| Recommendation | Denominator | Numerator |
|---|---|---|
| Imaging for low back pain | ||
| Do not do imaging for lower-back pain unless red flags are present (CFPC; CAR; CSS). | Inclusion criteria: claim for visit to primary care physician with diagnosis of low back pain, with first visit as index date Exclusions: age < 18 yr or > 105 yr; red flag medical history up to 5 yr previous: previous low back pain diagnoses, certain diagnoses (e.g., neoplasms, neurologic diagnoses, fractures), visits to neurosurgeons or orthopaedic surgeons, prior spine-related scans or operations | Patients who meet inclusion criteria with at least 1 claim for spine CT or MRI up to 3 mo after index event. |
| Repeat DEXA scans | ||
| Do not repeat DEXA scans more often than every 2 yr (CRA; CANM). | Inclusion criteria: claim for baseline or subsequent DEXA scan with claim date as index date Exclusions: age < 40 or > 105 yr | Patients meet inclusion criteria with at least 1 claim for repeat DEXA scan within 2 years of index date. |
| Cervical cancer screening | ||
| Do not screen women with Papanicolaou tests if they are under 21 years of age or over 69 years of age (CFPC; CAP). | Inclusion criteria: women aged < 21 or > 69 yr Exclusions: age < 13 or > 105 yr; previous gynecologic cancer diagnoses; previous hysterectomy; pregnancy; HIV infection | Patients who meet inclusion criteria with at least 1 claim for cervical cancer screening with Papanicolaou test |
Note: CANM = Canadian Association of Nuclear Medicine, CAP = Canadian Association of Pathologists, CAR = Canadian Association of Radiologists, CFPC = College of Family Physicians of Canada, CRA = Canadian Rheumatology Association, CSS = Canadian Spine Society, DEXA = dual X-ray absorptiometry.