# Strategies to Reduce Unnecessary Noninvasive Imaging

> **NIH VA IK2** · VETERANS HEALTH ADMINISTRATION · 2022 · —

## Abstract

Background: Patients undergo millions of noninvasive diagnostic imaging tests, including computed
tomography, magnetic resonance imaging, and nuclear medicine, in the United States annually. Based on
Appropriate Use Criteria (AUC) developed by professional medical societies, 20-30% of these tests may be
inappropriate, i.e., the potential benefit-to-risk ratio is not maximized. Limited data on appropriateness of
imaging within the Veterans Health Administration (VHA) suggests that inappropriate use is similar to that
outside the VHA. A variety of methods have been employed to encourage more appropriate use of noninvasive
imaging. One of the most popular is an electronic decision support tool (DST). These software products are
added to patient care workflows to capture meaningful AUC data and reduce unnecessary testing. A recent
VHA Evidence Synthesis Program (ESP) report concluded that little is known about the implementation of
DSTs and possible negative ramifications of their use. Further, the cost to the VHA of noninvasive imaging
testing, which has not been calculated, is needed to determine the burden of inappropriate tests.
Specific Aims: In the course of this award, we will achieve the following specific aims: (1) assess potential
barriers and facilitators to successful adoption of a DST, (2) determine the effectiveness of a DST using a
stepped implementation process, and (3) estimate the fiscal effectiveness of a DST in the VA health system by
developing a micro-costing model for delivery of noninvasive imaging tests.
Significance: Through these investigations, we will glean valuable insight into how to adjust processes to
improve the ordering of millions of costly tests. If effective at reducing unnecessary tests, the results from this
proposal will ultimately improve Veterans' access to care and reduce radiation risks.
Innovation: Study of DSTs has focused primarily on effectiveness, with little attention paid to the
implementation process and possible adverse effects such as provider dissatisfaction and inefficiency. Our
investigations will break new ground in studying these aspects of DSTs. The use of qualitative and micro-
costing methods as we propose is innovative given their underuse for clinically oriented research.
Methods: We will apply the Practical Robust Implementation and Sustainability Model (PRISM) and
Theoretical Domains Framework (TDF) to the specific aims for this award. In Specific Aim 1, we will use
qualitative and quantitative methods to identify possible barriers and facilitators to DST implementation through
interviews and surveys of providers who order noninvasive tests. In Specific Aim 2, implementation of a DST
for noninvasive imaging will be assessed from the rate of testing, the proportion of testing that is inappropriate,
and feedback from providers in three discrete steps. First, providers blinded to AUC for imaging tests will order
tests as usual. Second, at the point of ordering, they will receive immediat...

## Key facts

- **NIH application ID:** 10305698
- **Project number:** 5IK2HX002066-05
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** David E Winchester
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2017-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10305698

## Citation

> US National Institutes of Health, RePORTER application 10305698, Strategies to Reduce Unnecessary Noninvasive Imaging (5IK2HX002066-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10305698. Licensed CC0.

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