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Imaging services ordered more frequently by advanced practice clinicians than PCPs
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Advanced practice clinicians, including nurse practitioners and physician assistants, were more likely to order imaging services for patients than primary care physicians, according to results of a recent retrospective analysis.
Researchers evaluated data on diagnostic imaging ordered by advanced practice clinicians (APCs) and PCPs collected from Medicare claims from 2010 to 2011. General and family practice and internal medicine specialists were classified as PCPs; physician assistants and nurse practitioners were classified as APCs.
Episodes of care were defined as office visits for evaluation and management, with no other claims made during the prior 30 days. Analysis was restricted to episodes in which no other claims were made during the subsequent 30 days after the visit, apart from either a single imaging event or claims for services not related to imaging. The primary outcome was whether an imaging order followed from a qualified evaluation and management visit. Other evaluated factors included demographic and geographic information and comorbidities as indicated by the Charlson comorbidity index.
The analysis included 651,074 care episodes. Of those, 8% were performed by APCs and 92% by PCPs. A single imaging event within 30 days after the visit occurred in 1.9% of these episodes. Among imaging events, 72.2% were radiography and 27.8% were advanced imaging services.
PCPs ordered imaging in 1.9% of care episodes compared with 2.7% of APCs, who were associated with more imaging vs. PCPs regardless of patient group and imaging service (OR=1.34; 95% CI, 1.27-1.42), according to adjusted analysis. Overall, ACPs ordered 0.3% more images than PCPs per episode of care.
Specifically, radiography orders were significantly more common among APCs, for both new (OR=1.36; 95% CI, 1.13-1.66) and established patients (OR=1.33; 95% CI, 1.24-1.43). APCs ordered 0.3% more images per episode for new patients and 0.2% more for established patients. Advanced imaging was increased for established patients among APCs (OR=1.28; 95% CI, 1.14-1.44) with 0.1% more images per episode compared with PCPs. APCs and PCPs did not differ significantly with regard to advanced imaging ordered for new patients.
“While the increased use of imaging appears modest for individual patients, this increase may have important ramifications on care and overall costs at the population level,” the researchers concluded. “This does not mean that APCs cannot serve an important, growing role in primary care access. But any such expansion must be mindful of the additional cost, safety and quality implications it may incur. Greater PCP and APC team coordination, as some have suggested, may produce better outcomes than merely expanding the scope of APC practice alone.”
Disclosure: The researchers report no relevant financial disclosures.
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