubmed">31011973</ArticleId></ArticleIdList></Reference><Reference><Citation>J Am Coll Radiol. 2016 Sep;13(9):1057-66</Citation><ArticleIdList><ArticleId IdType="pubmed">27344246</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2016 Feb;176(2):191-7</Citation><ArticleIdList><ArticleId IdType="pubmed">26640973</ArticleId></ArticleIdList></Reference><Reference><Citation>Radiology. 2010 Oct;257(1):240-5</Citation><ArticleIdList><ArticleId IdType="pubmed">20736333</ArticleId></ArticleIdList></Reference><Reference><Citation>Ann Intern Med. 2007 Oct 2;147(7):478-91</Citation><ArticleIdList><ArticleId IdType="pubmed">17909209</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2017 Nov 1;177(11):1577-1585</Citation><ArticleIdList><ArticleId IdType="pubmed">28973068</ArticleId></ArticleIdList></Reference><Reference><Citation>Arch Fam Med. 2000 Nov-Dec;9(10):1015-21</Citation><ArticleIdList><ArticleId IdType="pubmed">11115201</ArticleId></ArticleIdList></Reference><Reference><Citation>J Am Coll Radiol. 2016 Sep;13(9):1079-82</Citation><ArticleIdList><ArticleId IdType="pubmed">27325470</ArticleId></ArticleIdList></Reference><Reference><Citation>J Am Coll Radiol. 2010 Mar;7(3):192-7</Citation><ArticleIdList><ArticleId IdType="pubmed">20193924</ArticleId></ArticleIdList></Reference><Reference><Citation>Spine J. 2011 Jul;11(7):622-32</Citation><ArticleIdList><ArticleId IdType="pubmed">21601533</ArticleId></ArticleIdList></Reference><Reference><Citation>Med Care. 2018 Jun;56(6):520-528</Citation><ArticleIdList><ArticleId IdType="pubmed">29668650</ArticleId></ArticleIdList></Reference><Reference><Citation>Adm Policy Ment Health. 2015 Sep;42(5):533-44</Citation><ArticleIdList><ArticleId IdType="pubmed">24193818</ArticleId></ArticleIdList></Reference><Reference><Citation>Clin J Pain. 2016 Sep;32(9):800-16</Citation><ArticleIdList><ArticleId IdType="pubmed">26710217</ArticleId></ArticleIdList></Reference><Reference><Citation>AJR Am J Roentgenol. 2019 Feb;212(2):386-394</Citation><ArticleIdList><ArticleId IdType="pubmed">30476451</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2018 Jan 1;178(1):85-91</Citation><ArticleIdList><ArticleId IdType="pubmed">29181542</ArticleId></ArticleIdList></Reference><Reference><Citation>Am J Med Qual. 2019 Jul/Aug;34(4):409-411</Citation><ArticleIdList><ArticleId IdType="pubmed">30654620</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Intern Med. 2013 Mar 25;173(6):416-7</Citation><ArticleIdList><ArticleId IdType="pubmed">23440265</ArticleId></ArticleIdList></Reference><Reference><Citation>Radiology. 2005 Nov;237(2):597-604</Citation><ArticleIdList><ArticleId IdType="pubmed">16244269</ArticleId></ArticleIdList></Reference><Reference><Citation>Neurology. 2004 Jan 13;62(1):119-21</Citation><ArticleIdList><ArticleId IdType="pubmed">14718712</ArticleId></ArticleIdList></Reference><Reference><Citation>Lancet. 2009 Feb 7;373(9662):463-72</Citation><ArticleIdList><ArticleId IdType="pubmed">19200918</ArticleId></ArticleIdList></Reference><Reference><Citation>Ethn Dis. 2019 Feb 21;29(Suppl 1):93-96</Citation><ArticleIdList><ArticleId IdType="pubmed">30906155</ArticleId></ArticleIdList></Reference><Reference><Citation>J Gen Intern Med. 2016 Feb;31(2):156-163</Citation><ArticleIdList><ArticleId IdType="pubmed">26215847</ArticleId></ArticleIdList></Reference><Reference><Citation>Qual Health Res. 2002 Jul;12(6):855-66</Citation><ArticleIdList><ArticleId IdType="pubmed">12109729</ArticleId></ArticleIdList></Reference><Reference><Citation>Health Res Policy Syst. 2018 Sep 26;16(1):95</Citation><ArticleIdList><ArticleId IdType="pubmed">30257678</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>États-Unis</li></country><region><li>Californie</li><li>Oregon</li><li>Washington (État)</li></region><settlement><li>Portland</li><li>Seattle</li></settlement><orgName><li>Université de Washington</li><li>Université des sciences et de la médecine de l'Oregon</li></orgName></list><tree><country name="États-Unis"><noRegion><name sortKey="Nevedal, Andrea L" sort="Nevedal, Andrea L" uniqKey="Nevedal A" first="Andrea L" last="Nevedal">Andrea L. Nevedal</name></noRegion><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><name sortKey="Barnett, Paul G" sort="Barnett, Paul G" uniqKey="Barnett P" first="Paul G" last="Barnett">Paul G. Barnett</name><name sortKey="Chou, Roger" sort="Chou, Roger" uniqKey="Chou R" first="Roger" last="Chou">Roger Chou</name><name sortKey="Jacobs, Josephine" sort="Jacobs, Josephine" uniqKey="Jacobs J" first="Josephine" last="Jacobs">Josephine Jacobs</name><name sortKey="Jacobs, Josephine" sort="Jacobs, Josephine" uniqKey="Jacobs J" first="Josephine" last="Jacobs">Josephine Jacobs</name><name sortKey="Jarvik, Jeffrey G" sort="Jarvik, Jeffrey G" uniqKey="Jarvik J" first="Jeffrey G" last="Jarvik">Jeffrey G. Jarvik</name><name sortKey="Lewis, Eleanor T" sort="Lewis, Eleanor T" uniqKey="Lewis E" first="Eleanor T" last="Lewis">Eleanor T. Lewis</name><name sortKey="Lewis, Eleanor T" sort="Lewis, Eleanor T" uniqKey="Lewis E" first="Eleanor T" last="Lewis">Eleanor T. Lewis</name><name sortKey="Wu, Justina" sort="Wu, Justina" uniqKey="Wu J" first="Justina" last="Wu">Justina Wu</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Bois/explor/WillowV1/Data/Main/Exploration
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000209 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd -nk 000209 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Bois
|area= WillowV1
|flux= Main
|étape= Exploration
|type= RBID
|clé= pubmed:31832927
|texte= Factors Influencing Primary Care Providers' Unneeded Lumbar Spine MRI Orders for Acute, Uncomplicated Low-Back Pain: a Qualitative Study.
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Exploration/RBID.i -Sk "pubmed:31832927" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd \
| NlmPubMed2Wicri -a WillowV1
| This area was generated with Dilib version V0.6.37. |  |