Work

Evaluation of a national intervention to reduce unnecessary brain magnetic resonance imaging in Norway – Effect on referral quality and justification rate

Year: 2025

Type: article

Abstract: INTRODUCTION: Magnetic Resonance Imaging (MRI) is the most used imaging modality in patients with headaches. However, advanced imaging is often used unwarrantedly, wasting valuable health resources and reducing the quality of care. This study evaluates the outcomes of a national intervention implemented in private imaging centers, assessing differences in profession, referral quality, and justification rate for brain MRI in patients with headaches. METHODS: A before-and-after study was set up to assess referrals retrospectively. Six centers each provided 30 referrals received at the imaging center in January and February 2022, before and 30 referrals after the intervention was implemented (January and February 2023). Four radiographers and four radiologists, all experienced in referral vetting, assessed the referrals using an assessment form, blinded for the year. The chi-square test was used to compare groups (α < 0.05). Kappa statistics were used to assess interrater reliability. RESULTS: All assessors assessed 353 referrals. Overall, 53 % of referrals were assessed as justified. Interrater agreement was moderate. The rate of justified referrals increased by six percentage points after the intervention. Referral quality increased slightly after the intervention. The interrater agreement was good. Radiologists rated more referrals as high-quality and unjustified compared to radiographers. The interrater agreement in justification assessment was higher among radiologists compared to radiographers. CONCLUSIONS: The intervention increased the rate of justified referrals and decreased the rate of unjustified referrals. However, even after the intervention, 33 % of referrals were rated unjustified, and 57 % were assessed as low-quality. This indicates that referral quality and vetting can be improved. IMPLICATIONS FOR PRACTICE: To reduce unnecessary brain MRI use, and increase the overall quality of medical imaging, referral quality must be improved, and radiographers need more training in referral vetting.

Source: Radiography

DOI: 10.1016/j.radi.2025.103282

Authors: E. Kjelle, I.Ø. Brandsæter, J. Porthun, B.M. Hofmann

Institutions: Norwegian University of Science and Technology, University of South-Eastern Norway, University of Oslo

Language: English

Topic: Healthcare cost, quality, practices

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $2,990