Primary Submission Category: Health care/services
CT Utilization for Headache and Back Pain: System-Level Variation and Length of Stay Impacts
Authors: Victoria Beal, Erika Johnson,
Presenting Author: Vernon Herbener*
Background
Significant variation in CT utilization persists across health systems. This leads to unnecessary resource utilization, increases costs and imposes additional financial and time burdens on patients, along with the risk of unnecessary testing. This research aims to quantify the inter- and intra-system variation in CT utilization and assess the incremental length of stay (LOS) associated with CT use in the emergency department (ED).
Methods
Using the Vizient Clinical Data Base, health systems with three or more EDs were identified across the U.S. Variation in CT scan utilization was measured within and across health systems for encounters with a diagnosis of headache/migraine disorders (ages 18-44 and 45-64) and nonspecific neck and back pain (ages 45-64 and 65+). Additionally, the incremental LOS associated with CT utilization in the ED was calculated.
Results
Across 64 health systems, the mean aggregate system-level CT utilization rate in the ED ranged from 33-56% across age groups and diagnoses, with an interquartile range of 7-12%. Within-system variation in utilization ranged from approximately 11-47%. The increase in ED LOS for encounters with a CT scan was roughly 1 additional hour compared to those without a CT scan for headache/migraine diagnoses. For nonspecific neck and back pain, the incremental increase in LOS was approximately 1.25 hours.
Implications
Health systems provide the potential for scaling best practices to ensure the right care is delivered at the right place and time. However, patients continue to experience differing care both within and across health systems. Discretionary CT utilization in the ED can impact capacity management and increase healthcare costs for patients and health systems. To enhance consistency, cost-efficiency, and quality of care, health systems should examine and refine their quality procedures to ensure standardized, evidence-based decision-making across all sites of care.