Managed Care Weekly Digest

New data from H.H. Pham et al illuminate research in medicare and medicaid

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"We modified a measure of inappropriate imaging developed by the National Committee on Quality Assurance. We characterized the rapidity (< 28 days, 29-180 days, none within 180 days) and modality of imaging (computed tomography or magnetic resonance imaging [CT/MRI], only radiograph, or no imaging). We used ordered logit models to assess relationships between imaging and patient demographics and physician/practice characteristics including exposure to financial incentives based on patient satisfaction, clinical quality, cost profiling, or productivity. Of 35 039 beneficiaries with LBP, 28.8% underwent imaging within 28 days and an additional 4.6% between 28 and 180 days. Among patients who received imaging, 88.2% received radiography, while 11.8% received CT/MRI as their initial study. White patients received higher levels of imaging than black patients or those of other races. Medicaid patients received less rapid or advanced imaging than other patients. had higher levels of imaging if their primary care physician worked in large practices. Compared with no incentives, clinical quality-based incentives were associated with less advanced imaging (10.5% vs 1.4% for within 28 days; P< .001), whereas incentive combinations including satisfaction measures were associated with more rapid and advanced imaging. persisted in multivariate analyses and when the outcome was redefined as the number of imaging studies performed. Rapidity and modality of imaging for LBP is associated with patient and physician characteristics but the directionality of associations with desirable care processes is opposite of associations for measures targeting underuse," wrote H.H. Pham and colleagues.

The researchers concluded: "Metrics that encompass overuse may suggest new areas of focus for quality improvement. Arch Intern Med. 2009; 169(10): 972-981."

Pham and colleagues published their study in Archives of Internal Medicine (Rapidity and Modality of Imaging for Acute Low Back Pain in Elderly Patients. Archives of Internal Medicine, 2009;169(10):972-981).

For additional information, contact H.H. Pham, Center Studying Health Systems Change, 600 Maryland Avenue SW, Ste. 550, Washington, DC 20024, USA.

Publisher contact information for the journal Archives of Internal Medicine is: American Medical Association, 515 N State St., Chicago, IL 60610-0946, USA.

Keywords: United States, Washington, Medicare and Medicaid, Back Pain Relief, Health Policy, Internal Medicine, Lower Back Pain, Magnetic Resonance, Medicare.

This article was prepared by Managed Care Weekly Digest editors from staff and other reports. Copyright 2009, Managed Care Weekly Digest via NewsRx.com.