Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
AJR Am J Roentgenol. 2012 Apr;198(4):858-65. doi: 10.2214/AJR.11.6475.
The objective of our study was to assess the association of hospital characteristics and diagnosis with repeated utilization of CT and MRI using the nationwide population-based Taiwan National Health Insurance database.
All CT and MR examinations for all health care services-including inpatient, outpatient, and emergency services-performed during 2004 and 2005 were identified. Logistic regression using generalized estimating equations was used for multivariate analysis to explore the relationships between hospital characteristics, diagnosis, and the use of CT and MRI repeated within 90 days.
A total of 2,152,292 patients underwent CT and MR examinations during the study period, and 21.5% of those patients underwent repeat scanning within 90 days. The medical center had the highest rate of repeat scanning (24.9%) followed by the regional hospital (20.4%) and community hospital (13%). Repeat CT or MRI was most commonly performed of patients with a malignancy (31.8%), a neurologic disorder (24.0%), or a brain or spinal injury (25.3%).
Our study shows that repeat use of CT and MRI within 90 days is high and is related to both diagnosis and hospital characteristics. Although the Taiwanese experience might not apply to all countries, this knowledge should aid in the review of health care policies so that guidelines for repeat scanning may be tailored to the different levels of hospitals (medical centers, 25%; regional hospital, 20%; community hospital, 13%) and to different diseases (malignant neoplasms, 32%; neurologic disorders and brain, neck, or spinal injury, 25%; other entities, 20%) to achieve maximum efficiency within a limited health care budget.
本研究旨在利用全台湾全民健康保险数据库评估医院特征和诊断与 CT 和 MRI 重复使用之间的关联。
确定 2004 年至 2005 年期间所有医疗保健服务（包括住院、门诊和急诊服务）进行的所有 CT 和 MRI 检查。使用广义估计方程的逻辑回归进行多变量分析，以探索医院特征、诊断与 90 天内 CT 和 MRI 重复使用之间的关系。
本研究期间共有 2152292 名患者接受 CT 和 MRI 检查，其中 21.5%的患者在 90 天内接受重复扫描。医疗中心的重复扫描率最高（24.9%），其次是区域医院（20.4%）和社区医院（13%）。重复 CT 或 MRI 最常用于恶性肿瘤（31.8%）、神经障碍（24.0%）或脑或脊髓损伤（25.3%）患者。
本研究表明，90 天内 CT 和 MRI 的重复使用率较高，与诊断和医院特征有关。尽管台湾的经验可能不适用于所有国家，但这些知识应该有助于审查医疗保健政策，以便根据不同级别的医院（医疗中心，25%；区域医院，20%；社区医院，13%）和不同疾病（恶性肿瘤，32%；神经障碍和脑、颈部或脊髓损伤，25%；其他实体，20%）制定重复扫描指南，以在有限的医疗保健预算内实现最大效率。
