Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom.
J Magn Reson Imaging. 2019 Jun;49(7):e176-e182. doi: 10.1002/jmri.26560. Epub 2019 Jan 13.
Since 2008 primary care physicians (GPs) in our region have been allowed open access to knee MRI scans. There are questions about whether this changes referral practice and if it is an effective use of resources.
To describe the change in demographics of patients referred for knee MRI following implementation of a new referral pathway.
Retrospective observational study.
All primary care referrals between 2008 and 2015 for knee MRI from a population of 900,000.
FIELD STRENGTH/SEQUENCE: Not applicable.
Demographic profile and number of knee MRI referrals and subsequent arthroscopies.
Comparisons between urban and rural populations used the t-test. Test for normality used Shapiro-Wilks. Comparison between abnormal MRI proportions used a chi-squared test.
There were 23,928 knee MRI referrals (10,695 from GPs) between 2000 and 2015. MRI knee referrals rose from 210 in 2008 to 2379 in 2015. The average age of the patient decreased from 46.8 (SD = 14.9) in 2008 to 41.3 (SD = 14.7) in 2015. Conversion to arthroscopy declined from 15.4% to 10.2%, but there was no significant change in abnormal scan proportion. Conversion rates showed no significant difference between rural (9.6%) and urban populations (10.5%). Referral rates were significantly higher in low socioeconomic status areas (47.3% vs. 34.6%). The median referral rate per 1000 patients was 13.8 (interquartile range = 8.4). Referral rates varied widely between practices.
Despite a large rise in knee MRI referrals from primary care, there has been no substantial change in the age profile, suggesting that there has been no increase in inappropriate referral of elderly patients in whom MRI is unlikely to influence management. A modest decrease in the conversion rate to arthroscopy may be reasonably offset against a decrease in secondary care referrals. Socioeconomic status of the target population must be considered when planning primary care knee MRI services.
4 Technical Efficacy Stage: 6 J. Magn. Reson. Imaging 2019.
自 2008 年以来，我们地区的初级保健医生（全科医生）获准自由获取膝关节 MRI 扫描。有人质疑这是否会改变转诊实践，以及这是否是有效利用资源。
描述在实施新转诊途径后，接受膝关节 MRI 检查的患者人群特征的变化。
回顾性观察研究。
2008 年至 2015 年期间，来自 90 万人群的所有初级保健转诊接受膝关节 MRI。
场强/序列：不适用。
人口统计学特征、膝关节 MRI 转诊人数以及随后的关节镜检查人数。
城乡人群比较采用 t 检验。正态性检验采用 Shapiro-Wilks。异常 MRI 比例的比较采用卡方检验。
2000 年至 2015 年期间，共进行了 23928 次膝关节 MRI 检查（10695 次由全科医生进行）。MRI 膝关节检查从 2008 年的 210 次增加到 2015 年的 2379 次。患者平均年龄从 2008 年的 46.8（标准差=14.9）降至 2015 年的 41.3（标准差=14.7）。转换为关节镜检查的比例从 15.4%降至 10.2%，但异常扫描比例无显著变化。农村（9.6%）和城市人群（10.5%）之间的转化率无显著差异。在社会经济地位较低的地区（47.3% vs. 34.6%），转诊率明显更高。每 1000 名患者的中位数转诊率为 13.8（四分位间距=8.4）。转诊率在不同实践之间差异很大。
尽管初级保健膝关节 MRI 检查的数量大幅增加，但年龄分布没有明显变化，这表明对接受 MRI 检查不太可能影响治疗的老年患者的不适当转诊并未增加。关节镜检查转化率的适度下降可能与二级保健转诊的减少相抵消。在规划初级保健膝关节 MRI 服务时，必须考虑目标人群的社会经济地位。
4 技术功效分期：6 J. 磁共振成像 2019。
