ElHabr Andrew, Merdan Selin, Ayer Turgay, Prater Adam, Hanna Tarek N, Horný Michal, Duszak Richard, Hughes Danny R
Department of Industrial and Systems Engineering, Georgia Institute of Technology, 755 Ferst Dr NW, Atlanta, GA 30332.
Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
AJR Am J Roentgenol. 2022 Jan;218(1):165-173. doi: 10.2214/AJR.21.25864. Epub 2021 Aug 4.
The volume of emergency department (ED) visits and the number of neuroimaging examinations have increased since the start of the century. Little is known about this growth in the commercially insured and Medicare Advantage populations. The purpose of our study was to evaluate changing ED utilization of neuroimaging from 2007 through 2017 in both commercially insured and Medicare Advantage enrollees. Using patient-level claims from Optum's deidentified Clinformatics Data Mart database, which annually includes approximately 12-14 million commercial and Medicare Advantage health plan enrollees, annual ED utilization rates of head CT, head MRI, head CTA, neck CTA, head MRA, neck MRA, and carotid duplex ultrasound (US) were assessed from 2007 through 2017. To account for an aging sample population, utilization rates were adjusted using annual relative proportions of age groups and stratified by patient demographics, payer type, and provider state. Between 2007 and 2017, age-adjusted ED neuroimaging utilization rates per 1000 ED visits increased 72% overall (compound annual growth rate [CAGR], 5%). This overall increase corresponded to an increase of 69% for head CT (CAGR, 5%), 67% for head MRI (CAGR, 5%), 1100% for head CTA (CAGR, 25%), 1300% for neck CTA (CAGR, 27%), 36% for head MRA (CAGR, 3%), and 52% for neck MRA (CAGR, 4%) and to a decrease of 8% for carotid duplex US (CAGR, -1%). The utilization of head CT and CTA of the head and neck per 1000 ED visits increased in enrollees 65 years old or older by 48% (CAGR, 4%) and 1011% (CAGR, 24%). Neuroimaging utilization in the ED grew considerably between 2007 and 2017, with growth of head and neck CTA far outpacing the growth of other modalities. Unenhanced head CT remains by far the dominant ED neuroimaging examination. The rapid growth of head and neck CTA observed in the fee-for-service Medicare population is also observed in the commercially insured and Medicare Advantage populations. The appropriateness of this growth should be monitored as the indications for CTA expand.
自本世纪初以来，急诊科就诊量和神经影像学检查数量均有所增加。对于商业保险人群和医疗保险优势计划人群的这种增长情况，我们了解得很少。我们研究的目的是评估2007年至2017年商业保险人群和医疗保险优势计划参保者神经影像学检查在急诊科的使用变化情况。利用Optum公司去识别化的临床信息数据集市数据库中的患者层面理赔数据，该数据库每年大约包含1200万至1400万商业保险和医疗保险优势计划的参保者，评估了2007年至2017年头颅CT、头颅MRI、头颅CT血管造影（CTA）、颈部CTA、头颅磁共振血管造影（MRA）、颈部MRA以及颈动脉双功超声（US）的年度急诊科使用率。为了考虑样本人群老龄化因素，使用率按照年龄组的年度相对比例进行了调整，并按患者人口统计学特征、支付方类型和医疗机构所在州进行了分层。2007年至2017年期间，每1000次急诊科就诊的年龄调整后神经影像学检查使用率总体增长了72%（复合年增长率[CAGR]为5%）。这种总体增长对应着头颅CT增长69%（CAGR为5%）、头颅MRI增长67%（CAGR为5%）、头颅CTA增长1100%（CAGR为25%）、颈部CTA增长1300%（CAGR为27%）、头颅MRA增长36%（CAGR为3%）、颈部MRA增长52%（CAGR为4%），而颈动脉双功超声下降了8%（CAGR为 -1%）。65岁及以上参保者每1000次急诊科就诊的头颅CT和头颈部CTA使用率分别增长了48%（CAGR为4%）和1011%（CAGR为24%）。2007年至2017年期间，急诊科的神经影像学检查使用率大幅增长，头颈部CTA的增长远远超过其他检查方式。未增强头颅CT仍然是目前急诊科主要的神经影像学检查。在按服务收费的医疗保险人群中观察到的头颈部CTA的快速增长，在商业保险人群和医疗保险优势计划人群中也同样存在。随着CTA适应证的扩大，应监测这种增长的合理性。
