公众报告对腰椎间盘 MRI 检查应用的影响。

Effect of Public Reporting on MR Imaging Use for Low Back Pain.

机构信息

From the Department of Management, Policy and Community Health, University of Texas School of Public Health, 1200 Pressler St, Houston, TX 77030 (C.M.G., L.F.); The Commonwealth Fund, New York, NY (M.Z.); Centers for Medicare & Medicaid Services, Baltimore, Md (J.D.S.); and Department of Radiology, University of Texas School of Medicine, Houston, Tex (S.D.J.).

出版信息

Radiology. 2015 Jul;276(1):175-83. doi: 10.1148/radiol.15141145. Epub 2015 Mar 9.

DOI:10.1148/radiol.15141145

PMID:25759966

Abstract

PURPOSE

To determine whether magnetic resonance (MR) imaging examination rates for low back pain before conservative therapy in the Medicare and privately insured populations changed after introduction of a Centers for Medicare & Medicaid Services public reporting initiative.

MATERIALS AND METHODS

Institutional review board approval was obtained, with waiver of informed consent. A retrospective study was performed by using fee-for-service claims data from Medicare and a commercial carrier (Blue Cross Blue Shield of Texas [BCBSTX]) for Texas enrollees. OP-8 was calculated, which is a publicly reported measure as of 2009 of the proportion of MR imaging examinations performed for low back pain without history of conservative therapy. For 330 463 MR imaging examinations, OP-8 rates, trends, and regional variation were analyzed for 2008-2011 within different outpatient settings-outpatient hospital department (OHD) and nonhospital outpatient department (NOD)-according to payer. Largest-volume hospitals were also evaluated within the Medicare population.

RESULTS

No significant reduction was found in annual OP-8 values for Medicare or BCBSTX (Medicare OHD, 0.35 for 2008 vs 0.36 for 2009 [P = .01]; BCBSTX OHD, 0.42 for 2008 vs 0.44 for 2009 [P = .03]; Medicare NOD, 0.33 for 2008 vs 0.35 for 2009 [P < .0001]; and BCBSTX NOD, 0.43 for 2008 vs 0.42 for 2009[P = .23]). These changes were not sustained during subsequent years in the BCBSTX population, and there were no further changes in Medicare rates. Among hospitals with highest Medicare volumes, those with the highest OP-8 rates in 2008 were associated with the highest decrease in their measure. (The annual change rate was negative for all years, with 2008 as the reference [P < .0001 for 2009-2011].) Hospitals with the lowest OP-8 rates had increases in OP-8 rates, which persisted in following years (P = .006 for 2009, P = .037 for 2010, and P = .004 for 2011). Hospitals with baseline OP-8 rates in the 25th-75th percentile remained relatively steady over time.

CONCLUSION

No evidence was found that public reporting (OP-8) reduced MR imaging rates for low back pain without conservative therapy in either Medicare or commercially insured populations in hospital or nonhospital settings.

摘要

目的

确定在医疗保险和私人保险人群中，在医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）推出公共报告倡议后，接受保守治疗前进行腰椎磁共振（MR）成像检查的比率是否发生变化。

材料和方法

获得机构审查委员会批准，并放弃知情同意。通过使用来自德克萨斯州医疗保险和商业保险公司（蓝十字蓝盾德克萨斯州[BCBSTX]）的按服务收费索赔数据，对德克萨斯州参保人员进行了回顾性研究。OP-8 是截至 2009 年的一项公共报告措施，用于衡量无保守治疗史的腰痛患者进行 MR 成像检查的比例。对 2008 年至 2011 年不同门诊环境（门诊医院科[OHD]和非医院门诊科[NOD]）中，根据支付方对 330463 例 MR 成像检查的 OP-8 率、趋势和区域变化进行了分析。还对 Medicare 人群中最大容量的医院进行了评估。

结果

医疗保险或 BCBSTX 中，每年的 OP-8 值没有明显下降（医疗保险 OHD，2008 年为 0.35，2009 年为 0.36[P=.01]；BCBSTX OHD，2008 年为 0.42，2009 年为 0.44[P=.03]；医疗保险 NOD，2008 年为 0.33，2009 年为 0.35[P<.0001]；BCBSTX NOD，2008 年为 0.43，2009 年为 0.42[P=.23]）。在 BCBSTX 人群中，这些变化在随后几年并没有持续，医疗保险率也没有进一步变化。在 Medicare 量最高的医院中，那些 2008 年 OP-8 率最高的医院与该指标的降幅最大相关。（所有年份的年度变化率均为负值，以 2008 年为参照[2009 年至 2011 年，P<.0001]）。OP-8 率最低的医院 OP-8 率有所上升，并且在随后的几年中持续上升（2009 年，P=.006；2010 年，P=.037；2011 年，P=.004）。OP-8 率处于第 25 至 75 百分位的医院基线水平相对稳定。