22 Nov Cardiac Stress Testing Increases Modestly in Commercially Insured Patients
MedicalResearch.com Interview with:
Vinay Kini, MD, MS
Division of Cardiovascular Medicine
Hospital of the University of Pennsylvania
The Leonard Davis Institute of Health Economics
University of Pennsylvania
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Recent studies have shown that use of cardiac stress tests has declined by about 25% among Medicare beneficiaries and by about 50% in Kaiser Permanente over the last several years. However, the reasons for these declines is not well understood. Decreases in the use of stress testing could be due to dissemination of appropriate use criteria and other clinical practice guidelines, advances in preventive care, reductions in reimbursement for testing, or other health system organizational characteristics.
Therefore, our goal was to determine whether similar declines in testing are observed among a nationally representative cohort of commercially insured patients. We identified over 2 million stress tests performed among 33 million members of the commercial insurance company, and found that there was a 3% increase in the overall use of stress testing in this cohort between 2005 and 2012. Declines in the use of nuclear SPECT tests were offset by increases in the use of stress echocardiography, exercise electrocardiography, and newer stress test modalities such as coronary computed tomography angiography.
The largest increase in use of testing was seen among younger individuals – there was a 60% increase in use of testing among patients aged 25-34, and a 30% increase among individuals aged 35-44.
MedicalResearch.com: What should readers take away from your report?
Response: Our findings suggest that observed trends in the use of cardiac stress tests may have been driven more by unique characteristics of populations and health systems than national efforts to reduce the overuse of testing. Furthermore, the disparate trends in use of testing between commercially insured patients, Medicare beneficiaries, and patients in the Kaiser health system suggest that organizational characteristics of heath system may strongly influence patterns of stress test use.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: First, more research is needed to understand how these divergent patterns in use of testing may be affecting inappropriate testing (i.e., testing that provides little or no benefit to patients), or appropriate testing (i.e., testing that is thought to improve patient outcomes).
Second, more research is needed to explore the specific processes/structures of care that are influencing stress test use at a local level. These might include clinical reminders, performance metrics, or payment structures. As the healthcare system transitions from fee-for-service reimbursement to value-based payment models, it will be critical to find effective ways of minimizing inappropriate testing while maintaining good patient outcomes.
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Kini V, McCarthy FH, Dayoub E, Bradley SM, Masoudi FA, Ho PM, Groeneveld PW. Cardiac Stress Test Trends Among US Patients Younger Than 65 Years, 2005-2012. JAMA Cardiol. Published online November 15, 2016. doi:10.1001/jamacardio.2016.3153
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