'Shaming' docs to reduce inappropriate imaging? It's worth a try

In the current debate about healthcare in this country, medical imaging has been a large target of ongoing efforts to reduce costs while maintaining quality of care.

Campaigns like Choosing Wisely or the development of evidence based guidelines to establish appropriateness criteria are just a couple of the ways the medical imaging community is tackling the problem by focusing on inappropriate imaging.

Now, a recent study out of Sweden, performed jointly by New York University and Swedish researchers, has come up with what appears to be a fairly easy strategy to curb inappropriate imaging--a "gentle shaming" of the doctors who don't follow guidelines that discourage inappropriate imaging of men with early-stage, low-risk prostate cancer. It may be an initiative worth considering in the U.S., considering the high rates of inappropriate prostate imaging we're experiencing here.

According to study co-author Danil Makarov, M.D., of NYU's Langone Medical Center, the researchers determined that use of "gentle shaming" reduced imaging rates among Swedish men with very low-risk prostate cancers from 43 percent to an astonishingly low 3 percent.

The initiative in Sweden publicized imaging rates--along with information about imaging guidelines--from institution to institution. For example, one aspect of the Swedish campaign involved presenting local statistics on inappropriate imaging at urology meetings. It was a way of incentivizing the reduction of unwarranted testing, and it worked.

Of course "gentle shaming" may just be a clever term representing the strategic use of data as a way of educating physicians about imaging guidelines and modifying behaviors. And there are a variety of ways in which this can work.

An article in last week's FierceMedicalImaging detailed a program at Massachusetts General Hospital in which the hospital introduced an email feedback report system to successfully reduce the number of cardiac CT angiography examinations performed with significantly higher radiation doses than the departmental mean. The physicians involved may not have experienced "gentle shaming," but they were presented with information that encouraged them to modify their behaviors.

According to Makarov, a Swedish-style campaign at urological conferences in this country could result in more uniform and appropriate prostate cancer imaging rates, which are badly needed.

Whether that kind of campaign could work here is unclear, but we do know that the imaging community has done a commendable job establishing guidelines for the appropriate use of imaging for all clinical conditions. The question has been how best to implement these guidelines.

Whether it's the introduction of a campaign like Image Wisely, or the "gentle shaming" program out of Sweden, the more initiatives we have to consider, the better. - Mike  @FierceHealthIT

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