Outpatient facility-based order variation in combined imaging

English version

Autoři: Adam C. Powell ^aff001; Yan Wang ^aff001; Gary L. Smith ^aff001; James W. Long ^aff002; Uday U. Deshmukh ^aff001; David P. Friedman ^aff001; Christopher G. Roth ^aff001; Baskaran Sundaram ^aff001
Působiště autorů: HealthHelp, Houston, TX, United States of America ^aff001; Humana Inc., Louisville, KY, United States of America ^aff002; Thomas Jefferson University, Philadelphia, PA, United States of America ^aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0224735

Souhrn

Objective

Combined computed tomography (CT) occurs when one anatomical area is simultaneously imaged both without and with contrast, or two overlapping anatomical areas are imaged concurrently. While this has been studied in a Traditional Medicare population, it has not been studied in other populations subject to prior authorization. This study explores between-facility variation in ordering and receiving orders to render combined CT in a mixed commercial and Medicare Advantage population.

Methods

Orders for CT abdomen (without/with contrast), CT thorax (without/with contrast), and concurrent CT brain and sinus authorized by a prior authorization company from 2013–2017, pertaining to patients with commercial or Medicare Advantage health plans from one national insurer, were extracted. Orders were issued and rendered by both hospitals and nonhospitals. The analysis was performed separately for each anatomical area in two ways: orders were grouped by ordering facility, and by designated rendering facility. For each facility, the ratio of combined to total orders was calculated, and analysis of variance was used to determine whether there were significant differences in this rate by year. The association between health plan type and combined imaging rates was assessed.

Results

Combined rates [ratio±standard deviation] for abdomen, thorax, and brain/sinus were 0.306±0.246, 0.089±0.142, and 0.002±0.01 respectively when the analysis was conducted according to ordering facility, and 0.311±0.178, 0.096±0.113, and 0.001±0.006 when the analysis was conducted according to designated rendering facility. Combined CT abdomen and CT thorax rates decreased monotonically from 2013 to 2017, decreases that were significant (P < .01) regardless of whether orders were grouped by ordering or rendering facility. Combined CT abdomen and CT thorax rates significantly differed between orders pertaining to people with commercial and Medicare Advantage plans.

Discussion

Variability was greater when orders were grouped by ordering facility, rather than rendering facility. Health plan type may influence whether a patient receives combined CT.

Klíčová slova:

Computed axial tomography – Hospitals – Medicare – Neuroimaging – Outpatients – Physicians

Zdroje

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Outpatient facility-based order variation in combined imaging

Souhrn

Objective

Methods

Results

Discussion

Klíčová slova:

Zdroje

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