A research paper titled, “Outpatient Facility-based Order Variation in Combined Imaging” has been published online by the journal PLOS ONE. Two posters related to elements of the study were presented at the 2019 annual meetings of the American College of Radiology and AcademyHealth.
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. Although combined exams are sometimes clinically necessary, they expose patients to additional radiation. Identification of outlier facilities may be useful in targeting quality improvement initiatives. The objective of the study was to examine the variation between healthcare facilities in ordering and receiving orders for three types of combined CT: CT abdomen (without/with contrast), CT thorax (without/with contrast), and concurrent CT brain and sinus. The study additionally sought to describe the relationship between health plan type (commercial versus Medicare Advantage) and the ordering of combined imaging.
The study analyzed orders for CT images that had been authorized through the prior authorization process of a non-denial prior authorization company. The study population consisted of all authorized outpatient orders for abdominal, thoracic, and brain/sinus CT, issued from 2013 to 2017, pertaining to people with commercial and Medicare Advantage health plans, extracted from the database of a prior authorization company.
The analysis was performed in two ways: orders were grouped by ordering facility and by designated rendering facility. For each facility and anatomical area, the number of orders authorized for single CTs and combined CTs were counted. Then, 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.
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.
The study concluded that variability was greater when orders were grouped by ordering facility, rather than rendering facility. Furthermore, associations were found between health plan type and combined CT ordering. In response to the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., remarked, “While the rate of combined CT imaging has been examined in other contexts, we believe that this is the first study to compare the rate of combined CT orders pertaining to patients with commercial versus Medicare Advantage health plans. Furthermore, while prior research has focused on claims, we have been able to study ordering patterns due to our access to prior authorization data. Thanks to the research collaboration between HealthHelp, Humana, and radiologists from Thomas Jefferson University, we were in the unique position to study CT ordering behavior as it pertains to patients with commercial and Medicare Advantage health plans.”
To read this study in its entirety, please click here: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0224735