Downward trends in bronchoscopies performed between 1991 and 1997.
OBJECTIVE
To examine the frequency of bronchoscopy performance in a large tertiary medical center over a period of 8 years.


METHODS
Retrospective data analysis.


METHODS
Academic medical center.


METHODS
Using a computerized database of all bronchoscopies performed between 1991 and 1997, we analyzed trends in (1) the total number of bronchoscopies; and (2) the numbers of bronchoscopies performed for patients on the basis of the postbronchoscopic diagnosis in the following three main disease groups: AIDS, interstitial lung disease (ILD), and lung cancer. We measured the following outcomes in the patients of high-volume and low-volume bronchoscopists: procedure length (time to perform procedure), nondiagnostic rate, and repeat-bronchoscopy rate. In addition, we compared total admissions, outpatient visits, and insurance status of the patients during the same period.


RESULTS
In total, 5,580 bronchoscopies were performed. A 17% decline in the number of procedures was noted between 1991 and 1997 (from 943 to 783, respectively; p < 0.05). The number of AIDS-related bronchoscopies fell from 235 (25% of 943) to 96 (12% of 783), a 59% decline during this period (p < 0.05). There was a corresponding 76% decrease in the number of bronchoscopies associated with a diagnosis of Pneumocystis carinii pneumonia (PCP; p < 0.05). During the same period, no similar decrease was noted in the number of bronchoscopies associated with a diagnosis of ILD or lung cancer. Moreover, no significant differences were noted in the procedure length, nondiagnostic rate, or repeat-bronchoscopy rate between high-volume and low-volume bronchoscopists. Although there was no significant change in the number of total admissions between 1991 and 1997, there was a 48% increase in the number of managed-care patients and a 25.4% increase in the number of Medicaid health insurance program for California patients between 1991 and 1997.


CONCLUSIONS
We noted a significant decline in the number of bronchoscopies performed between 1991 and 1997. The significant reduction in the number of AIDS-associated bronchoscopies accounted for 87% of the decline. Other possible factors include the introduction of a management pathway for the empiric treatment of PCP in 1996, a reduction in the number of pulmonary admissions, an increase in the number of managed care patients, and a reduction in the remuneration for the performance of bronchoscopy.
Balfe
D
D
Department of Medicine, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA 90048, USA.
Mohsenifar
Z
Z
D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D001999:Bronchoscopy / Q000706:statistics & numerical data / Q000639:trends*; D016208:Databases, Factual; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000453:epidemiology*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies