BLOG: IRIS Registry employed to learn about retina specialists' use of ancillary testing
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Retina specialists have a series of ancillary testing modalities at their disposal.
But data on how often clinicians leverage platforms such as OCT, fluorescein angiography (FA) and color fundus photography (CFP) — and whether use patterns vary by location, practice type, payers, surgical volume and diagnostic distribution — remain murky.
To address this question, my research partners and I conducted a review of the American Academy of Ophthalmology IRIS Registry (Intelligence in Research and Sight), the results of which were shared at the Academy’s 2021 annual meeting. The IRIS Registry is ophthalmology’s specialty-specific clinical database comprised of real-world patient data that is aggregated from electronic health records. As of October 2021, the IRIS Registry contains data from 407 million patient visits from more than 70 million unique patients covering more than 7 years of longitudinal data. Because more than 70% of U.S. retina specialists contribute to the IRIS Registry, the real-world data housed within it reliably depict a cross-section of modern practice patterns.
In our study, the frequency of OCT, FA and CFP usage among IRIS Registry contributors who are classified as retina specialists was calculated during a 3-year period from January 2018 to December 2020. We stratified results by region, payer type and practice type.
Among the approximately 4.1 million unique patients whose data were entered into the IRIS Registry during that period, we observed 19.4 million OCT imaging procedures, 4.1 million CFP procedures and 1.9 million FA procedures. In examining the same group of approximately 4.1 million patients, we determined that nearly all of them underwent OCT imaging, approximately 2.2 million underwent CFP and 1.2 million underwent FA.
A portion of the time frame we examined included the first 9 months of the COVID-19 pandemic. We observed an overall reduction in patient volume that correlated with a dip in the volume of OCT, FA and CFP procedures. Patient volume and imaging frequency rebounded in tandem after April 2020, with both metrics approximately approaching pre-pandemic levels.
Clinicians practicing in the Midwest performed significantly more OCT procedures compared with their counterparts in the South, West and Northeast. OCT procedures were also significantly higher among patients who had Medicare or Medicare Advantage coverage compared with those who had commercial, Medicaid or other health care coverage. Similarly, OCT imaging occurred more often among populations with HMO plans compared with those without HMO plans.
Although no significant differences were detected in OCT rates among small, medium and large practices, practices owned by private equity groups performed significantly fewer OCTs than their privately owned counterparts. Nonacademic medical centers performed more OCTs compared with academically oriented institutions.
Our team sought to understand if OCT volume correlated with any practice patterns. No correlation was observed among physicians’ surgical volume and the frequency with which it used OCT imaging. However, clinicians who saw higher numbers of new wet age-related macular degeneration patients used OCT at a higher rate than those with a low volume of new wet AMD patients. Higher volumes of new wet AMD patients were observed in the Midwest, among patients with Medicare or Medicare Advantage, and in nonacademic medical centers — all of which were factors linked to higher OCT usage.
A data-based study about the use of ancillary imaging in retina would have been difficult to execute were it not for the curated nature of the IRIS Registry. The Academy’s partnership with Verana Health, the official data and analytics partner of the IRIS Registry, led to an organized, coherent database from which we drew conclusions.
Reference:
- Leng T. Variations in vitreoretinal physician utilization of ancillary testing: An IRIS Registry analysis. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
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