UH3 Project: Lumbar Imaging with Reporting of Epidemiology (LIRE)
Principal Investigator: Jeffrey Jarvik, MD, MPH
Sponsoring Institution: University of Washington
Kaiser Permanente, Northern California
Kaiser Permanente Washington Health Research Institute
Mayo Clinic Health System
Henry Ford Health System
Oregon Health and Science University
NIH Institutes Providing Oversight:
Program Official: Chuck Washabaugh (NIAMS)
Project Scientist: Robin Boineau (NCCIH)
ClinicalTrials.gov Identifier: NCT02015455
Trial Status: Ongoing, but not recruiting participants
Low back pain is an Institute of Medicine priority condition for comparative effectiveness research and is of major public health importance. It is one of the most common reasons for physician visits and an important cause of functional limitation and disability. Imaging is frequently performed as part of the diagnostic evaluation and is an important contributor to the cost of back pain care.
LIRE is a large pragmatic, cluster-randomized controlled trial testing the effectiveness of a simple and inexpensive intervention: inserting epidemiologic benchmarks into lumbar spine imaging reports. The goal of the trial is to reduce subsequent tests and treatments, including cross-sectional imaging (such as magnetic resonance and computed tomography), opioid prescriptions, spinal injections, or surgery. The LIRE trial has the potential to demonstrate the feasibility of randomly assigning clinics within large health systems to receive a clinical decision support-type intervention as well as the feasibility of passively collecting outcomes data up to 2 years after enrollment using the robust electronic medical record systems available at each health system.