Variation in MRI/CT utilization among FAMILY physicians and general internists in a multi-specialty group practice.
Variation in MRI/CT utilization among FAMILY physicians and general internists in a multi-specialty group practice.
复制标题
家庭医生和普通内科医生在多专业小组实践中 MRI/CT 使用情况的差异。
DOI：
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发表时间：
2005
影响因子：
3.1
通讯作者：
David Lindzey
中科院分区：
文献类型：
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作者：
G. Couchman;S. Forjuoh;Michael D. Reis;G. Bartels;David Lindzey
背景
本研究的目的是检查MRI/CT利用率的变化之间的家庭医生（FP）和普通内科医生（IM）在多专业组的做法。
材料/方法
使用管理数据，我们计算了每1，000名门诊患者和每1，000名独特患者的MRI/CT订购率和比率（RR），以比较34名FP和24名IM在位于放射设施50英里内的7家诊所中执业的比率。我们还评估了专业内的变化。通过多元线性回归建模分别确定FP和IM的变异来源和程度。
结果
IMs的MRI/CT检查率是FP的两倍（每1,000人中有29.6人对14.8人）。尽管各专业的绝对范围在统计学上相似，但IM的方差显著更高（86.1 vs. 52.3; p<0.0001）。FP的订购率范围为2.8 - 35.2（SD=7.23），而IM的范围为16.0 - 47.9（SD=9.27）。女性医生以更高的比率订购测试（RR=1.38; 95% CI=1.17-1.53）。在控制了医生性别、执业年限和患者小组规模后，从他们的诊所到放射设施的距离和患者严重程度指数是唯一与FP中MRI/CT排序显著相关的变量，解释了总方差的39%。
结论
尽管IM订购MRI/CT的比率较高，但来自两个专业的女性也是如此，高和低FP使用者之间的比率较高。FP的变化可以部分解释为他们的诊所距离放射设施网站和他们的病人的严重程度指数。
BACKGROUND
The objective of this study was to examine variations in MRI/CT utilization between family physicians (FPs) and general internists (IMs) within a multi-specialty group practice.
MATERIAL/METHODS
Using administrative data, we computed ordering rates of MRI/CT per 1,000 outpatient clinic visits and per 1,000 unique patients and rate ratios (RR) to compare rates between 34 FPs and 24 IMs practicing in 7 clinics located within 50 miles of the radiology facility. We also assessed intra-specialty variation. Sources and degree of variation were determined separately for FPs and IMs through multivariate linear regression modeling.
RESULTS
The IMs ordered MRI/CTs at twice the rate of FPs (29.6 vs. 14.8 per 1,000). Although the absolute ranges by specialty were statistically similar, the variance was significantly higher for IMs (86.1 vs. 52.3; p<0.0001). FPs' ordering rates ranged from 2.8 to 35.2 (SD=7.23), while IMs' ranged from 16.0 to 47.9 (SD=9.27). Female physicians ordered the tests at a higher rate (RR=1.38; 95% CI=1.17-1.53). After controlling for physician gender, years of practice, and patient panel size, distances from their clinics to the radiology facility site and patient severity index were the only variables that were significantly associated with MRI/CT ordering among FPs, explaining 39% of the total variance.
CONCLUSIONS
Although IMs ordered MRI/CTs at a higher rate, as were females from both specialties, there was a higher ratio between high and low FP utilizers. The variation in FPs can be partly explained by their clinic distance to the radiology facility site and their patient severity index.