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Variability in imaging utilization in U.S. pediatric hospitals
Ryan W Arnold1, Dionne A Graham, Patrice R Melvin
1Department of Radiology, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA.
Insights
Medical imaging use and costs vary significantly across pediatric hospitals. This variability persists even after accounting for patient complexity, highlighting potential areas for optimization.
Area of Science:
- Pediatric healthcare research
- Health services research
- Medical imaging analysis
Background:
- Medical imaging use is under scrutiny due to rising healthcare costs and radiation exposure concerns.
- Significant variability exists in medical imaging utilization and associated costs across pediatric hospitals.
- Understanding these variations is crucial for optimizing resource allocation and patient safety.
Purpose of the Study:
- To compare medical imaging utilization and costs across pediatric hospitals.
- To identify potential determinants of variability in imaging practices.
- To inform strategies for cost containment and radiation dose reduction.
Main Methods:
- Data extracted from the Pediatric Health Information System (PHIS) database for inpatient encounters at 40 U.S. children's hospitals.
- Imaging utilization and costs analyzed by insurance type, region, hospital size, illness severity, length of stay, and imaging type for specific diagnoses.
- Statistical analysis performed to compare utilization rates and costs, adjusting for case mix index (CMI).
Main Results:
- Imaging utilization varied more than twofold between the highest and lowest utilizing hospitals.
- Imaging costs ranged from $154 to $671 per patient.
- Utilization rates were significantly higher in Pediatric Intensive Care Units (PICU) and Neonatal Intensive Care Units (NICU) compared to general wards.
- Case Mix Index (CMI) and length of stay correlated with imaging utilization, but CMI explained only 36% of the variation.
Conclusions:
- Diagnostic imaging utilization and costs exhibit wide variability in pediatric hospital settings.
- Further research is needed to understand the drivers of this variability beyond case mix.
- Potential exists for standardizing imaging protocols to reduce costs and radiation exposure.
Background:
Use of medical imaging is under scrutiny because of rising costs and radiation exposure. We compare imaging utilization and costs across pediatric hospitals to determine their variability and potential determinants.
Materials And Methods:
Data were extracted from the Pediatric Health Information System (PHIS) database for all inpatient encounters from 40 U.S. children's hospitals. Imaging utilization and costs were compared by insurance type, geographical region, hospital size, severity of illness, length of stay and type of imaging, all among specific diagnoses.
Results:
The hospital with the highest utilization performed more than twice as many imaging studies per patient as the hospital with the lowest utilization. Similarly, imaging costs ranged from $154 to $671/patient. Median imaging-utilization rate was 1.7 exams/patient on the ward and increased significantly in the PICU (11.8 exams/patient) and in the NICU (17.7 exams per patient, (P < 0.001). Considerable variability in imaging utilization persisted despite adjustment for case mix index (CMI, range in variation 16.6-25%). We found a significant correlation between imaging utilization and both CMI and length of stay, P < 0.0001). However, only 36% of the variation in imaging utilization could be explained by CMI.
Conclusion:
Diagnostic imaging utilization and costs vary widely in pediatric hospitals.
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