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Research ArticleArticles

With “Big Data” Comes Big Responsibility

Outreach to North Carolina Medicaid Patients With 10 or More Computed Tomography Scans in 12 Months

Holly Biola, Randall M. Best, Rita M. Lahlou, Lauren M. B. Burke, Charles Dewar, Carlos T. Jackson, Joshua Broder, Linda Grey, Richard C. Semelka and Allen Dobson
North Carolina Medical Journal March 2014, 75 (2) 102-109; DOI: https://doi.org/10.18043/ncm.75.2.102
Holly Biola
physician consultant, Community Care of North Carolina, Raleigh, North Carolina; and family physician and quality improvement physician champion, Lincoln Community Health Center, Durham, North Carolina
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  • For correspondence: holly.biola@duke.edu
Randall M. Best
chief medical officer, Division of Medical Assistance, North Carolina Department of Health and Human Services, Raleigh, North Carolina; and assistant professor, Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Rita M. Lahlou
graduate, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lauren M. B. Burke
assistant professor of radiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Charles Dewar
analytics manager, Community Care of North Carolina, Raleigh, North Carolina
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Carlos T. Jackson
assistant director of program evaluation, North Carolina Community Care Networks, Inc., Raleigh, North Carolina; and adjunct assistant professor of psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Joshua Broder
associate professor and residency program director, Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Linda Grey
account manager, OptumInsight, Raleigh, North Carolina
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Richard C. Semelka
professor of radiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Allen Dobson
president and chief executive officer, Community Care of North Carolina, Raleigh, North Carolina
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Abstract

BACKGROUND Patients are being exposed to increasing levels of ionizing radiation, much of it from computed tomography (CT) scans.

METHODS Adults without a cancer diagnosis who received 10 or more CT scans in 2010 were identified from North Carolina Medicaid claims data and were sent a letter in July 2011 informing them of their radiation exposure; those who had undergone 20 or more CT scans in 2010 were also telephoned. The CT scan exposure of these high-exposure patients during the 12 months following these interventions was compared with that of adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population.

RESULTS The average number of CT scans per month for the high-exposure population decreased over time, but most of that reduction occurred 6–9 months before our interventions took place. At about the same time, the number of CT scans per month also decreased in adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population.

LIMITATIONS Our data do not include information about CT scans that may have been performed during times when patients were not covered by Medicaid. Some of our letters may not have been received or understood. Some high-exposure patients were unintentionally excluded from our study because organization of data on Medicaid claims varies by setting of care.

CONCLUSION Our patient education intervention was not temporally associated with significant decreases in subsequent CT exposure. Effecting behavior change to reduce exposure to ionizing radiation requires more than an educational letter or telephone call.

  • ©2014 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.
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North Carolina Medical Journal: 75 (2)
North Carolina Medical Journal
Vol. 75, Issue 2
March-April 2014
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With “Big Data” Comes Big Responsibility
Holly Biola, Randall M. Best, Rita M. Lahlou, Lauren M. B. Burke, Charles Dewar, Carlos T. Jackson, Joshua Broder, Linda Grey, Richard C. Semelka, Allen Dobson
North Carolina Medical Journal Mar 2014, 75 (2) 102-109; DOI: 10.18043/ncm.75.2.102

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With “Big Data” Comes Big Responsibility
Holly Biola, Randall M. Best, Rita M. Lahlou, Lauren M. B. Burke, Charles Dewar, Carlos T. Jackson, Joshua Broder, Linda Grey, Richard C. Semelka, Allen Dobson
North Carolina Medical Journal Mar 2014, 75 (2) 102-109; DOI: 10.18043/ncm.75.2.102
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