Abstract 14699: Utilization Management Reduces Repeated Outpatient Cardiovascular Imaging

Abstract

Background and Objectives: Utilization Management (UM) programs have been shown to reduce inappropriate use of imaging procedures. Less is known about the influence of such programs on repeated downstream utilization of imaging. The objectives of this study were: 1) to evaluate the impact of a UM program (closely modeled on American College of Cardiology Foundation’s Appropriate Use Criteria) on repeated cardiac imaging utilization, and 2) to explore factors that influence the probability of repeated imaging.

Methods: Through medical insurance claims analysis, patients undergoing cardiovascular imaging (MPI, SE, PET or CT) with no imaging in the preceding year and continuous insurance eligibility for three years were identified (N=112,308). Cardiac imaging utilization rates for up to 24 months following the index test were compared for patients subject to a UM program (N=48,455) versus those without UM requirement (N=63,853). Claims-derived cardiac risk scores were created and validated against clinical risk scores. One-to-one propensity score matching was used to match the cardiac risk score of patients with UM to patients without UM (N=96,906). All analyses were conducted on the matched cohort. Differences in post-index imaging rates were examined through generalized estimating equations. Factors driving repeated downstream imaging were assessed through stratified survival analyses. Cox proportional hazards model was used.

Results: Post index cardiac imaging tests were performed for 10, 630 (21.9%) and 12, 012 patients (24.8%) in the UM and non-UM groups respectively. Post-index 12-month imaging rate in the UM group was 222 tests per 1000 versus 251 tests per 1000 in the non-UM group. Adjusting for age, gender, Deyo-Charlson comorbodity index, cardiac risk score, type of index imaging test and prior history of cardiovascular disease, the adjusted rate was 18 tests per 1000 lower in the UM group (p < .001). After controlling for similar covariates, the relative risk of obtaining a repeated downstream cardiac imaging in the UM group was 11.7% lower than the non-UM group (Hazard Ratio: 0.883, p < .001).

Conclusions: Controlling for key factors, the utilization management program was associated with reduced volume of downstream cardiac imaging.