One of the main reasons for higher healthcare cost is imaging, for instance, tomographies. A new study published online, in advance of the April issue of The American Journal of Medicine , shows that doctors use head computed tomography (CT) scans in a significant variety of ways, even within a single emergency department. In their new study, the researchers from Brigham and Women’s Hospital and Harvard Medical School show that strategies that reduce the varied use of CT scans could potentially cut costs whilst improving the quality of care.

The Centers for Medicare and Medicaid recently approved measures to evaluate variations in the use of head CT in patients with atraumatic headaches amongst nationwide hospitals. The investigators speculated that there are substantial variations in the way physicians use CT scans even within a single facility.

Lead investigator Luciano M. Prevedello, MD from the Center for Evidence-Based Imaging and Department of Radiology explains:

“Even after accounting for a number of factors associated with ordering behavior, we found that greater than 2-fold variability in head CT use still persists.”

The investigators recorded how many head CT scans physicians had performed in 55,281 patient visits to the adult-only emergency department at a large urban academic hospital throughout 2009. The noted the patient data, which included information on the patient’s gender, age, emergency department location, the severity of the emergency, and disease categorization and physician data that included the physician’s gender and how many years they have been in practice.

From 55,281 patients, 8.9% received a head CT scan, with the scan rates per physician ranging from 4.4% to 16.9%. The majority of those who underwent a CT tended to be males, who were older and classed as more urgent. The investigators noted that those who were more likely to receive a head CT were patients with head trauma followed by those who suffered a stroke or had a headache and other types of trauma. Unlike previous studies the investigators observed no substantial link between the physician’s age or gender and ordering a CT scan.

Dr. Prevedello states:

“The variability may have been due to physician’s practice style, knowledge gaps, risk tolerance, or other factors. We are currently investigating the impact of real-time evidence-based clinical decision support (embedded in the electronic health record) on variation in test ordering behavior of physicians to improve quality of care and improve appropriateness of testing.”

A famous expert in the field, Robert G. Stern, MD, from the Department of Radiology at the University of Arizona College of Medicine in Tucson comments:

“Attempts to reduce utilization of expensive imaging studies have been made in the past, without any real focus on quality of care and appropriate ordering patterns. Dr. Prevedello and his colleagues underscore the need to develop evidence-based systems to reduce costly and inappropriate resource allocations.”

In conclusion, editor-in-chief Joseph S. Albert, MD, of the University of Arizona College of Medicine, Tucson, writes:

“The US healthcare system is awash with excessive numbers of imaging studies. At least part of the reason for this is physician fear of liability. This new feature will attempt to educate clinicians and bring rationality into the ordering of imaging studies.”

Written by Petra Rattue