Stress testing: national patterns and predictors of test ordering

Area of Science:

• Cardiology
• Health Services Research
• Medical Practice Patterns

Background:

• Exercise stress testing is a widely used diagnostic tool for heart disease.
• Understanding the patterns of ordering these tests is important for healthcare costs and appropriate patient management.
• Factors beyond clinical necessity may influence the utilization of exercise stress tests.

Purpose of the Study:

• To identify predictors associated with the ordering of exercise stress tests.
• To investigate the influence of clinical and nonclinical factors on exercise stress test utilization.

Main Methods:

• Analysis of data from the 1991 and 1992 National Ambulatory Medical Care Surveys.
• Multivariate logistic regression was employed to determine predictors of exercise stress test ordering.

Main Results:

• In an estimated 1.12 billion adult physician visits, 6.2 million exercise stress tests were ordered.
• Cardiologists were significantly more likely to order tests than internists, family practitioners, or general practitioners.
• Nonclinical factors such as male sex, white race, new referral status, and private insurance were associated with increased ordering, while Medicare recipients were less likely to have tests ordered.

Conclusions:

• Factors beyond a patient's clinical condition significantly influence the ordering of exercise stress tests.
• These nonclinical influences may represent modifiable aspects of medical practice.
• Identifying and addressing these factors can lead to more appropriate utilization and potentially reduce healthcare costs.