Case Studies: Overutilzation of Resources

Problem:

A major health care plan in the Northeast saw a 30% rise in neuroimaging (CT, MRI) over a one year period. An analysis of claims data showed that much of the increase was associated with a complaint of headache. Furthermore, much of the neuroimaging was being ordered by primary care physicians.

The overall goal of this project was to reduce neuroimaging costs while enhancing the quality of care for migraine and other headaches, based on best evidence medicine. Specific goals of the project were to:

• Reduce ER visits by migraineurs.
• Reduce inappropriate referrals for headache.
• Reduce unnecessary diagnostic procedures for headache patients.

Other project goals were aimed at directly benefiting patients. These goals included:

• Reducing frequency, severity or duration of attacks.
• Improving function and reducing disability.
• Improving quality of life.

Process:

• Target the desired providers (high referral rates, patients visit the ER, high neuroimaging utilization).
• Determine appropriate outcomes measures.
• Gain the perspective of the providers as to the issues (forces, barriers, images, attitudes, clinical competencies) involved in recognizing, diagnosing and treating migraine. Interviews, focus groups, surveys and other assessments will be used where appropriate.
• Develop and implement initiatives based on an analysis of the provider feedback, clinical and claims data, and other information gathered.
• Develop and implement interventions with input of local experts.
• Measure results and compare to project goals.

Solutions:

• Enhance provider access to current medical records to avoid redundant testing.
• Continuing Medical Education (CME) interventions to enhance PCP ability to diagnose and manage headache appropriately.
• Patient and family education interventions to reduce inappropriate demands for testing.
• Communications workshops to enable clinicians to communicate effectively with patients and families while providing appropriate clinical care.

Opportunities:

Information gathered directly from stakeholders (physicians, patients, staff, administrators) helps to develop more effective interventions targeted to physicians, patients, and the local healthcare system.