Study: Regional imaging variations should guide policymaking

A new study has demonstrated that inappropriate prostate cancer and breast cancer imaging rates are associated at the regional level, suggesting that policymakers need to understand regional patterns of care if they are going to optimize initiatives like Choosing Wisely.

In the study, published online March 12 in JAMA Oncology, researchers from NYU Langone Medical Center, led by Danil V. Makarov, MD, assistant professor of urology, population health and health policy at NYU Langone, examined the medical records of 9,219 men with low-risk prostate cancer and 30,398 women with low-risk breast cancer between 2004 and 2007 (described by the authors as as the “pre-Choosing Wisely era”). These patients were treated at 84 different hospital referral regions across the country.

While much as been studied about the regional variation in the cost and utilization of healthcare, “little is known about the regional-level drivers of utilization,” Makarov and his colleagues wrote. Furthermore, they pointed out, the Institute of Medicine has gone on the record as suggesting that regional factors were less important than individual-level decisionmaking in driving inappropriate imaging.

“Studying prostate and breast cancer imaging patterns in the pre–Choosing Wisely era may help determine the potential existence of a yet undiscovered regional-level driver of health care resource utilization and the extent to which it might affect cancer care,” the authors wrote.

Overall, the authors found “high” overall rates of inappropriate imaging for prostate cancer (44.4%) and breast cancer (41.8%), which suggests “Choosing Wisely was appropriately focused on these as important cancer care delivery problems.”

They also found that at the hospital referral region level, inappropriate prostate cancer imaging rates were associated with inappropriate breast cancer imaging rates.

“Because prostate and breast cancers affect different patient populations and are often treated by different specialists, there should not be an association between their imaging patterns,” the authors wrote. “A correlation between regional rates of prostate and breast cancer imaging would suggest that regional imaging behaviors share common determinants.”

For example, they wrote, an association of inappropriate imaging between prostate and breast cancer suggested that “regional culture and infrastructure to health care utilization contribute to health care utilization patterns across diseases."

"These findings challenge us to move in a different direction than focusing exclusively on individual patient/doctor decision making," said Makarov in a press release. "Policy makers and researchers need to target high-utilization regions and promote incentives for appropriate care. Such a focus would enhance efforts to cut excessive health spending and build value-based strategies into health care practice."