Burke James F, Kerr Eve A, McCammon Ryan J, Holleman Rob, Langa Kenneth M, Callaghan Brian C
From the Department of Neurology (J.F.B., B.C.C.), Department of Internal Medicine (E.A.K., R.J.M., K.M.L.), Institute for Healthcare Policy and Innovation (J.F.B., E.A.K., K.M.L., B.C.C.), and Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor; and Neurology Section (J.F.B., B.C.C.) and Center for Clinical Management and Research (E.A.K., R.H., K.M.L.), VA Ann Arbor Healthcare System, MI.
Neurology. 2016 Aug 23;87(8):792-8. doi: 10.1212/WNL.0000000000002963. Epub 2016 Jul 8.
To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.
Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n = 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n = 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.
For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1% in the VA (p < 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0% in the VA (p < 0.001), and the difference persisted after excluding nontarget conditions.
Overuse of neuroimaging is likely less common in the VA than in a Medicare population. Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing.
为了给减少过度使用的举措提供信息依据，我们将一个大型医疗保险队列中的神经影像学检查适宜性与退伍军人事务部（VA）队列进行了比较。
2004年至2011年期间，在医疗保险和退伍军人事务部中分别针对头痛和神经病变建立了回顾性队列。医疗保险队列包括所有参加健康与退休研究（HRS）且有相关医疗保险理赔记录的患者（HRS - 医疗保险；头痛患者1244例，神经病变患者998例）。退伍军人事务部队列包括所有在退伍军人事务部接受服务的患者（头痛患者93755例，神经病变患者183642例）。纳入标准为年龄超过65岁且因新发神经病变或原发性头痛进行门诊就诊。使用现行程序术语代码来衡量神经影像学检查的使用情况，并依据已发表的用于行政数据的标准来定义潜在的过度使用情况。越来越具体的适宜性标准排除了神经影像学检查可能适用的非目标病症。
对于周围神经病变和头痛，与退伍军人事务部相比，HRS - 医疗保险队列中潜在不适当的影像学检查更为常见。在HRS - 医疗保险队列中，所有头痛患者中有49%接受了神经影像学检查，而在退伍军人事务部队列中这一比例为22.1%（p < 0.001），并且在分析更具体的过度使用定义时差异仍然存在。在HRS - 医疗保险队列中，所有新发神经病变患者中有23.7%接受了神经影像学检查，而在退伍军人事务部队列中这一比例为9.0%（p < 0.001），排除非目标病症后差异仍然存在。
退伍军人事务部中神经影像学检查的过度使用可能比医疗保险人群中少见。更好地理解退伍军人事务部中神经影像学检查使用更具选择性的原因，有助于为未来减少诊断性检查过度使用的举措提供信息依据。
