Zachary Bouck1, Graham Mecredy1, Noah M Ivers1, Ciara Pendrith1, Ben Fine1, Danielle Martin1, Richard H Glazier1, Joshua Tepper1, Wendy Levinson1, R Sacha Bhatia2. 1. Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bouck, Ivers, Bhatia) and Department of Family and Community Medicine (Martin), Women's College Hospital; Choosing Wisely Canada (Bouck, Levinson, Bhatia); Institute for Clinical Evaluative Sciences (ICES) (Mecredy, Ivers, Glazier, Bhatia), Toronto, Ont.; Cumming School of Medicine (Pendrith), University of Calgary, Calgary, Alta.; Trillium Health Partners (Fine), Mississauga, Ont.; Institute for Health Care Policy Management and Evaluation (Martin, Tepper), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital; Departments of Diagnostic Imaging (Fine), Family and Community Medicine (Glazier, Tepper) and Medicine (Levinson), University of Toronto, Toronto Ont. 2. Women's College Hospital Institute for Health Systems Solutions and Virtual Care (Bouck, Ivers, Bhatia) and Department of Family and Community Medicine (Martin), Women's College Hospital; Choosing Wisely Canada (Bouck, Levinson, Bhatia); Institute for Clinical Evaluative Sciences (ICES) (Mecredy, Ivers, Glazier, Bhatia), Toronto, Ont.; Cumming School of Medicine (Pendrith), University of Calgary, Calgary, Alta.; Trillium Health Partners (Fine), Mississauga, Ont.; Institute for Health Care Policy Management and Evaluation (Martin, Tepper), University of Toronto; Department of Family and Community Medicine (Glazier), St. Michael's Hospital; Departments of Diagnostic Imaging (Fine), Family and Community Medicine (Glazier, Tepper) and Medicine (Levinson), University of Toronto, Toronto Ont. sacha.bhatia@wchospital.ca.
Abstract
BACKGROUND: Many evidence-based recommendations advocate against the use of routine chest x-rays for asymptomatic, low-risk outpatients; however, it is unclear how regularly chest x-rays are ordered in primary care. Our study aims to describe the frequency of, and variation in, routine chest x-ray use in low-risk outpatients among primary care physicians. METHODS: In this retrospective cohort study, Ontario residents aged 18 years and older with a periodic health examination (PHE) between Apr. 1, 2010, and Mar. 31, 2015, were identified via administrative claims data. Patients with a recent history (last 3 years) of any of the following were excluded: cardiac or pulmonary disease, high-risk comorbidity (e.g., diabetes), consultations/visits or procedures involving cardiac or pulmonary specialists, cancer and severe chest trauma. The primary outcome, a routine chest x-ray, was defined as at least 1 chest x-ray claim within 7 days after a PHE. RESULTS: While a routine chest x-ray followed only 2.42% of 2 847 508 PHEs, one-quarter of family physicians (499/2031) ordered chest x-rays for more than 5.0% of their PHEs (interquartile range 1.5%-5.0%) and accounted for 62.9% of all tests observed. Routine chest x-ray use declined by 2.0% per quarter (adjusted rate ratio 0.98, 95% confidence interval [CI] 0.97-0.98). Older age (45-64 yr v. 18-44 yr, adjusted odds ratio [OR] 1.82, 95% CI 1.78-1.86; ≥ 65 yr v. 18-44 yr, adjusted OR 2.48, 95% CI 2.39-2.58) and male sex of the patient (OR 2.19, 95% CI 2.14-2.24) and male sex of the provider (OR 1.55, 95% CI 1.51-1.59) were significantly associated with increased odds of a routine chest x-ray being ordered. INTERPRETATION: It is relatively uncommon for a chest x-ray to be ordered as part of a PHE in Ontario; however, the substantial variation observed among physicians suggests potential for interventions targeted at the most frequent users. Copyright 2018, Joule Inc. or its licensors.
BACKGROUND: Many evidence-based recommendations advocate against the use of routine chest x-rays for asymptomatic, low-risk outpatients; however, it is unclear how regularly chest x-rays are ordered in primary care. Our study aims to describe the frequency of, and variation in, routine chest x-ray use in low-risk outpatients among primary care physicians. METHODS: In this retrospective cohort study, Ontario residents aged 18 years and older with a periodic health examination (PHE) between Apr. 1, 2010, and Mar. 31, 2015, were identified via administrative claims data. Patients with a recent history (last 3 years) of any of the following were excluded: cardiac or pulmonary disease, high-risk comorbidity (e.g., diabetes), consultations/visits or procedures involving cardiac or pulmonary specialists, cancer and severe chest trauma. The primary outcome, a routine chest x-ray, was defined as at least 1 chest x-ray claim within 7 days after a PHE. RESULTS: While a routine chest x-ray followed only 2.42% of 2 847 508 PHEs, one-quarter of family physicians (499/2031) ordered chest x-rays for more than 5.0% of their PHEs (interquartile range 1.5%-5.0%) and accounted for 62.9% of all tests observed. Routine chest x-ray use declined by 2.0% per quarter (adjusted rate ratio 0.98, 95% confidence interval [CI] 0.97-0.98). Older age (45-64 yr v. 18-44 yr, adjusted odds ratio [OR] 1.82, 95% CI 1.78-1.86; ≥ 65 yr v. 18-44 yr, adjusted OR 2.48, 95% CI 2.39-2.58) and male sex of the patient (OR 2.19, 95% CI 2.14-2.24) and male sex of the provider (OR 1.55, 95% CI 1.51-1.59) were significantly associated with increased odds of a routine chest x-ray being ordered. INTERPRETATION: It is relatively uncommon for a chest x-ray to be ordered as part of a PHE in Ontario; however, the substantial variation observed among physicians suggests potential for interventions targeted at the most frequent users. Copyright 2018, Joule Inc. or its licensors.
Authors: R Sacha Bhatia; Wendy Levinson; Samuel Shortt; Ciara Pendrith; Elana Fric-Shamji; Marjon Kallewaard; Wilco Peul; Jeremy Veillard; Adam Elshaug; Ian Forde; Eve A Kerr Journal: BMJ Qual Saf Date: 2015-06-19 Impact factor: 7.035
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Authors: Janet E Squires; Danielle Cho-Young; Laura D Aloisio; Robert Bell; Stephen Bornstein; Susan E Brien; Simon Decary; Melissa Demery Varin; Mark Dobrow; Carole A Estabrooks; Ian D Graham; Megan Greenough; Doris Grinspun; Michael Hillmer; Tanya Horsley; Jiale Hu; Alan Katz; Christina Krause; John Lavis; Wendy Levinson; Adrian Levy; Michelina Mancuso; Steve Morgan; Letitia Nadalin-Penno; Andrew Neuner; Tamara Rader; Wilmer J Santos; Gary Teare; Joshua Tepper; Amanda Vandyk; Michael Wilson; Jeremy M Grimshaw Journal: CMAJ Date: 2022-02-28 Impact factor: 16.859
Authors: Zachary Bouck; Jacob Ferguson; Noah M Ivers; Eve A Kerr; Kaveh G Shojania; Min Kim; Peter Cram; Ciara Pendrith; Graham C Mecredy; Richard H Glazier; Joshua Tepper; Peter C Austin; Danielle Martin; Wendy Levinson; R Sacha Bhatia Journal: JAMA Netw Open Date: 2018-10-05