Henley M B, Mann F A, Holt S, Marotta J
Department of Orthopaedic Surgery, Harborview Medical Center, University of Washington, Box 359798, 325 9th Ave., Seattle, WA 98104-2499, USA.
AJR Am J Roentgenol. 2001 Apr;176(4):851-4. doi: 10.2214/ajr.176.4.1760851.
The objective of our study was to determine the utilization rates of diagnostic radiology services at an urban level 1 trauma center.
This was an observational study of imaging use patterns from 1993 to 1998. Data were segregated by patient type and imaging procedure. Annual hospital admissions were adjusted for severity of illness using the Health Care Financing Administration's case-mix index. Per-patient imaging trends for the emergency department and outpatients were assessed using a ratio of the total number of procedures to the number of patient visits. Linear regression models were used to assess the strength of associations between resource use, measured as relative value units (RVUs), and independent variables (calendar year, patient type, and examination type).
The RVUs for all imaging increased 53% for inpatients, 69% for outpatients, and 85% in the emergency department. No significant trend for use was found for the aggregate of inpatient imaging. There was a significant increase in the inpatient MR imaging RVUs (p = 0.04). No significant trend was found for the aggregated outpatient imaging RVUs. The trends were significant for angiography (p = 0.006), MR imaging (p = 0.002), and sonography (p = 0.04). The aggregated emergency room imaging RVUs showed a significant increase over time (p < 0.03).
The number of imaging procedures increased during the study period. There was no overall trend toward increasing use of imaging in inpatients once an adjustment for severity of illness was made. Increases in patient visit-adjusted emergency department use of CT, sonography, and nuclear medicine procedures resulted from changes in practice patterns. For emergency department and outpatient settings, adjusting for the number of patient visits explains a significant portion of the increase in utilization.
我们研究的目的是确定一家城市一级创伤中心诊断放射学服务的利用率。
这是一项对1993年至1998年影像使用模式的观察性研究。数据按患者类型和影像检查程序进行分类。使用医疗保健财务管理局的病例组合指数对年度医院入院病例进行疾病严重程度调整。通过将检查程序总数与患者就诊次数之比来评估急诊科和门诊患者的人均影像检查趋势。使用线性回归模型评估以相对价值单位（RVU）衡量的资源使用与自变量（日历年份、患者类型和检查类型）之间关联的强度。
所有影像检查的RVU，住院患者增加了53%，门诊患者增加了69%，急诊科增加了85%。住院患者影像检查的总体使用情况未发现显著趋势。住院患者磁共振成像的RVU有显著增加（p = 0.04）。门诊患者影像检查的总体RVU未发现显著趋势。血管造影（p = 0.006）、磁共振成像（p = 0.002）和超声检查（p = 0.04）的趋势显著。随着时间推移，急诊科影像检查的总体RVU显著增加（p < 0.03）。
在研究期间，影像检查程序的数量有所增加。在对疾病严重程度进行调整后，住院患者影像检查的使用没有总体增加趋势。急诊科经患者就诊次数调整后的CT、超声检查和核医学检查使用量的增加是由实践模式的变化导致的。对于急诊科和门诊环境，对患者就诊次数进行调整解释了利用率增加的很大一部分原因。
