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The association between local diagnostic testing intensity and invasive cardiac procedures
D E Wennberg1, M A Kellett, J D Dickens
1Division of Health Services Research, Department of Medicine, Maine Medical Center, Portland 04107, USA.
JAMA
|April 17, 1996
Summary
Geographic variation in invasive cardiac procedures is largely explained by diagnostic testing intensity. Local stress test use strongly predicts coronary angiography and revascularization rates in Medicare beneficiaries.
Area of Science:
- Cardiology
- Health Services Research
- Medical Economics
Background:
- Geographic variations exist in the utilization of invasive cardiac procedures.
- The role of diagnostic testing in driving these variations is not fully understood.
Purpose of the Study:
- To investigate the relationship between diagnostic testing and invasive cardiac procedures.
- To determine if diagnostic testing explains geographic variations in procedure rates.
Main Methods:
- Population-based cohort study using Medicare Part B data from northern New England.
- Analysis of utilization rates for stress tests, coronary angiography, and revascularization across 12 service areas.
- Linear regression to assess relationships between procedure categories, excluding tests performed post-intervention.
Main Results:
- A strong positive correlation was observed between total stress test rates and subsequent coronary angiography (R2=0.61).
- Imaging stress tests significantly explained variance in angiography rates (R2=0.50).
- Coronary angiography strongly predicted revascularization rates (R2=0.82), and stress tests also related to revascularization (R2=0.55).
Conclusions:
- Diagnostic testing rates substantially explain variations in subsequent invasive cardiac procedures.
- Local testing intensity is a key factor influencing the use of cardiac interventions.
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