Evidence-Based Systems Needed to Reduce Unnecessary Imaging Tests

According to new study in The American Journal of Medicine

Philadelphia, PA, March 9, 2012 – Imaging has been identified as one of the key drivers of increased healthcare costs. A new study from Brigham and Women’s Hospital and Harvard Medical School has found significant variation in the use of head computed tomography (CT), even within a single emergency department. Strategies to reduce such variation in head CT use may reduce cost and improve quality of care. The study appears online in advance of publication in the April issue of The American Journal of Medicine.

A recent measure approved by the Centers for Medicare and Medicaid is assessing variations in the use of head CT in patients with atraumatic headaches between hospitals nationwide. Researchers hypothesized that there is a significant variation in physician head CT use even within a single facility. “Even after accounting for a number of factors associated with ordering behavior, we found that greater than 2-fold variability in head CT use still persists,” explains lead author Luciano M. Prevedello, MD, Center for Evidence-Based Imaging and Department of Radiology, Brigham and Women’s Hospital, and Harvard Medical School.

The study looked at whether a head CT was performed in 55,281 patient visits to the adult-only emergency department at a large urban academic hospital throughout 2009. Patient variables included patient age, gender, severity of the emergency, emergency department location, and disease categorization. Physician-specific variables included years in practice and gender.

Overall, 8.9% of the visits generated head CT examinations. Rates per physician ranged from 4.4% to 16.9%. Patients receiving head CT were more likely to be male, older, and in a more urgent emergency category. Patients with head trauma were more likely to obtain a CT, followed by patients with stroke, headache, and other types of trauma. Contrary to earlier studies, the researchers found no significant correlation between physician age or gender and CT ordering.

“The variability may have been due to physician’s practice style, knowledge gaps, risk tolerance, or other factors,” says Dr. Prevedello. “We are currently investigating the impact of real-time evidence-based clinical decision support (embedded in the electronic health record) on variation in test ordering behavior of physicians to improve quality of care and improve appropriateness of testing.”

“Robert G. Stern, MD, Department of Radiology, University of Arizona College of Medicine, Tucson, a noted expert in the field comments, “Attempts to reduce utilization of expensive imaging studies have been made in the past, without any real focus on quality of care and appropriate ordering patterns. Dr. Prevedello and his colleagues underscore the need to develop evidence-based systems to reduce costly and inappropriate resource allocations.”

This clinical research study is featured in a new section of The American Journal of Medicine called “Imaging for the Clinician.” Editor-in-Chief Joseph S. Albert, MD, of the University of Arizona College of Medicine, Tucson, notes, “The US healthcare system is awash with excessive numbers of imaging studies. At least part of the reason for this is physician fear of liability. This new feature will attempt to educate clinicians and bring rationality into the ordering of imaging studies.”
 

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Notes for editors
"Variation in Use of Head Computed Tomography by Emergency Physicians,” by L.M. Prevedello, A.S. Raja, R.D. Zane, et al. It appears online in advance of publication in The American Journal of Medicine, Volume 125, Issue 4 (April 2012) published by Elsevier.

Full text of the article is available to credentialed journalists upon request. Contact Jane Grochowski at +1 406 542 8397or ajmmedia@elsevier.com to obtain copies. To schedule an interview with the authors please contact Marjorie Montemayor-Quellenberg, Brigham and Women's Hospital, at +1 617 534 2208 or mmontemayor-quellenberg@partners.org.

About The American Journal of Medicine
 
The American Journal of Medicine, known as the “Green Journal,” is one of the oldest and most prestigious general internal medicine journals published in the United States. It has an Impact Factor of 5.115, which ranks it 9 out of 153 General and Internal Medicine titles according to the Journal Citation Reports® 2010 published by Thomson Reuters.

AJM, the official journal of The Association of Professors of Medicine, a group comprised of chairs of departments of internal medicine at 125-plus U.S. medical schools, publishes peer-reviewed, original scientific studies that have direct clinical significance. The information contained in this article in The American Journal of Medicine is not a substitute for medical advice or treatment, and the Journal recommends consultation with your physician or healthcare professional. AJM is published by Elsevier.

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