Factors Driving CT Utilisation in Tertiary Hospitals: a Decomposition Analysis Using Linked Administrative Data in Western Australia

Overview

Journal BMJ Open

Specialty General Medicine

Date 2021 Nov 12

PMID 34764174

Citations 1

Authors

Ninh Thi Ha

Susannah Maxwell

Max K Bulsara

Jenny Doust

Donald McRobbie

Peter OLeary

John Slavotinek

Rachael Moorin

Affiliations

Soon will be listed here.

Abstract

Objectives: While CT scanning plays a significant role in healthcare, its increasing use has raised concerns about inappropriate use. This study investigated factors driving the changing use of CT among people admitted to tertiary hospitals in Western Australia (WA).

Design And Setting: A repeated cross-sectional study of CT use in WA in 2003-2005 and 2013-2015 using linked administrative heath data at the individual patient level.

Participants: A total of 2 375 787 tertiary hospital admissions of people aged 18 years or older.

Main Outcome Measure: Rate of CT scanning per 1000 hospital admissions.

Methods: A multivariable decomposition model was used to quantify the contribution of changes in patient characteristics and changes in the probability of having a CT over the study period.

Results: The rate of CT scanning increased by 112 CT scans per 1000 admissions over the study period. Changes in the distribution of the observed patient characteristics were accounted for 62.7% of the growth in CT use. However, among unplanned admissions, changes in the distribution of patient characteristics only explained 17% of the growth in CT use, the remainder being explained by changes in the probability of having a CT scan. While the relative probability of having a CT scan generally increased over time across most observed characteristics, it reduced in young adults (-2.8%), people living in the rural/remote areas (-0.8%) and people transferred from secondary hospitals (-0.8%).

Conclusions: Our study highlights potential improvements in practice towards reducing medical radiation exposure in certain high risk population. Since changes in the relative probability of having a CT scan (representing changes in scope) rather than changes in the distribution of the patient characteristics (representing changes in need) explained a major proportion of the growth in CT use, this warrants more in-depth investigations in clinical practices to better inform health policies promoting appropriate use of diagnostic imaging tests.

Citing Articles

Patterns of computed tomography utilisation in injury management: latent classes approach using linked administrative data in Western Australia.

Ha N, Harris M, Bulsara M, Doust J, Kamarova S, McRobbie D Eur J Trauma Emerg Surg. 2023; 49(6):2413-2427.

PMID: 37318517 PMC: 10728237. DOI: 10.1007/s00068-023-02303-y.

References

Tung M, Sharma R, Hinson J, Nothelle S, Pannikottu J, Segal J . Factors associated with imaging overuse in the emergency department: A systematic review. Am J Emerg Med. 2017; 36(2):301-309. PMC: 5815889. DOI: 10.1016/j.ajem.2017.10.049. View

van de Wetering R, Batenburg R, Versendaal J, Lederman R, Firth L . A balanced evaluation perspective: picture archiving and communication system impacts on hospital workflow. J Digit Imaging. 2006; 19 Suppl 1:10-7. PMC: 3045172. DOI: 10.1007/s10278-006-0628-2. View

Wright C, Bulsara M, Norman R, Moorin R . Increase in computed tomography in Australia driven mainly by practice change: A decomposition analysis. Health Policy. 2017; 121(7):823-829. DOI: 10.1016/j.healthpol.2017.04.010. View

Chakera T, Nagree Y, Song S, Jones P . Bridging the communication gap between public and private radiology services. Med J Aust. 2009; 191(10):558-60. DOI: 10.5694/j.1326-5377.2009.tb03310.x. View

Benchimol E, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I . The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. PLoS Med. 2015; 12(10):e1001885. PMC: 4595218. DOI: 10.1371/journal.pmed.1001885. View

