Farzana Mehzabin Rahman FRCR, MBBS, Presenter: Nothing to Disclose

Seyed Ameli-Renani MBBS, FRCR, Abstract Co-Author: Nothing to Disclose

Christopher Stephen Bowles MBBS, Abstract Co-Author: Nothing to Disclose

Mohammad Shah MBBS, Abstract Co-Author: Nothing to Disclose

Ioannis Vlahos MRCP, FRCR, Abstract Co-Author: Research Consultant, Siemens AG Research Consultant, General Electric Company

Amy Davis MBBS, MRCP, Abstract Co-Author: Nothing to Disclose

In 2008, the UK Department of Health designed funding mechanisms in trauma management to incentivize and improve clinical practice. Payments are linked to a 1-hour scan time target, whereby any major trauma patient should have a CT within one hour of being admitted to the Emergency room. Linking reimbursement mechanisms to targets can result in unintended consequences and outcomes.The aim of this study is to assess the impact of this national policy on scanning practices and whether these policies have resulted in unnecessary CT scanning in certain patients.  

Data from four discrete 3-month time periods in 2011 and 2012 was retrospectively collated at our institution. Workflow pattern was assessed by analyzing the total number of major trauma CTs (n = 1004) in relation to the number of major trauma referrals (n = 1483). These CTs were then categorized into the type of scan performed (whole body CT versus non-whole body CT) and scan findings; namely positive (trauma related findings), negative (no significant findings) and incidental (findings unrelated to trauma). Bivariate analysis (Chi-Squared Test for Variables) was used to assess for statistically significant changes in these groups.

There was a statistically significant increase in the percentage of major trauma CTs across three of the time intervals from 2011 and 2012 (p<0.05). This was accompanied by a significant increase in the percentage of negative CTs (p<0.05) for the same intervals. There was also a significant increase in the percentage of whole body CTs immediately after the introduction of these payment incentives (p< 0.01) although the percentage of whole body CTs did not increase beyond the immediate time interval.  

There was a significant increase in both the percentage of major trauma CTs in 2011 and 2012 as well as the percentage of these studies that had negative findings. The increased percentage of negative CTs is a particular area of concern as it could indicate some patients are being unnecessarily scanned.

The 1-hour to scan target may lower the threshold for scanning patients at low risk in order to avoid possible financial loss. This could result in patients having a CT when they may have otherwise been managed without imaging. This could be a potentially unintended consequence of designing policy incentives whereby reimbursement is linked to rapid access to imaging.

Rahman, F, Ameli-Renani, S, Bowles, C, Shah, M, Vlahos, I, Davis, A, Have Incentives to Improve Quality of Care Led to Unnecessary CT Scanning in Major Trauma?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14015216.html