# Causes and Consequences of Inappropriate MRI of the Lumbar Spine

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2020 · —

## Abstract

Background: Low back pain is a significant and growing problem in Veterans. It is especially prevalent in
returning Veterans. Among returning Veterans who have disabling pain, it is the most frequent site of their
pain. Magnetic Resonance Imaging (MRI) conducted early in an episode of uncomplicated low back pain is not
helpful and may lead to unneeded surgeries and medical procedures, greater use of pain medications, and poor
outcomes. The percentage of orders for MRI of the lumbar spine that are inappropriate in VA is similar to what
has been observed in Medicare and commercial insurance claims. The VA Choosing Wisely Committee and VA
national program offices for pain, diagnostic services, and utilization management are working to reduce rates
of inappropriate LS-MRI imaging in VA. Attempts to implement guidelines for advanced imaging with
decision support tools have generally had modest, short-term effects. Guideline dissemination and audit and
feedback have not been effective in improving compliance with guidelines for treatment of low-back pain. New
understanding of the barriers and facilitators to guideline adherence is needed to design an effective
implementation effort. Inappropriate low back scans are associated with downstream costs from low value
treatments for back pain, but this has not been studied in VA.
Objectives: National data on new episodes of uncomplicated low-back pain will be studied to identify providers
who consistently order a large number of inappropriate scans. Qualitative interviews with a small number of
providers will identify differences between providers who are highly concordant with guidelines and those that
are less than concordant. The interviews will identify potential modifiable factors that can be the basis of a
program to reduce inappropriate ordering. VA utilization data will evaluate the association of inappropriate
LS-MRI orders with patient pain, and high-cost, potentially low value services: spinal fusion, laminectomy,
epidural injections, and prescription opiates.
Methods: The appropriateness of LS-MRI orders will be evaluated over 3 years using national VA
administrative data in order to identify a potential focus for implementation efforts: a consistent group of
providers that orders a high number of inappropriate scans, and/or particular services or sites where
inappropriate ordering is common. A qualitative assessment of a small number of these providers (and a
comparison group of providers that follow guidelines) will be conducted to identify potential modifiable factors
associated with inappropriate ordering, such as routine order sets, lack of knowledge of guidelines, beliefs
about the value of scans, knowledge and availability of care for patients with pain of the lumbar spine. Finally,
the effect of inappropriate orders on outcomes, care, and cost will be studied. A cohort of new cases of
uncomplicated low-back pain will be identified. Episodes in which LS-MRI is provided in the first 6 weeks...

## Key facts

- **NIH application ID:** 10027246
- **Project number:** 5I01HX002016-03
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** ANDREA L. NEVEDAL
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2016-10-01 → 2019-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10027246

## Citation

> US National Institutes of Health, RePORTER application 10027246, Causes and Consequences of Inappropriate MRI of the Lumbar Spine (5I01HX002016-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10027246. Licensed CC0.

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