Geographic variation in cancer-related imaging: Veterans Affairs health care system versus Medicare.
Geographic variation in cancer-related imaging: Veterans Affairs health care system versus Medicare.
复制标题
DOI：
10.7326/m14-0650
复制
发表时间：
2014-12-02
影响因子：
39.2
通讯作者：
Keating NL
中科院分区：
文献类型：
--
作者：
McWilliams JM;Dalton JB;Landrum MB;Frakt AB;Pizer SD;Keating NL
医疗服务使用的地域差异被解释为医疗服务浪费的间接证据。然而，较少的过度使用服务可能并不可靠地与较少的地理差异相关。比较收费医疗保险和退伍军人事务部(VA)医疗保健系统之间癌症相关成像使用的平均使用情况和地理差异。使用与癌症登记数据相关联的联邦医疗保险和退伍军人管理局使用数据，对2003-2005年间与癌症相关的成像进行观察分析。我们使用多水平模型来估计地理区域内医疗保险和退伍军人管理局患者队列之间的年度成像使用的平均差异，以及每个队列的不同区域使用的差异，并根据社会人口学和肿瘤特征进行调整。40个医院转诊地区。患有肺癌、结直肠癌或前列腺癌的老年男性，包括34,475名传统医疗保险受益人(联邦医疗保险队列)和6,835名退伍军人患者(VA队列)。1)每个患者的以肺癌、结直肠癌或前列腺癌为主要诊断的成像研究的数量(每项研究以标准化价格加权)；2)过度使用的直接衡量-前列腺癌的先进成像，转移风险较低。VA组调整后的癌症相关成像的年使用量低于医疗保险队列(价格加权计算，每名患者197vs.379vs.379美元；P<；0.001)，转移风险较低的前列腺癌的高级成像的年度使用量(41美元vs.117vs.117美元；P<；0.001)。在退伍军人事务部和联邦医疗保险队列中，癌症相关影像使用的地理差异在大小上是相似的。观察性研究设计。在退伍军人医疗保健系统中，癌症相关成像的使用低于收费医疗保险，但较低的使用与较少的地理差异无关。服务使用的地理差异可能不是过度使用程度的可靠指标。多丽丝·杜克慈善基金会和退伍军人事务部，政策和规划办公室。
Geographic variations in use of medical services have been interpreted as indirect evidence of wasteful care. Less overuse of services, however, may not be reliably associated with less geographic variation. To compare average use and geographic variation in use of cancer-related imaging between fee-for-service Medicare and the Department of Veterans Affairs (VA) health care system. Observational analysis of cancer-related imaging from 2003–2005, using Medicare and VA utilization data linked to cancer registry data. We used multilevel models to estimate mean differences in annual imaging use between cohorts of Medicare and VA patients within geographic areas and variation in use across areas for each cohort, adjusting for sociodemographic and tumor characteristics. 40 hospital referral regions. Older men with lung, colorectal, or prostate cancer, including 34,475 traditional Medicare beneficiaries (Medicare cohort) and 6,835 VA patients (VA cohort). 1)Per-patient count of imaging studies for which lung, colorectal, or prostate cancer was the primary diagnosis (each study weighted by a standardized price); 2)a direct measure of overuse—advanced imaging for prostate cancer at low risk of metastasis. Adjusted annual use of cancer-related imaging was lower in the VA cohort than the Medicare cohort (price-weighted count, $197 vs. $379/patient; P<0.001), as was annual use of advanced imaging for prostate cancer at low risk of metastasis ($41 vs. $117/patient; P<0.001). Geographic variation in cancer-related imaging use was similar in magnitude in the VA and Medicare cohorts. Observational study design. Use of cancer-related imaging was lower in the VA health care system than in fee-for-service Medicare, but lower use was not associated with less geographic variation. Geographic variation in service use may not be a reliable indicator of the extent of overuse. Doris Duke Charitable Foundation and Department of Veterans Affairs Office of Policy and Planning.