Nonclinical factors associated with primary care physicians’ ordering patterns of magnetic resonance imaging/computed tomography for headache1

Couchman, Glen R.; Forjuoh, Samuel N.; Rajab, Mohammad; Phillips, Charles D.; Yu, Jihnhee

doi:10.1016/j.acra.2004.03.050

Cited by 27 publications

(18 citation statements)

References 16 publications

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“…14–21 Additionally, there is unexplained variation in care between different hospital types. 22,23 An evaluation of practice variation provides opportunities for optimizing resource utilization and quality improvement.…”

Section: Introductionmentioning

confidence: 99%

Variation in advanced imaging for pediatric patients with abdominal pain discharged from the ED

Horner

Jones

Wang

et al. 2016

The American Journal of Emergency Medicine

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Background Pediatric abdominal pain visits to emergency departments (ED) are common. The objectives of this study are to assess variation in imaging [ultrasound (US) ± computed tomography (CT)] and factors associated with isolated CT use. Methods This was a retrospective cohort study of ED visits for pediatric abdominal pain resulting in discharge from 16 regional EDs from 2007–2013. Primary outcome was US or CT imaging. Secondary outcome was isolated CT use. We used multivariable logistic regression to evaluate patient- and hospital-level covariates associated with imaging. Results Of the 21,152 visits, imaging was performed in 29.7%, and isolated CT in 13.4% of visits. In multivariable analysis, black patients (OR: 0.4 (95%CI: 0.4, 0.5)) and Medicaid (OR: 0.6 (95%CI: 0.5, 0.7)) had lower odds of advanced imaging compared to white patients and private insurance, respectively. General EDs were less likely to perform imaging (OR: 0.6 (95%CI: 0.5, 0.7)) compared to the pediatric ED; however, for visits with imaging, 3.5% of visits to the pediatric ED compared to 76% of those to general EDs included an isolated CT (P<0.001). Low pediatric volume (OR: 1.8 (95%CI:1.5, 2.2)) and rural (OR:1.8 (95%CI:1.3, 2.5)) EDs had higher odds of isolated CT use, compared to higher pediatric volumes and non-rural EDs, respectively. Conclusion There are racial and insurance disparities in imaging for pediatric abdominal pain. General EDs are less likely than pediatric EDs to use imaging, but more likely to use isolated CT. Strategies are needed to minimize disparities and improve the use of “ultrasound-first.”

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Section: Introductionmentioning

confidence: 99%

Variation in advanced imaging for pediatric patients with abdominal pain discharged from the ED

Horner

Jones

Wang

et al. 2016

The American Journal of Emergency Medicine

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“…10,11 Less access to the healthcare system coupled with decreased imaging among the uninsured may contribute to the lower rates of treatment of unruptured intracranial aneurysm among racial/ethnic minorities and lower income patients in the United States.…”

Section: December 2012mentioning

confidence: 99%

Racial and Ethnic Disparities in the Treatment of Unruptured Intracranial Aneurysms

Brinjikji

Rabinstein

Lanzino

et al. 2012

Stroke

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We purchased the NIS hospital discharge database for the period [2001][2002][2003][2004][2005][2006][2007][2008][2009] P<0.0001). In all, 9.7% of patients receiving treatment for SAH were self-payers versus 3.0% of patients being treated for unruptured intracranial aneurysm (P<0.0001). In all, 62.2% of patients receiving treatment for SAH were white compared with 76.4% of patients being treated for unruptured intracranial aneurysm (P<0.0001). There was a higher proportion of black, Hispanic, and Asian patients in the SAH treatment group when compared with the unruptured aneurysm treatment group (P<0.0001 for all groups). Conclusions-When compared with patients undergoing treatment for SAH, patients undergoing surgical and endovascular treatment for unruptured intracranial aneurysm are generally from higher socioeconomic strata and are more likely to be insured, women, and white. Future studies are needed to determine the underlying causes and solutions for this disparity. (Stroke. 2012;43:3200-3206.)

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“…4,5 The context in which the decision is made also plays an important part. In primary care, GPs experience difficulty in diagnosing headaches, 6 while in secondary care, patients will often anticipate the exclusion of secondary pathology and consultants will be under pressure to make a diagnosis at the first appointment.…”

Section: Introductionmentioning

confidence: 99%

Imaging patients with suspected brain tumour: guidance for primary care

Kernick

Ahmed²,

Bahra

et al. 2008

Br J Gen Pract

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The number of referrals by primary care practitioners to secondary care neurology services, particularly for headache, may be difficult to justify. Access to imaging by primary care practitioners could avoid referral without compromising patient outcomes, but the decision to refer is based on a number of complex factors. Due to the paucity of rigorous evidence in this area, available data are combined with expert opinion to offer support for GPs. The study suggests management for three levels of risk of tumour: red flags >1%; orange flags 0.1-1%; and yellow flags <0.1% but above the background population rate of 0.01%. Clinical presentations are stratified into these three groups. Important secondary causes of headache where imaging is normal should not be overlooked, and normal investigation does not eliminate the need for follow-up or appropriate management of headache.

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Nonclinical factors associated with primary care physicians’ ordering patterns of magnetic resonance imaging/computed tomography for headache1

Cited by 27 publications

References 16 publications

Variation in advanced imaging for pediatric patients with abdominal pain discharged from the ED

Variation in advanced imaging for pediatric patients with abdominal pain discharged from the ED

Racial and Ethnic Disparities in the Treatment of Unruptured Intracranial Aneurysms

Imaging patients with suspected brain tumour: guidance for primary care

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