Problem the Project Seeks to Solve: Imaging tests—such as X rays, ultrasound scans, CAT scans, and MRI scans—are commonly used in modern health care. These tests are used to detect disease, and they help predict disease progression. Despite such value, concerns that these tests are overused abound. Patients and healthcare professionals do not have access to information in order to weigh the beneficial and potentially harmful effects of imaging tests. PCORI highlighted the lack of standards for evaluating diagnostic tests and the need to develop improved methods to measure the impact of diagnostic tests on patient outcomes.
Outcomes We Hope to Achieve: The PROD study will provide new guidelines to allow patients and healthcare providers to make more informed choices about diagnostic tests. We will explore patient, caregiver, and healthcare stakeholder experiences with different types of imaging tests, and identify the most important patient-centered outcomes. We will systematically review the existing literature for imaging tests over 27 priority areas, and we will determine which patient-centered outcomes are used in existing studies. Finally, we will produce new guidelines for how to judge imaging tests, with a focus on the 27 priority clinical areas, and we will explore ways to communicate this information with patients.
Background on Why This Is Important to Patients: An estimated 6 billion tests—including approximately half a million imaging tests—are performed each year in the United States. The costs of these tests have escalated two to three times faster than have prescription drug costs. While imaging tests provide many health benefits, some people are concerned that they are being overused. The Choosing Wisely initiative, which is supported by 73 professional organizations, identified 272 tests and treatments that are potentially overused in outpatient settings. Of these, imaging tests are potentially overused in 27 clinical areas. At present, patients and their healthcare providers have limited ways to make informed choices about which tests to select. This is because, currently, most test evaluation is based on accuracy, which is important, but overlooks many other patient-centered outcomes that may be equally important to patients.
How will patients and other stakeholders help the project to succeed? We have engaged many different stakeholders for the PROD study. We will recruit patient stakeholders from the CERTAIN (Comparative Effectiveness Research Translation Network) Patient Advisory Network, and from a five-state (Washington, Wyoming, Alaska, Montana, and Idaho) practice and research network. Patients will become active “patient researchers” and be involved in all aspects of the PROD study. In addition, we will engage with primary care clinicians, radiologists, and other healthcare stakeholders who are involved in day-to-day use of imaging tests. Additional stakeholders include Choosing Wisely, the American College of Radiologists, and the diagnostics industry.
VIDEO (below): The Pros and Cons of Diagnostic Tests
This principal investigator discusses research on both the benefits and risks of tests such as MRIs and x-rays.