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Published on: November 27, 2017
Temporal and geographical variations in musculoskeletal imaging: a register-based study in Norway with focus on
Ingrid Øfsti Brandsæter1, Jan Porthun2, Eivind Richter Andersen2
1Department of Health Sciences Gjøvik at The Norwegian University of Science and Technology (NTNU), NTNU Gjøvik, PB 191, Gjøvik, 2802, Norway. ingrid.o.brandsater@ntnu.no.
Background:
Musculoskeletal (MSK) issues generate extensive use of diagnostic imaging. Geographical variations in imaging are of interest as they can indicate under- and overutilisation. Low-value imaging is defined as examinations where evidence suggests it confers no or very little benefit on patients.
Purpose:
To assess the temporal and geographical variations in MSK imaging with special attention to two potential low-value MSK examinations, i.e. MRI of knee and MRI of lower back, in Norway from 2013 to 2022.
Materials And Methods:
Both inpatient and outpatient examinations from 2013 to 2022 were included. Data on outpatients was collected from the Norwegian Health Economics Administration, while inpatient data was gathered directly from strategically selected hospitals in Norway. Missing inpatient data was extrapolated based on population and outpatient data for each hospital trust. The rates are adjusted for age and sex to the European Standard Population.
Results:
Yearly, 1,884,614 MSK examinations were conducted in Norway. I.e. 3,586 examinations per 10,000 inhabitants. The use of MSK imaging decreased by 6.8% during the study period. The geographical variations were highest for the use of the potential low-value MSK examinations, where the region with the highest use conducted over twice as many examinations than the region with the lowest use.
Conclusion:
The temporal variations in the use of MSK examinations was small. However, there were substantial geographical variations between the hospital trusts, and modest variations between the regional health trusts. Reducing low-value examinations could free up resources for examinations with high value.
Insights
Geographical variations in musculoskeletal (MSK) imaging, particularly for knee and lower back MRIs, were substantial in Norway. Reducing low-value MSK imaging can optimize healthcare resources.
Area of Science:
- Radiology and Imaging
- Healthcare Management
- Public Health
Background:
- Musculoskeletal (MSK) conditions lead to significant diagnostic imaging utilization.
- Geographical variations in imaging can signal under- or overutilization.
- Low-value imaging provides minimal to no patient benefit.
Purpose of the Study:
- To evaluate temporal and geographical variations in MSK imaging in Norway (2013-2022).
- To specifically analyze variations in MRI of the knee and MRI of the lower back, identified as potentially low-value examinations.
Main Methods:
- Inclusion of inpatient and outpatient MSK examinations from 2013-2022.
- Data collection from the Norwegian Health Economics Administration and selected hospitals.
- Extrapolation of missing inpatient data and age/sex standardization to the European Standard Population.
Main Results:
- Approximately 1.88 million MSK examinations were performed annually in Norway.
- Overall MSK imaging use decreased by 6.8% over the study period.
- Significant geographical disparities were observed in potentially low-value MSK examinations, with some regions using over double the rate of others.
Conclusions:
- Temporal variations in MSK imaging use were minimal.
- Substantial geographical variations exist in MSK imaging utilization across hospital trusts.
- Reducing low-value MSK imaging can potentially reallocate resources to higher-value services.
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