Updated Trends,Disparities, and Clinical Impact of Neuroimaging Utilization in Ischemic Stroke in the Medicare Population: 2012 to 2019 |
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| Institution: | 1. Imaging Clinical Effectiveness and Outcomes Research, Health System Science Institute, Feinstein Institutes for Medical Research, Manhasset, New York;2. Associate Professor and Health Economist, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;3. Biostatistician, The Harvey L. Neiman Health Policy Institute, Reston, Virginia;4. Visiting Scholar, Feinstein Institutes for Medical Research, Imaging Clinical Effectiveness and Outcomes Research, Health System Science Institute, Feinstein Institutes for Medical Research, Manhasset, New York;5. Siemens Medical Solutions USA Inc, Malvern, Pennsylvania;6. Chief, Neurovascular Services and Director, Neurology Service Line, and Director, Neuroendovascular Surgery, Comprehensive Stroke Center and Stroke Unit, North Shore University Hospital, Manhasset, New York;7. Hospital Director, Neuroendovascular Surgery, South Shore University Hospital, Bay Shore, New York;8. Professor, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;9. Professor, Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;10. Senior Research Associate, The Harvey L. Neiman Health Policy Institute, Reston, Virginia;11. Principal Research Scientist, The Harvey L. Neiman Health Policy Institute, Reston, Virginia;12. Executive Director, The Harvey L. Neiman Health Policy Institute, Reston, Virginia;13. Imaging Clinical Effectiveness and Outcomes Research, Health System Science Institute, Feinstein Institutes for Medical Research, Manhasset, New York;14. Vice Chair, Research, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York;1. Partner, Keating Jones Hughes, PC, Portland, Oregon;2. Associate Professor of Radiology, Department of Radiology, University of Washington, Seattle, Washington;1. Director, Radiology Quality, Department of Radiology, Children’s Healthcare of Atlanta, Atlanta, Georgia; Associate Professor, Emory University School of Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and Co-Chair, ACR Closing the Loop TEP, honorarium;2. Chief, Section of Administration, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; and Co-Chair, ACR Closing the Loop TEP, honorarium;3. Director, Quality Management Programs, ACR, Reston, Virginia;4. Vice President, Quality Management Programs, ACR, Reston, Virginia;5. Professor, Emergency Medicine and Chief, Section of Emergency Ultrasound, Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; and Co-Chair, ACR Closing the Loop TEP, honorarium;6. Medical Director, Sutter Physicians Network, Sacramento, California; Medical Director, Quality and Safety and Neuroradiologist, Sutter Medical Group-Sutter Medical Network, Sacramento, California; and Co-Chair, ACR Closing the Loop TEP, honorarium;1. Staff Neuroradiologist, Andrews Air Force Base, Washington, DC;2. Chief Medical Officer, The Radiology Leadership Institute of the American College of Radiology, Wynnewood, Pennsylvania;3. Reston Radiology Consultants, Reston, Virginia;4. Hackensack Radiology Group, Hackensack, New Jersey;5. Radiology Department, WellSpan Chambersburg/Waynesboro Hospitals, Chambersburg, Pennsylvania;1. Professor and Vice Chair and Director of the Imaging Policy Analytics for Clinical Transformation (IMPACT) Research Center, the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia;2. Senior Research Associate, Harvey L. Neiman Health Policy Research Institute, Reston, Virginia;3. Principal Research Scientist, Harvey L. Neiman Health Policy Research Institute, Reston, Virginia; and Health Services Management, University of Minnesota, St Paul, Minnesota;4. Professor and Interim Chair, Radiology and Imaging Sciences, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia;5. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; and Professor and Director, Health Economics, Analytics Lab (HEAL), School of Economics, Georgia Institute of Technology, Atlanta, Georgia;6. Executive Director, Harvey L. Neiman Health Policy Research Institute, Reston, Virginia;1. Associate Professor and Section head, Vascular Interventional Radiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;2. Professor, Vice Chair, Quality and Safety, and Medical Director, MRI, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;3. Ernest H. Wood Distinguished Professor of Radiology and Chair, Radiology, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;4. Associate Professor and Executive Vice Chair, Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;1. Associate Program Director, Radiology Residency, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania;2. Assistant Program Director, Diagnostic Radiology Residency Program, Department of Radiology, Breast Imaging and Intervention, University of Alabama at Birmingham, Birmingham, Alabama;3. Penn State College of Medicine, Hershey, Pennsylvania;4. Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania |
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| Abstract: | ObjectiveThe purpose of this study was to update trends, investigate sociodemographic disparities, and evaluate the impact on mortality of stroke neuroimaging across the United States from 2012 to 2019.MethodsRetrospective cohort study using CMS Medicare 5% Research Identifiable Files, representing consecutive ischemic stroke emergency department or hospitalized patients aged ≥65 years. A total of 85,547 stroke episodes with demographic and clinical information were analyzed using Cochran-Mantel-Haenszel tests and logistic regression. Outcome measures were neuroimaging (CT angiography CTA], CT perfusion CTP], MRI, MR angiography MRA]) utilization, acute treatment (endovascular thrombectomy EVT] and intravenous thrombolysis IVT]), and mortality while in the hospital and at 30 days and 1 year post discharge.ResultsSignificantly increasing utilization trends for CTA (250%), CTP (428%) and MRI (18%), and a decreasing trend for MRA (?33%) were observed from 2012 to 2019 (P < .0001). Controlling for covariates in the logistic regression models, CTA and CTP were significantly associated with higher EVT and IVT utilization. Although CTA, MRI, and MRA were associated with lower mortality, CTP was associated with higher mortality post discharge. Less neuroimaging was performed in rural patients; older patients (≥80 years) had lower utilization of CTA, MRI, and MRA; female patients had lower rates of CTA; and Black patients had lower utilization of CTA and CTP.ConclusionsCTA and CTP utilization increased in the Medicare ischemic stroke population from 2012 to 2019 and both were associated with greater EVT and IVT use. However, disparities exist in neuroimaging utilization across all demographic groups, and further understanding of the root causes of these disparities will be crucial to achieving equity in stroke care. |
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| Keywords: | Angiography ischemic stroke neuroimaging perfusion trend analysis |
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