Vest J, Jung H, Ostrovsky A, Das L, McGinty G . Image Sharing Technologies and Reduction of Imaging Utilization: A Systematic Review and Meta-analysis. J Am Coll Radiol. 2015; 12(12 Pt B):1371-1379.e3. PMC: 4730956. DOI: 10.1016/j.jacr.2015.09.014. View

Mendelson R, Bairstow P . Inappropriate imaging: why it matters, why it happens, what can be done. J Med Imaging Radiat Oncol. 2010; 54(3):173-7. DOI: 10.1111/j.1754-9485.2010.02173.x. View

Colla C, Morden N, Sequist T, Schpero W, Rosenthal M . Choosing wisely: prevalence and correlates of low-value health care services in the United States. J Gen Intern Med. 2014; 30(2):221-8. PMC: 4314495. DOI: 10.1007/s11606-014-3070-z. View

Korley F, Pham J, Kirsch T . Use of advanced radiology during visits to US emergency departments for injury-related conditions, 1998-2007. JAMA. 2010; 304(13):1465-71. PMC: 11660594. DOI: 10.1001/jama.2010.1408. View

10.

Picano E . Sustainability of medical imaging. BMJ. 2004; 328(7439):578-80. PMC: 381057. DOI: 10.1136/bmj.328.7439.578. View

11.

Holman C, Bass A, Rosman D, Smith M, Semmens J, Glasson E . A decade of data linkage in Western Australia: strategic design, applications and benefits of the WA data linkage system. Aust Health Rev. 2008; 32(4):766-77. DOI: 10.1071/ah080766. View

12.

Holman C, Bass A, Rouse I, Hobbs M . Population-based linkage of health records in Western Australia: development of a health services research linked database. Aust N Z J Public Health. 1999; 23(5):453-9. DOI: 10.1111/j.1467-842x.1999.tb01297.x. View

13.

Holman C, Preen D, Baynham N, Finn J, Semmens J . A multipurpose comorbidity scoring system performed better than the Charlson index. J Clin Epidemiol. 2005; 58(10):1006-14. DOI: 10.1016/j.jclinepi.2005.01.020. View

14.

Bairstow P, Mendelson R, Dhillon R, Valton F . Diagnostic imaging pathways: development, dissemination, implementation, and evaluation. Int J Qual Health Care. 2005; 18(1):51-7. DOI: 10.1093/intqhc/mzi078. View

15.

Blazak P, Hacking C, Presneill J, Reade M . Early repeat computed tomographic imaging in transferred trauma and neurosurgical patients: Incidence, indications and impact. J Med Imaging Radiat Oncol. 2018; . DOI: 10.1111/1754-9485.12711. View

16.

Martins R, Raimundo P, Alves P, Monteiro R, Silva L, Gomes A . Appropriateness of Radiology Test Requests by an Emergency Department: A Retrospective Study. Acta Med Port. 2020; 33(1):7-14. DOI: 10.20344/amp.12075. View

17.

Bhatia R, Levinson W, Shortt S, Pendrith C, Fric-Shamji E, Kallewaard M . Measuring the effect of Choosing Wisely: an integrated framework to assess campaign impact on low-value care. BMJ Qual Saf. 2015; 24(8):523-31. DOI: 10.1136/bmjqs-2015-004070. View

18.

Pelc N . Recent and future directions in CT imaging. Ann Biomed Eng. 2014; 42(2):260-8. PMC: 3958932. DOI: 10.1007/s10439-014-0974-z. View

19.

Ip I, Mortele K, Prevedello L, Khorasani R . Repeat abdominal imaging examinations in a tertiary care hospital. Am J Med. 2012; 125(2):155-61. PMC: 4447187. DOI: 10.1016/j.amjmed.2011.03.031. View

20.

Hong A, Ross-Degnan D, Zhang F, Wharam J . Small Decline In Low-Value Back Imaging Associated With The 'Choosing Wisely' Campaign, 2012-14. Health Aff (Millwood). 2017; 36(4):671-679. DOI: 10.1377/hlthaff.2016.1263. View