Healthcare institutions are increasingly directing patients to nurse practitioners and physician's assistants in order to trim their budgets, but is there really cost reduction if these mid-level providers tend to order a greater number of unnecessary, advanced imaging exams?
Dr. David Schuster from the Asheville Veteran's Affairs Medical Center in North Carolina said his department asked themselves this question when a high number of requisitions for CT, MR, ultrasound, and nuclear medicine scans were submitted by mid-level providers.
"This study came about because of the perception that mid-level providers were ordering more imaging exams, perhaps unnecessarily so," he told attendees of the American Roentgen Ray Society meeting in May. "Is there a difference in rates of imaging utilization between physicians and mid-level providers? We studied 11 doctors and eight mid-level providers in an ambulatory care setting with a retrospective, three-month analysis."
In total, the 19 practitioners saw 9,992 patients and ordered 1,022 advanced imaging exams. While the results of this small study did not yield statistically significant results, they did offer some preliminary information on imaging utilization rates: mid-level providers ordered twice as many CT scans as physicians and three times as many MRI and nuclear medicine tests, Schuster said.
However, the "appropriateness (of the test) was not evaluated," Schuster added. "We took the number of imaging studies ordered by a practitioner and divided it by the number of patient visits in that time period, and we came up with the imaging utilization rate. But this data had great variation and did not achieve statistical significance."
One variation that was not accounted for was how long the mid-level professional or physician had been practicing.
"It may be that with increasing years or experience, this may correlate inversely with the imaging utility rate," Schuster said. "It may also be that mid-level providers are inappropriately ordering more exams or it may be that physicians are ordering too few exams."
These issues will be addressed in a broader study currently underway, Schuster said. This retrospective multicenter study will look at the imaging utilization rates for eight mid-Atlantic VA hospitals in 1999. Early data from two hospitals are in line with the results of the Asheville study, thus far, but there are no definite numbers yet, Schuster said.
If the results of the multicenter study continue to produce similar information, the next step will be to develop educational material outlining advanced imaging protocols, he said.
One ARRS attendee asked if the mid-level providers at Asheville had been informed of the study results, and whether that would affect their advanced imaging utilization rates. Schuster said his department has not opened up the data for review by either the subjects or other departments.
By Shalmali Pal
AuntMinnie.com staff writer
June 9, 2000
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