News | July 01, 2013

Patient Factors Play Key Role in Emergency Department Imaging

MRI

Despite concerns to the contrary, very little of the variation in Emergency Department (ED) imaging utilization is attributable to physician experience, training or gender, according to a new study published online in the journal Radiology.

Imaging exams like X-rays and CT scans are common in the ED. In 2010, slightly more than 47 percent of all ED visits in the United States had an imaging exam associated with them.

"Analyzing and understanding drivers of use of imaging in the ED is important for several reasons," said Christopher L. Sistrom, M.D., M.P.H., Ph.D., from the departments of radiology at Massachusetts General Hospital in Boston and the University of Florida in Gainesville, Fla. "There's a balance of cost and benefits to the patient, institution and payer, as well as the overarching issue of radiation exposure."

Previous studies have found substantial variation in imaging rates across and within EDs, suggesting different tendencies among physicians when ordering imaging. However, much of the existing research is limited, according to Dr. Sistrom.

"A lot of literature on imaging variability can lead to a false assumption that doctors are primarily responsible," he said. "The problem is that it is difficult to fully describe and quantify variability at the different levels it can occur."

In the new study, Dr. Sistrom and colleagues analyzed 88,851 ED visits during 2011 at Massachusetts General Hospital. They used an analytical tool known as hierarchical logistic regression to identify multiple predictors of the probability that imaging was ordered during a given visit.

"That's what makes our paper unique," Dr. Sistrom said. "Hierarchal modeling allows us to ask very specific questions about the relative contributions of various factors to imaging use."

The overall rate of imaging utilization in the Massachusetts General ED was 45.4 percent in 2011, similar to the 2010 national average of 47.2 percent. Analysis of the data revealed that physician-related factors like gender, experience and training did not correlate with imaging use.

"The key finding in our study is that doctors don't make much difference in imaging utilization," Dr. Sistrom said. "Our data showed that doctors are responsible for about one percent of the variability in probability of having an imaging exam during an ED visit."

Instead, patient and visit factors were the predominant predictors of the likelihood of imaging for a given ED visit. These factors include prior visit, referral source, arrival mode and clinical reason for the visit.

The workload of the ED was another significant factor in imaging use. When the ED was the least busy, the odds of low-cost imaging were 11 percent higher than the reference standard. A busier ED resulted in a tendency towards more high-cost imaging.

The new study shows that medical management efforts looking to reduce imaging utilization may be misguided in focusing on remediating ED physicians.

"To reduce imaging utilization, a lot of people in quality improvement and medical management might try to identify high outliers and punish them," Dr. Sistrom said. "In settings like the one we studied, that strategy won't get you anything but angry doctors."

For more information: RadiologyInfo.org

Related Content

Technology | Focused Ultrasound Therapy | June 19, 2018
EDAP TMS SA has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its Focal One device for...
Elekta Unity High-Field MR-Linac Receives CE Mark
News | Image Guided Radiation Therapy (IGRT) | June 18, 2018
Elekta announced that its Elekta Unity magnetic resonance radiation therapy (MR/RT) system has received CE mark,...
Metropolitan Washington Orthopaedic Practice Upgrades DR With Agfa DX-D 300s
News | Digital Radiography (DR) | June 15, 2018
Agfa announced that it has installed two DX-D 300 digital radiography (DR) solutions at the multi-office Centers for...
Washington University in St. Louis Begins Clinical Treatments With ViewRay MRIdian Linac
News | Image Guided Radiation Therapy (IGRT) | June 14, 2018
June 14, 2018 — The Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in S
Reduced hippocampal volume on MRI

This figure shows reduced hippocampal volume over the course of 6 years as seen on progressive volumetric analysis and also coronal MRI evaluations (arrows).Progressive volume loss in the mesial temporal lobe on MRI is a characteristic imaging feature of AD. This patient was a case of Alzheimer’s Dementia.

 

News | Neuro Imaging | June 12, 2018
According to a UCLA Medical Center study, a new technology shows the potential to help doctors better determine when...
High Prevalence of Atherosclerosis Found in Lower Risk Patients
News | Magnetic Resonance Imaging (MRI) | June 08, 2018
Whole-body magnetic resonance angiography (MRA) found a surprisingly high prevalence of atherosclerosis in people...
Zebra Medical Vision Unveils AI-Based Chest X-ray Research
News | Artificial Intelligence | June 08, 2018
June 8, 2018 — Zebra Medical Vision unveiled its Textray chest X-ray research, which will form the basis for a future
Konica Minolta Launches AeroRemote Insights for Digital Radiography
Technology | Analytics Software | June 07, 2018
Konica Minolta Healthcare Americas Inc. announced the release of AeroRemote Insights, a cloud-based, business...
Philips Receives FDA 510(k) for Ingenia Elition MR System
Technology | Magnetic Resonance Imaging (MRI) | June 07, 2018
Philips announced that it has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for its...
News | Digital Radiography (DR) | May 25, 2018
Konica Minolta Healthcare Americas Inc. announced that two clinical studies utilizing the company’s Dynamic Digital...
Overlay Init