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Geographic variation and trends in carotid imaging among medicare beneficiaries, 2001 to 2006.

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Date
2010-11
Authors
Curtis, LH
Greiner, MA
Patel, MR
Duncan, PW
Schulman, KA
Matchar, DB
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Abstract
<h4>Background</h4>Diagnostic imaging among Medicare beneficiaries is an important contributor to rising health care costs. We examined temporal trends and geographic variation in the use of carotid ultrasound, carotid magnetic resonance angiography (MRA), and carotid x-ray angiography.<h4>Methods and results</h4>Analysis of a 5% national sample of claims from the Centers for Medicare and Medicaid Services for 1999 through 2006. Patients were 65 years or older and underwent carotid ultrasound, carotid MRA, carotid x-ray angiography, or a carotid intervention. The main outcome measures were annual age-adjusted rates of carotid imaging and interventions and factors associated with the use of carotid imaging. Rates of imaging increased by 27%, from 98.2 per 1000 person-years in 2001 to 124.3 per 1000 in 2006. Rates of carotid ultrasound increased by 23%, and rates of MRA increased by 66%. Carotid intervention rates decreased from 3.6 per 1000 person-years in 2001 to 3.1 per 1000 person-years in 2006. In 2006, rates of carotid ultrasound were lowest in the New England, Mountain, and West North Central regions and highest in the Middle Atlantic and South Atlantic regions. Regional differences persisted after adjustment for patient demographic characteristics, history of vascular disease and other comorbid conditions, and study year.<h4>Conclusions</h4>From 2001 through 2006, there was substantial growth and variation in the use of carotid imaging, including a marked increase in the use of MRA, and a decrease in the overall rate of carotid intervention.
Type
Journal article
Subject
Carotid Arteries
Humans
Cardiovascular Diseases
Magnetic Resonance Angiography
Coronary Angiography
Ultrasonography
Age Factors
Comorbidity
Cost of Illness
Aged
Aged, 80 and over
Mid-Atlantic Region
New England
Female
Male
Permalink
https://hdl.handle.net/10161/22911
Published Version (Please cite this version)
10.1161/circoutcomes.110.950279
Publication Info
Curtis, LH; Greiner, MA; Patel, MR; Duncan, PW; Schulman, KA; & Matchar, DB (2010). Geographic variation and trends in carotid imaging among medicare beneficiaries, 2001 to 2006. Circulation. Cardiovascular quality and outcomes, 3(6). pp. 599-606. 10.1161/circoutcomes.110.950279. Retrieved from https://hdl.handle.net/10161/22911.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

Curtis

Lesley H. Curtis

Professor in Population Health Sciences
Lesley H. Curtis is Professor and Chair of the Department of Population Health Sciences in the Duke School of Medicine.  A health services researcher by training, Dr. Curtis is an expert in the use of Medicare claims data for health services and clinical outcomes research, and a leader in national data quality efforts. Dr. Curtis serves as co-PI of the FDA’s Sentinel Innovation Center, Co-Investigator of the Data Core for the FDA’s Sentinel Initiative to monitor the safety of

Pamela Woods Duncan

Adjunct Professor in the Department of Orthopaedic Surgery
Dr. Duncan is a nationally and internationally renowned physical therapist and epidemiologist, who is considered one of the world&#8217;s leading experts and consultants in the selection of outcome measures for stroke clinical trials. A recognized leader and innovator in stroke rehabilitation; she has dedicated her career to elevating the science of rehabilitation, improving the physical function of the elderly, and improving stroke care and outcomes. Most importantly her passion is to cont
Matchar

David Bruce Matchar

Professor of Medicine
My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention. Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analy
Patel

Manesh Raman Patel

Professor of Medicine
Manesh Patel is the Chief of the Division of Cardiology and the Division of Clinical Pharmacology.  His clinical interests include diagnostic and interventional coronary angiography, peripheral angiography and endovascular intervention.  His is involved in several clinical trials involving patients with cardiovascular disease and in cardiac imaging.  He is also the Chair of the American College of Cardiology Task Force for Appropriate Use Criteria for Cardiovascular Procedures and
Schulman

Kevin Alan Schulman

Adjunct Professor in the Department of Medicine
Kevin A. Schulman, MD, MBA, is a professor of medicine and the Gregory Mario and Jeremy Mario Professor of Business Administration (2010 - 2016) at Duke University. He is a visiting professor of business administration at Harvard Business School. He holds several leadership appointments at Duke. He is an associate director of the Duke Clinical Research Institute in the School of Medicine, the country's largest academic clinical research organization. In Duke's Fuqua School of Business, he s
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
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