Work

Facility-Level Variation in Cardiac Stress Test Use Among Patients With Diabetes: Findings From the Veterans Affairs National Database

Year: 2020

Type: article

Abstract: Cardiac stress testing in patients with diabetes mellitus (DM) is a topic of much debate (1,2). The clinical heterogeneity and varied interpretation of atypical symptoms in this population may lead to significant variation in cardiac stress testing with downstream implications in health care expenditure. We evaluated facility-level variation in cardiac stress test use among patients with DM across the Veterans Affairs (VA) health care system. We identified patients with DM aged ≥18 years with a primary care clinic visit during VA fiscal year 2014 at one of the 130 VA facilities and associated clinics. Patient demographics and medical history were identified using clinical data sources and ICD-9-CM codes. We calculated diagnostic cost group relative risk score (DCG-RRS), a validated surrogate for overall illness burden. Facility-level cardiac stress test use was defined as the number of stress tests performed per facility per 100 patients with DM in the preceding 365 days. Stress testing modalities evaluated included exercise treadmill test, stress echocardiography, and SPECT/PET MPI (myocardial perfusion imaging [single photon emission computed tomography or positron emission tomography]). Facilities with <10 studies/year were excluded. Median risk ratio (MRR), a well-established measure of facility-level variation (3), was derived by constructing multivariable hierarchical modified regression models adjusted for patient clustering and modeled patient characteristics as filter effects within each facility and individual facilities as a random effect (4). Unadjusted and adjusted MRRs (adjustment for patient, provider, and facility-level variables) were calculated for overall stress testing and individual stress modalities. MRR represents the likelihood of two …

Source: Diabetes Care

DOI: 10.2337/dc19-2160