Technische Universität Berlin, Department of Health Care Management, Berlin, Germany.
Z Evid Fortbild Qual Gesundhwes. 2022 Dec;175:76-80. doi: 10.1016/j.zefq.2022.09.004. Epub 2022 Nov 2.
Germany ranks high concerning the per capita supply of computer tomographs (CT) and positron emission tomographs (PET) which may incentivize supply-induced use. Beyond that, international comparison shows high per capita examinations. However, misuse of diagnostic imaging may cause harm to patients and the health care system. The use of diagnostic imaging in Germany has been insufficiently studied so far. Therefore, the study aimed to determine the extent of regional differences as well as supply and demand side factors of per capita CT and PET examinations in German inpatient care.
Cartographic visualizations and a random intercept model controlling for the regional disease burden, ambulatory provided supply and demand, and population deprivation between 2010 and 2017 for CT and between 2016 and 2017 for PET were applied. For this purpose, the Nationwide hospital discharge data (DRG statistics), hospital structured quality reports, the National Association of Statutory Health Insurance Physicians, the Central Research Institute of Ambulatory Health Care in Germany, and the German Index of Socioeconomic Deprivation were used.
We found a substantial regional variation of examination rates (-63 to +108% for CT and from -94 up to +847% for PET). Regarding PET, the supply structures have a significant impact on examinations per 1,000 inhabitants (28.46, p < .000). Both devices were used in correlation with the regional disease burden. Ambulatory and inpatient CT examination rates were positively associated.
The regional differences identified are to some extent attributable to the regional burden of disease and thus warranted. Although the inpatient PET supply influences utilization rates, the direction of the effect should be investigated more closely for valid statements. The findings in terms of CT should be treated with caution. The cartographic distribution and examination rates indicate global overuse. The clear separation of inpatient and ambulatory sectors leads to misallocation of scarce resources, medically unnecessary multiple examinations, and capacity utilization problems.
The results obtained have great potential for assessing and analyzing the adoption and rapid expansion of imaging technologies. Capacity utilization figures should be the focus of further research to assess utilization rates both economically and medically. Policy makers should address ongoing issues of operational and organizational separation of inpatient and ambulatory sectors in the German health care system.
德国的人均计算机断层扫描（CT）和正电子发射断层扫描（PET）供应量位居世界前列，这可能会刺激供应诱导的使用。除此之外，国际比较还显示人均检查量较高。然而，诊断成像的滥用可能会对患者和医疗保健系统造成伤害。到目前为止，德国对诊断成像的使用情况研究不足。因此，该研究旨在确定德国住院患者人均 CT 和 PET 检查的区域差异程度以及供需方因素。
利用 2010 年至 2017 年 CT 以及 2016 年至 2017 年 PET 的区域疾病负担、门诊提供的供应和需求以及人口贫困情况的制图可视化和随机截距模型进行控制。为此，使用了全国性医院出院数据（DRG 统计数据）、医院结构化质量报告、国家法定健康保险医师协会、德国门诊保健中央研究所和德国社会经济剥夺指数。
我们发现检查率存在显著的区域差异（CT 为-63%至+108%，PET 为-94%至+847%）。对于 PET，供应结构对每 1000 名居民的检查数量有显著影响（28.46，p < 0.000）。两种设备都与区域疾病负担相关。门诊和住院 CT 检查率呈正相关。
所确定的区域差异在一定程度上归因于区域疾病负担，因此是合理的。尽管住院 PET 供应会影响利用率，但为了做出有效的陈述，还需要更仔细地研究其影响方向。CT 的发现应谨慎对待。地图分布和检查率表明整体过度使用。住院和门诊部门的明确分离导致了稀缺资源的配置不当、不必要的多次检查以及产能利用问题。
研究结果在评估和分析成像技术的采用和快速扩张方面具有巨大潜力。利用能力数据应该是进一步研究的重点，以从经济和医学角度评估利用率。政策制定者应解决德国医疗保健系统中住院和门诊部门在运营和组织上分离的持续问题。
