Imaging during low back pain ED visits: a claims-based descriptive analysis.

OBJECTIVE: Low back pain (LBP) is a common reason for emergency department (ED) visits. This study aimed to determine the frequency and type of nonindicated imaging during LBP ED visits and to describe demographic and prior health care use characteristics among the nonindicated population. METHODS: This study included index ED events for LBP occurring during 2011 through 2012 for Blue Cross Blue Shield of Michigan commercial members ages 18 to 64 years. We identified LBP imaging indications within 12 months before the index event. Frequency estimates of patient demographics, imaging prevalence, type of imaging, and prior health care use characteristics stratified by imaging and indication status are presented with 95% confidence intervals (CIs). RESULTS: Of the 14838 total events, 51.9% (95% CI, 51.1%-52.7%) did not have indications for imaging. Patients without imaging indications were less likely to have had ED visits, hospital stays, LBP, lower back imaging, primary care physician visits, and back-related specialist visits in the past year compared with patients with indications. Among nonindicated patients, 30.1% (95% CI, 29.1%-31.1%) received imaging; of these, 26.2% received advanced imaging (computed tomography or magnetic resonance imaging). Nonindicated patients who received imaging were slightly older than those who did not receive imaging (27.6% [95% CI, 25.8%-29.4%] were ages 55-64 years vs 20.6% [95% CI, 19.6%-21.7%]) and had a higher prevalence of observation/treatment room use (7.3% [95% CI, 6.2%-8.4%] vs 1.2% [95% CI, 0.9%-1.4%]). CONCLUSIONS: Our results suggest that a substantial proportion of the patient population presenting to the ED for LBP receives nonindicated imaging, revealing opportunities to reduce costs and radiation exposure.

Mapping a message for faith leaders: encouraging community health promotion with local health data.

This study reports the use of a community-based health survey to share local health information with faith leaders. Geographical information systems software identified survey respondents within 2 km (1.25 miles) of places of worship. Results were tabulated for the community surrounding each place of worship and were compared with city- and county-level data. Faith leaders were presented with community-specific reports describing the health attributes of residents who lived in the surrounding area, in order to assist with the identification issues of concern and opportunities to develop health ministries to address these issues. Faith leaders were encouraged to share this information with members of their faith community and develop means of obtaining additional information on the people of interest. We believe that engaging faith leaders with neighborhood-specific health information will be critical in providing an understanding of the importance of their voice in improving health outcomes of their faith community, the surrounding neighborhood, and the community at large. Our goal is to empower faith leaders to understand personal and community health issues and to act as a conduit for health-related information and health promotion at a local level. Church health teams developed an HIV and sexually transmitted infection prevention program for African American adolescents and young adults.