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E1960. Introduction to the American College of Radiology Appropriateness Criteria Through a Multimethod, Multidisciplinary Approach
Authors
  1. Jessica Telleria; University of Chicago Hospitals Department of Radiology
  2. Carina Yang; University of Chicago Hospitals Department of Radiology
  3. Julia Nath; University of Chicago Hospitals Department of Internal Medicine
  4. Annie Rhee; Mayo Clinic Hospital, Transitional Year Residency
  5. Erin Rieger; University of Chicago Pritzker School of Medicine
  6. Mike Cheng; University of California, San Francisco Department of General Internal Medicine
  7. Joyce Tang; University of Chicago Hospitals Department of Internal Medicine
Objective:
Inappropriate diagnostic image ordering contributes to healthcare waste, both fiscally and temporally. To enhance quality of care and to maximize efficient imaging utilization, diagnostic and interventional radiologists created the American College of Radiology (ACR) Appropriateness Criteria® (AC), evidence based recommendations for imaging ordering. However, many clinicians, including trainees, are unaware of this tool. This project’s objective is to develop and assess a curriculum which introduces the ACR AC to internal medicine residents, helping bridge the imaging gap.

Materials and Methods:
Individuals from University of Chicago internal medicine and radiology departments collaboratively developed a multimethod curriculum which consisted of two didactic lectures supplemented by online case scenarios via Radiology-TEACHES to be piloted with internal medicine interns at our institution. The lectures include topics such as consequences of imaging overuse, including financial risk, introduction to the ACR AC and appropriate imaging ordering practices. Online case scenarios were discussed as a group. To assess curriculum efficacy, pre- and post-curriculum (immediate, 3 and 11 month intervals) surveys regarding knowledge and attitude towards imaging ordering were administered. Appropriateness of imaging ordered during urgent care visits for low back pain by these interns was also assessed (pre- and post-curriculum).

Results:
23 interns completed the didactic lectures and surveys. Initial increases were seen in knowledge scores from 59% to 89% (p=0.0001), sense of knowledge about imaging cost from 4% to 74%, level of comfort in discussing cost with patients from 9% to 61%, and perception of the ACR AC as valuable from 65% to 95%, all statistically significant. At 3-11 month follow-up, knowledge scores remained improved, 78% of interns reported referencing the ACR AC at least monthly and 67% reported changing ordering practices due to the curriculum. Review of 219 low back pain outpatient encounters seen by interns who completed at least one lecture showed no change in frequency of radiologic mismanagement post-curriculum, both over and underutilization equally.

Conclusion:
We describe the development of a collaborative, multimethod curriculum that introduces internal medicine interns to the knowledge and tools necessary to ensure high value imaging ordering. We found this program to be effective in improving knowledge base, increasing comfort with and perception of the ACR AC. However, lack of significant decrease in radiologic mismanagement of low back pain by the participating interns may be multifactorial, given attending input and short course duration, among others. This curriculum demonstrates promise as a stepping stone for further implementation across institutions and specialties in order to improve knowledge, attitude and awareness of these topics.