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ER Imaging Variability Not Due to Physicians

Patient- and visit-level factors significantly tied to imaging utilization
WEDNESDAY, June 26 (HealthDay News) -- Very little variability in the use of imaging in the emergency department is actually attributable to physicians, according to a study published online June 25 in Radiology.
Hannah J. Wong, Ph.D., from York University in Toronto, and colleagues retrospectively studied 88,851 consecutive emergency department visits occurring in 2011 at a large urban teaching hospital. Multiple predictors for the probability that low- or high-cost imaging would be ordered during a given visit were identified using a regression model. Interphysician variation was also assessed.
The researchers found that measures of emergency department busyness, prior emergency department visit, referral source to the emergency department, and emergency department arrival mode were statistically significant patient- and visit-level predictors of imaging use. Imaging use did not correlate with physician-level factors. Interphysician variation was very low for low-cost imaging and for high-cost imaging. For low-cost imaging, the physician-specific odds ratio of imaging was 0.78, while the odds ratio was 0.76 for high-cost imaging.
"After careful and comprehensive case-mix adjustment by using hierarchical logistic regression, only about 1 percent of the variability in emergency department imaging utilization was attributable to physicians," the authors write.
Abstract (http://radiology.rsna.org/content/early/2013/06/11/radiol.13130972.abstract )Full Text (subscription or payment may be required) (http://radiology.rsna.org/content/early/2013/06/11/radiol.13130972.full )
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