Huntington Scott F, Zhu Weiwei, Hoag Jessica R, Wang Rong, Zeidan Amer M, Giri Smith, Podoltsev Nikolai A, Gore Steven D, Ma Xiaomei, Gross Cary P, Davidoff Amy J
Department of Internal Medicine, Section of Hematology.
Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University, New Haven, CT.
JNCI Cancer Spectr. 2019 May 11;3(2):pkz030. doi: 10.1093/jncics/pkz030. eCollection 2019 Jun.
Physician ownership of imaging equipment has been shown to be associated with greater use of low-value imaging. However, it is unclear whether ownership also influences utilization of appropriate imaging. We conducted a cohort study of older adults diagnosed with three non-Hodgkin lymphomas with distinct guideline recommendations concerning the use of positron emission tomography (PET) during staging (recommended, not recommended, or equivocal). We found patients who were treated by oncologists with PET ownership were more likely to receive a staging PET regardless of lymphoma subtype. However, the difference in utilization by ownership status was smallest (6%, 95% confidence interval = 2% to 11%, = .01) in the setting of diffuse large B cell lymphoma, where consensus guidelines recommend routine use of PET. Overall, removing financial incentives related to imaging self-referral may reduce utilization during cancer care, with the potential for greatest impact on imaging of equivocal or low clinical utility.
研究表明，医生拥有成像设备与更多地使用低价值成像有关。然而，尚不清楚设备所有权是否也会影响适当成像的使用。我们对被诊断患有三种非霍奇金淋巴瘤的老年人进行了一项队列研究，这些淋巴瘤在分期时关于正电子发射断层扫描（PET）的使用有不同的指南建议（推荐、不推荐或不明确）。我们发现，无论淋巴瘤亚型如何，由拥有PET设备的肿瘤学家治疗的患者更有可能接受分期PET检查。然而，在弥漫性大B细胞淋巴瘤的情况下，根据共识指南建议常规使用PET，按设备所有权状态划分的使用差异最小（6%，95%置信区间 = 2%至11%，P = 0.01）。总体而言，消除与影像自我转诊相关的经济激励措施可能会减少癌症治疗期间的影像使用，对不明确或临床效用低的影像影响可能最大。
