PROVIDER-DIRECTED EDUCATION TO REDUCE UNNECESSARY NEUROIMAGING IN UNCOMPLICATED HEADACHE DISORDERS: A QUALITY IMPROVEMENT PROJECT
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Publisher:The Ohio State University
Series/Report no.:The Ohio State University. College of Nursing Doctor of Nursing Practice Final Document Projects
Background: Over 1.9 million annual outpatient visits to neurologists in the U.S. are associated with headache diagnoses. For uncomplicated headache disorders, the evidence-based practice (EBP) guidelines recommend against neuroimaging unless specific neurological signs and symptoms are present. However, neuroimaging rates in this patient group have only modestly decreased since the guidelines were developed. The purpose of this quality improvement project was to reduce unnecessary neuroimaging in patients with uncomplicated headache disorders by implementing a provider-directed educational session about the EBP guidelines for neuroimaging in patients with uncomplicated headaches. Methods: A 15-minute provider-directed educational session focusing on uncomplicated headache disorders and the EBP guidelines for neuroimaging use in this patient population was presented orally and in-person to all general neurology providers (n =9) in a large urban outpatient neurology clinic. The providers were given an electronic version of the presentation and a pocket-sized EBP algorithm for neuroimaging use in patients presenting with uncomplicated headache symptoms. Results: Data collected from the project site’s neuroimaging dashboard showed a significantly lower proportion of unnecessary neuroimaging orders in the 8-week post-educational interval (4.2%) compared to the 8-week pre-education interval (7.2%) (t = 2.78, p = 0.014), a 41.6% reduction. Conclusions: This project’s findings indicate a provider-directed educational session reviewing the EBP guidelines for neuroimaging in patients with uncomplicated headache disorders was successful in lowering rates of a low value-service in a large urban outpatient neurology clinic. Implementing similar projects in other departments (e.g., primary care clinics) could further reduce unnecessary neuroimaging use across the organization.
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