Levin David C, Rao Vijay M, Parker Laurence, Frangos Andrea J
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania; HealthHelp, Inc, Houston, Texas.
Center for Research on Utilization of Imaging Services, Department of Radiology, Thomas Jefferson University Hospital and Jefferson Medical College, Philadelphia, Pennsylvania.
J Am Coll Radiol. 2014 Nov;11(11):1044-7. doi: 10.1016/j.jacr.2014.07.008. Epub 2014 Nov 3.
The aim of this study was to examine recent trends in imaging utilization in emergency departments (EDs) in the Medicare population.
The 2002 to 2012 Medicare Part B databases were used. Imaging studies were categorized by modality. Medicare's place-of-service codes identified those studies performed in ED patients. Specialty codes identified the specialties of the interpreting physicians. Utilization rates per 1,000 Medicare beneficiaries were calculated. Trends were assessed in plain radiography (XR), CT, noncardiac ultrasound, MRI, and nuclear medicine.
XR and CT were the most widely used modalities in ED patients. From 2002 to 2012, the XR utilization rate per 1,000 increased from 248.7 to 320.0 (+29%), and CT increased from 57.2 to 147.9 (+159%). Utilization rates of the other modalities were much lower. Ultrasound increased from 9.5 to 21.0 (+121%), while MRI increased from 1.4 to 5.1 (+264%). Growth in these 4 modalities was continuous and did not show the flattening that has characterized the utilization trends in other places of service. Nuclear medicine use was very low and remained essentially flat. During the study period, CT accrued 91 new examinations per 1,000, followed by XR at 71 and ultrasound at 11.5. The vast majority of examinations were interpreted by radiologists.
Despite the cessation of overall utilization growth of the various modalities in recent years, ED utilization rates continued to increase. The greatest increases, in terms of accrued new examinations per 1,000, were seen in CT and XR. This suggests that radiologists and ED physicians need to work together to better manage imaging utilization.
本研究旨在调查医疗保险人群中急诊科（ED）影像检查使用的近期趋势。
使用2002年至2012年医疗保险B部分数据库。影像检查按方式分类。医疗保险的服务地点代码确定了在急诊患者中进行的那些检查。专业代码确定了解读医师的专业。计算每1000名医疗保险受益人的使用率。评估了普通X线摄影（XR）、CT、非心脏超声、MRI和核医学的趋势。
XR和CT是急诊患者中使用最广泛的方式。从2002年到2012年，每1000人的XR使用率从248.7增加到320.0（增长29%），CT从57.2增加到147.9（增长159%）。其他方式的使用率要低得多。超声从9.5增加到21.0（增长121%），而MRI从1.4增加到5.1（增长264%）。这4种方式的增长是持续的，并未显示出其他服务地点使用趋势所具有的趋于平稳的情况。核医学的使用非常低且基本保持平稳。在研究期间，每1000人CT新增91项检查，其次是XR新增71项，超声新增11.5项。绝大多数检查由放射科医生解读。
尽管近年来各种方式的总体使用增长已经停止，但急诊使用率仍在继续上升。就每1000人新增检查而言，CT和XR的增长幅度最大。这表明放射科医生和急诊医生需要共同努力，更好地管理影像检查的使用。
