Trends in Low-Value Carotid Imaging in the Veterans Health Administration From 2007 to 2016

摘要: Importance As part of the Choosing Wisely campaign, primary care, surgery, and neurology societies have identified carotid imaging ordered for screening, preoperative evaluation, syncope as frequently low value. Objective To determine changes in overall indication-specific rates following recommendations. Design, Setting, Participants This serial cross-sectional study compared annual before recommendations (ie, 2007 to 2012) after 2013 2016) among adults receiving care Veterans Health Administration (VHA) national health system. Data analysis was performed from April 10, 2019, November 27, 2019. Exposures Release Main Outcomes Measures Annual imaging, stroke workup, low-value indications screening owing bruit, syncope). Indications were using a text lexicon algorithm based on electronic record review stratified random sample 1000 free-text orders. The subsequent performance procedures within 6 months assessed. Results Between 2016, 809 071 examinations (mean [SD] age patients undergoing 69 [10] years; 776 632 [96%] men), which 201 467 images (24.9%) (67 064 [8.2%] 25 032 [3.1%] 109 400 [13.5%] syncope), 257 369 (31.8%) 350 235 (43.3%) other indications. Imaging bruits declined across period while there no significant change or evaluation. Compared with years before, during 4 recommendations, trend syncope, small decline (post–Choosing trend, −0.1 [95% CI, Conclusions Relevance These findings suggest that not associated meaningful integrated reduce testing utilization cascades, interventions targeting ordering clinicians are needed augment impact public awareness campaigns.