Outpatient facility-based order variation in combined imaging.

Area of Science:

• Radiology and Medical Imaging
• Health Services Research

Background:

• Combined computed tomography (CT) involves simultaneous imaging of an anatomical area with and without contrast or concurrent imaging of overlapping areas.
• Previous studies on combined CT have focused on Traditional Medicare populations, leaving a gap in understanding its utilization in other populations subject to prior authorization.

Purpose of the Study:

• To explore variations in ordering and receiving combined CT scans across different facilities.
• To investigate the influence of health plan type on combined CT utilization in a mixed commercial and Medicare Advantage population.

Main Methods:

• Retrospective analysis of combined CT orders (abdomen, thorax, brain/sinus) from 2013-2017 for patients with commercial or Medicare Advantage plans.
• Orders were analyzed based on both the ordering and rendering facilities.
• Statistical methods, including analysis of variance, were used to assess differences in combined CT rates by year and health plan type.

Main Results:

• Combined CT rates for abdomen and thorax decreased significantly from 2013 to 2017.
• Significant differences in combined CT rates were found between commercial and Medicare Advantage plans.
• Greater variability in combined CT rates was observed when orders were grouped by ordering facility compared to rendering facility.

Conclusions:

• Facility-level variation and health plan type are significant factors influencing combined CT utilization.
• The findings highlight the need for further investigation into the drivers of these variations and their clinical implications.