Clinical Investigation
Imaging and Diagnostic Testing
Trends in echocardiography utilization in the Veterans Administration Healthcare System

https://doi.org/10.1016/j.ahj.2009.12.015Get rights and content

Background

There is growing concern over the impact of accelerating use of diagnostic imaging services on health care spending. Echocardiography is an important cardiovascular imaging procedure, but little is known about trends in its use or utilization. We examine trends in the utilization of echocardiography in a national health care system.

Methods

We used administrative data from the Veterans Healthcare Administration (VA) from 2000 to 2007 to identify patients receiving regular medical care (VA users) or echocardiograms at the VA. We then examined the number of echocardiograms performed each year within the VA and echocardiogram utilization (rates per 1,000 VA users). We examined changes in echocardiogram use and utilization over time and potential overuse of echocardiography.

Results

The number of echocardiograms increased from 92,269 in 2000 to 195,767 in 2007 (a 112.2% increase). Alternatively, echocardiogram utilization remained relatively stable, increasing from 68.8 per 1,000 VA users in 2000 to 71.5 per 1,000 VA users in 2007 because the number of VA users increased by 104.2% over the study period. The mean number of scans per year in echocardiogram recipients remained constant at 1.1/y, and the proportion of recipients receiving multiple scans remained constant at <10%.

Conclusions

Use of echocardiography in the VA increased dramatically between 2000 and 2007, but utilization rates increased only modestly. Our results suggest that, within the VA, growth in the use of echocardiography resulted from an increase in the number of patients receiving care from the VA on regular basis rather than the performance of a greater number of echocardiograms on a fixed patient population.

Section snippets

Data sources

We used VA Patient Treatment Files and Outpatient Care Files to identify all echocardiograms performed between fiscal year 2000 and 2007. The Patient Treatment File contains discharge abstract data for all patients hospitalized in VA medical centers. Key data elements include patient demographics, admission dates, primary and secondary diagnoses, and procedures performed during hospitalization (eg, echocardiography) as defined by International Classification of Diseases Ninth Revision, Clinical

Patient characteristics

Between 2000 and 2007, a total of 1,159,725 echocardiograms were performed in the VA, with the annual number of echocardiograms ranging from 92,269 in 2000 to 195,767 in 2007 (Figure 1). During the same period, the number of patients receiving care increased from 1,341,071 in 2000 to 2,739,215 during 2007 (Figure 1).

Compared with VA users who did not receive echocardiograms, echocardiogram recipients were significantly older and more likely to be of white or black race (Table I). Not

Discussion

In an analysis of VA administrative data, we found that use of echocardiography doubled between 2000 and 2007. Interestingly, and in contrast to our expectation, echocardiography utilization remained relatively constant over our study period. Alternatively, we did find evidence that, since 2004, echocardiogram utilization may be accelerating and an increasing proportion of patients may be receiving multiple studies.

A number of our study findings merit further discussion. First, it is important

Conclusions

We found that, among VA users, the use of echocardiography doubled between 2000 and 2007 but that echocardiogram utilization remained relatively constant, providing a measure of reassurance for those concerned about rapid growth in the use of imaging studies. Alternatively, we did find evidence that, since 2004, echocardiogram utilization has been accelerating and repeated imaging of patients has been on the rise. There is a wide range of geographic variability in echocardiography utilization

Disclosures

Funding sources: Dr Okrah receives fellowship stipend and tuition support from the Cardiovascular Interdisciplinary Research Training Grant, Iowa Cardiovascular Center, University of Iowa Carver College of Medicine. Dr Cram has an appointment in the Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP) at the Iowa City VA Medical Center, which is funded through the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and

References (25)

  • PearlmanA.S. et al.

    Evolving trends in the use of echocardiography: a study of Medicare beneficiaries

    J Am Coll Cardiol

    (2007)
  • ZhuS.C. et al.

    How many enrollees come to VA just for pharmacy? Heath Care financing and economics data brief #2004-10

    (2004)
  • Cited by (23)

    • Association of Liability Concerns with Decisions to Order Echocardiography and Cardiac Stress Tests with Imaging

      2016, Journal of the American Society of Echocardiography
      Citation Excerpt :

      Although regional variation in stress testing and echocardiography has been widely documented, the underlying influences are not well understood. Peer behavior and local practice effects, patient characteristics, and health system organizational characteristics all likely play a role in influencing decisions to order imaging stress tests and echocardiography.7,14,24-27 Liability concerns may contribute to practice variation by increasing testing rates in regions of the United States where rates of lawsuits for medical malpractice are high.

    View all citing articles on Scopus
    View full text