Document Type
Article
Publication Date
11-14-2019
Abstract
OBJECTIVE: Combined computed tomography (CT) occurs when one anatomical area is simultaneously imaged both without and with contrast, or two overlapping anatomical areas are imaged concurrently. While this has been studied in a Traditional Medicare population, it has not been studied in other populations subject to prior authorization. This study explores between-facility variation in ordering and receiving orders to render combined CT in a mixed commercial and Medicare Advantage population.
METHODS: Orders for CT abdomen (without/with contrast), CT thorax (without/with contrast), and concurrent CT brain and sinus authorized by a prior authorization company from 2013-2017, pertaining to patients with commercial or Medicare Advantage health plans from one national insurer, were extracted. Orders were issued and rendered by both hospitals and nonhospitals. The analysis was performed separately for each anatomical area in two ways: orders were grouped by ordering facility, and by designated rendering facility. For each facility, the ratio of combined to total orders was calculated, and analysis of variance was used to determine whether there were significant differences in this rate by year. The association between health plan type and combined imaging rates was assessed.
RESULTS: Combined rates [ratio±standard deviation] for abdomen, thorax, and brain/sinus were 0.306±0.246, 0.089±0.142, and 0.002±0.01 respectively when the analysis was conducted according to ordering facility, and 0.311±0.178, 0.096±0.113, and 0.001±0.006 when the analysis was conducted according to designated rendering facility. Combined CT abdomen and CT thorax rates decreased monotonically from 2013 to 2017, decreases that were significant (P < .01) regardless of whether orders were grouped by ordering or rendering facility. Combined CT abdomen and CT thorax rates significantly differed between orders pertaining to people with commercial and Medicare Advantage plans.
DISCUSSION: Variability was greater when orders were grouped by ordering facility, rather than rendering facility. Health plan type may influence whether a patient receives combined CT.
Recommended Citation
Powell, Adam C.; Wang, Yan; Smith, Gary L.; Long, James W.; Deshmukh, Uday U.; Friedman, David P.; Roth, Christopher G.; and Sundaram, Baskaran, "Outpatient facility-based order variation in combined imaging." (2019). Department of Radiology Faculty Papers. Paper 78.
https://jdc.jefferson.edu/radiologyfp/78
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
31725755
Language
English
Comments
This article is the author’s final published version in PLoS ONE, Volume 14, Issue 11, November 2019, Article number e0224735.
The published version is available at https://doi.org/10.1371/journal.pone.0224735. Copyright © Powell et al.