Study: Heavy CT utilization consistent with appropriate medical decision-making

While a substantial percentage of CT scans are performed unnecessarily, researchers have determined that the characteristics associated with those patients who undergo a large numbers of scans, as well as the physicians who order them, are consistent with appropriate medical decision-making.

In a study published online in the Journal of the American College of Radiology, James Begun, Ph.D., and colleagues analyzed 310,000 CT scan claims between 2009 and 2010 from a health plan serving 1.5 million members. The goal was to determine whether there were characteristics among patients and ordering physicians that could help distinguish high utilization rates from low ones.

High utilization of CT scanning continues to be a major concern, the authors wrote, particularly when it comes to emergency department scanning, which accounts for a large percentage of CT scans ordered. For example, a recent survey of emergency physicians in the St. Louis area found that respondents considered overutilization of CT to be a problem in the ED.

Begun and colleagues found that patients who received the greatest number of CT scans tended to be older, male and less affluent, saw more providers, used government insurance, took more prescription drugs and, in general, used more healthcare resources. Those physicians referring more CT scans tended to be male, board-certified, and in group practices.

"In sum, none of the associations suggested an obvious problem with overutilization," Begun and colleagues wrote.

Considering that it is accepted that some CT scans are unnecessary and inappropriate, and that analyzing aggregate insurance claims probably isn't enough to accurately identify and assess CT overuse patterns, the authors suggested that future research focus on several areas.

For example, focusing on conditions for which scan referrals are elective, they said, could help to identify factors influencing overuse. In addition, identifying those high-utilization patients and providers, and thoroughly analyzing their claims data, they said, could further determine reasons for high utilization.

To learn more:
- see the study in the JACR


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