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Appropriateness: analysis of outpatient radiology requests

Analisi dell’appropriatezza delle richieste ambulatoriali radiologiche

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Abstract

Purpose

This study assessed radiology requests and the influence of previous radiological procedures on their specificity and appropriateness, evaluated diagnostic outcomes and recorded the economic impact of inappropriate examinations.

Materials and methods

We prospectively analysed 4,018 outpatient requests, the appropriateness of which was assessed using an evaluation form. Economic analysis was based on costs listed in the Italian National Health Services (NHS) national tariff as established by the Ministerial Decree of 22 July 1996. Statistical analysis was carried out using Pearson’s test and univariate and multivariate logistic regression models.

Results

Of 4,018 outpatient requests, 57% were not included in a follow-up protocol and 56% were found to be appropriate. The diagnostic question was confirmed in 66% of cases considered appropriate (p<0.001). The existence of previous investigations had a significant impact on appropriateness and diagnostic outcome (p<0.001). The total cost of the requests was 257,317 euros, with inappropriate requests accounting for 94,012 euro (36.5%).

Conclusions

We found a 56% rate of appropriate requests and demonstrated that appropriate prescriptions provided with a specific clinical question led to significantly higher confirmation rates of the diagnostic hypothesis. In addition, inappropriate requests had a major negative economic impact.

Riassunto

Obiettivo

Scopo del nostro lavoro è stato verificare l’appropriatezza delle richieste di esami di diagnostica per immagini non inserite in programmi di follow-up e quanto i precedenti radiologici influiscano sulla specificità delle richieste e sull’appropriatezza, valutare il loro riscontro diagnostico, registrare l’impatto economico degli esami inappropriati.

Materiali e metodi

Abbiamo analizzato 4018 richieste ambulatoriali, l’appropriatezza è stata verificata mediante una scheda di valutazione dedicata. Nell’analisi economica sono stati valutate le tariffe previste dal nomenclatore per il Sistema Sanitario Nazionale (SSN) determinato dal Decreto Ministeriale (DM) del 22/07/1996. L’analisi statistica ha utilizzato il test di Pearson e modelli di regressione logistica univariata e multivariata.

Risultati

Le richieste non in follow-up hanno rappresentato il 57% delle prescrizioni esaminate e sono risultate appropriate nel 55,5% dei casi. La conferma del quesito diagnostico si è verificata nel 66% dei casi appropriati (p<0,001). La presenza di precedenti indagini ha influenzato l’appropriatezza delle richieste (p<0,001) e la conferma della diagnosi (p<0,001). Il fatturato totale degli esami è stato di 257317 euro, gli esami non appropriati hanno pesato per 94012 euro (36,5%).

Conclusioni

Abbiamo documentato una appropriatezza prescrittiva del 56% e come una richiesta appropriata associata alla presenza di un quesito specifico comporti una percentuale significativamente elevata di conferme dell’ipotesi diagnostica, calcolando inoltre il rilevante impatto sul piano finanziario delle richieste inappropriate.

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Correspondence to M. Cristofaro.

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Cristofaro, M., Busi Rizzi, E., Schininà, V. et al. Appropriateness: analysis of outpatient radiology requests. Radiol med 117, 322–332 (2012). https://doi.org/10.1007/s11547-011-0725-2

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  • DOI: https://doi.org/10.1007/s11547-011-0725-2

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