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Quantifying utilization and practice variation of electroconvulsive therapy

J R Westphal1, R Horswell, S Kumar

  • 1Department of Psychiatry, Louisiana State University Medical Center at Shreveport, LA 71130-3932, USA.

Convulsive Therapy
|January 23, 1998
PubMed
Summary
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This study analyzed electroconvulsive therapy (ECT) use in Louisiana Medicare patients aged 65+. Inpatient ECT utilization showed significant geographic variation, indicating disparities in access and practice across the state.

Area of Science:

  • Geriatric Medicine
  • Health Services Research
  • Psychiatric Treatments

Background:

  • Electroconvulsive therapy (ECT) is an effective treatment for severe mental illness.
  • Understanding utilization patterns and practice variations is crucial for healthcare policy and resource allocation.
  • Previous studies have indicated variability in ECT use, but state-specific data for older adults is limited.

Purpose of the Study:

  • To quantify inpatient electroconvulsive therapy (ECT) utilization rates among Medicare beneficiaries aged 65 and older in Louisiana.
  • To assess the practice variation and geographic distribution of inpatient ECT services within Louisiana.
  • To identify potential disparities in ECT access for the elderly population in the state.

Main Methods:

  • Analysis of Louisiana Medicare claims (MedPar) history and beneficiary denominator files for fiscal years 1993-1994.

Related Experiment Videos

  • Application of chi-squared tests to determine the statistical significance of utilization differences between parishes.
  • Utilized the modified systemic component of variance (SCV) to quantify the magnitude of geographic variation in ECT utilization.

    • Main Results:

    • The overall inpatient ECT utilization rate was 2.38 per 10,000 person-years, consistent with national averages.
    • Chi-squared analysis revealed significant nonrandom variation (p=0.0003) in ECT utilization across Louisiana parishes.
    • Systemic Component of Variance (SCV) indicated substantial geographic variability, with SCVs of 0.47 for major depression and 1.34 for inpatient ECT.

    Conclusions:

    • Inpatient electroconvulsive therapy (ECT) utilization among Louisiana Medicare beneficiaries aged 65+ exhibits significant geographic variability.
    • The observed practice variation suggests potential disparities in access to this important psychiatric treatment across different regions of the state.
    • Further research is warranted to identify and quantify the factors contributing to this geographic variation in inpatient ECT utilization.