Exploratory analysis of high CT scan utilization in claims data.

Area of Science:

• Health Services Research
• Medical Imaging Utilization
• Health Economics

Background:

• Computed tomography (CT) scans are a valuable diagnostic tool, but their utilization varies.
• Understanding factors driving CT scan use is crucial for optimizing healthcare resources and ensuring appropriate patient care.

Purpose of the Study:

• To identify patient and referring physician characteristics associated with higher and lower computed tomography (CT) scan utilization.
• To inform quality improvement strategies for medical imaging services.

Main Methods:

• Analysis of 310,467 CT scan claims from a large health insurance plan (2009-10).
• Classification of patients and referring physicians into utilization categories.
• Identification of distinguishing characteristics for high vs. low utilization groups.

Main Results:

• Higher CT utilization in patients was linked to male sex, older age, greater provider use, higher resource consumption, frailty, and government insurance.
• Physician factors associated with higher CT referrals included male sex, board certification, group practice, and specific specialties.
• Ownership interest showed a curvilinear association with claim volume, not claims per physician.

Conclusions:

• Aggregate analysis revealed no major anomalies in patient or physician characteristics linked to higher CT utilization.
• Further research on specific conditions, high-utilization patients, and high-referral physicians is needed for quality improvement.