Geographic Variation in the Utilization of Noninvasive Diagnostic Imaging: National Medicare Data, 1998-2007
Geographic Variation in the Utilization of Noninvasive Diagnostic Imaging: National Medicare Data, 1998-2007
复制标题
DOI：
10.2214/ajr.09.3528
复制
发表时间：
2010-04-01
影响因子：
5
通讯作者：
Rao, Vijay M.
中科院分区：
文献类型：
--
作者：
Parker, Laurence;Levin, David C.;Rao, Vijay M.
客观的。本研究概述了 1998 年至 2007 年期间医疗保险人群中无创诊断成像利用的地理变化。材料和方法。医疗保险和医疗补助服务中心 1998-2007 年医生供应商程序摘要主文件是该研究的主要数据源。医生供应商程序摘要主文件是所有 32-3700 万按服务收费受益人的完整 B 部分 Medicare 计费记录的汇总，并提供按地理区域分类的每种类型程序执行的总数。对于 10 个医疗保险和医疗补助服务中心地理区域，我们计算了研究每年的总体无创诊断成像程序利用率以及最高与最低区域的比率（相对风险统计数据）。在研究的第一年和最后几年，我们计算了 28 个无创诊断成像类别的这些数字。结果。 2007年，亚特兰大地区的利用率最高，人均4.60次，西雅图最低，人均2.99次。相对风险为1.54。在研究的10年里，各地区的相对利用率变化不大，相对风险在1.47到1.56之间。 2007年，骨密度测定显示区域相对风险最低（1.29），心血管PET显示区域相对风险最高（70.2）。心血管无创诊断成像和高科技、高成本的无创诊断成像（例如MRI、PET和核医学）显示出较高的区域相对风险。 结论。地区差异很大——最高地区比最低地区高约 50%——但并不大。地区差异略有增加。心血管和高科技手术显示出最大的地区差异。
OBJECTIVE. This study provides an overview of geographic variation in noninvasive diagnostic imaging utilization in the Medicare population over the period 1998 to 2007.MATERIALS AND METHODS. The Centers for Medicare and Medicaid Services Physician Supplier Procedure Summary Master Files for 1998-2007 were the primary data source for the study. Physician Supplier Procedure Summary Master Files are an aggregation of the complete Part B Medicare billing records for all 32-37 million fee-for-service beneficiaries and provide the total number of each type of procedure performed, categorized by geographic regions. For the 10 Centers for Medicare and Medicaid Services geographic regions, we calculated the overall noninvasive diagnostic imaging procedure utilization rate and the ratio of the highest to lowest region (a relative risk statistic) for each year of the study. For the first and last years of the study, we calculated these numbers for 28 noninvasive diagnostic imaging categories.RESULTS. In 2007, the Atlanta region had the highest utilization rate, with 4.60 procedures per capita, and Seattle had the lowest rate, with 2.99 procedures per capita. The relative risk was 1.54. Over the 10 years of the study, there was little change in the relative utilization rates of regions, and the relative risk ranged between 1.47 and 1.56. In 2007, bone densitometry showed the lowest regional relative risk (1.29), and cardiovascular PET showed the highest regional relative risk (70.2). Cardiovascular noninvasive diagnostic imaging and high-technology, high-cost noninvasive diagnostic imaging (e. g., MRI, PET, and nuclear medicine) showed high regional relative risk.CONCLUSION. Regional variation is substantial-about 50% higher in the highest regions than in the lowest regions-but is not huge. Regional variation is increasing slightly. Cardiovascular and high-technology procedures show the greatest regional variation.