Validation of billing code combinations to identify cardiovascular magnetic resonance imaging scans in Ontario, Canada: a retrospective cohort study

Roifman, Idan; Qiu, Feng; Connelly, Kim A.; Wright, Graham A.; Farkouh, Michael E.; Jiménez-Juan, Laura; Wijeysundera, Harindra C.

doi:10.1136/bmjopen-2017-021370

Cited by 4 publications

(1 citation statement)

References 15 publications

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“…Patient evaluation for chest pain as well as receipt of stress testing was ascertained by the Ontario Health Insurance Plan (OHIP) Physician Claims Database. The OHIP Physician Claims Database is the most frequently used ICES database and has been validated by multiple studies in many disease states 8 21 23–27. The Registered Persons Database, a registry of Ontario residents who are registered for Ontario Health insurance coverage, was used to obtain demographic information.…”

Section: Data Sourcesmentioning

confidence: 99%

Patient, physician and geographic predictors of cardiac stress testing strategy in Ontario, Canada: a population-based study

et al. 2022

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ObjectivesTo identify patient, physician and geographic level factors that are associated with variation in initial stress testing strategy in patients evaluated for chest pain.DesignRetrospective cohort study.SettingPopulation-based study of patients undergoing evaluation for chest pain in Ontario, Canada between 1 January 2011 and 31 March 2018.Participants103 368 patients who underwent stress testing (graded exercise stress testing (GXT), stress echocardiography (stress echo) or myocardial perfusion imaging (MPI)) following evaluation for chest pain.Primary and secondary outcome measuresTo identify the patient, physician and geographic level factors associated with variation in initial test selection, we fit two separate 2-level hierarchical multinomial logistic regression models for which the outcome was initial stress testing strategy (GXT, MPI or stress echo).ResultsThere was significant variability in the initial type of stress test performed, with approximately 50% receiving a GXT compared with approximately 36% who received MPI and 14% who received a stress echo. Physician-level factors were key drivers of this variation, accounting for up to 59.0% of the variation in initial testing. Physicians who graduated medical school >30 years ago were approximately 45% more likely to order an initial stress echo (OR 1.45, 95% CI 1.17 to 1.80) than a GXT. Cardiovascular disease specialists were approximately sevenfold more likely to order an initial MPI (OR 7.35, 95% CI 5.38 to 10.03) than a GXT. Patients aged >70 years were approximately fivefold more likely to receive an MPI (OR 4.74, 95% CI 4.42 to 5.08) and approximately 26% more likely to receive a stress echo (OR 1.26, 95% CI 1.15 to 1.38) than a GXT.ConclusionsWe report significant variability in initial stress testing strategy in Ontario. Much of that variability was driven by physician-level factors that could potentially be addressed through educational campaigns geared at reducing this variability and improving guideline adherence.

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Section: Data Sourcesmentioning

confidence: 99%