title: Using sonography to examine adult patients at an academic medical center: have usage patterns changed with the expansion of managed care?
abstract: OBJECTIVE
  This study was designed to determine whether significant changes have occurred in the utilization of sonography relative to more expensive cross-sectional imaging techniques in adult patients during a time of increasing reliance on managed care.
  
  
  METHODS
  Use of sonography was compared with use of CT and MR imaging of the abdomen, pelvis, and retroperitoneum in adult patients in 1993 and 1998 at an academic medical center. Clinicians who requested the greatest number of examinations in both years were surveyed to assess their perception of changes in their practice patterns during the interim.
  
  
  RESULTS
  Between 1993 and 1998, the use of sonography relative to the other cross-sectional imaging modalities decreased from 56% to 43% (p < or = 0.001). During the same time, CT use increased from 30% to 41% (p < or = 0.001), and MR imaging use increased from 14% to 16% (p < or = 0.001). Survey responses indicated that potential cost saving was not a major factor in physicians' decisions to use sonography rather than other cross-sectional imaging modalities.
  
  
  CONCLUSIONS
  Sonographic utilization decreased during a 5-year period in which managed care provided an increasingly large proportion of overall reimbursement. Cost did not appear to be a major factor in selection of diagnostic tests. Differences over time in refering clinicians' perception of the relative usefulness of sonography, CT, and MR imaging may have contributed to the change in usage patterns.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104, USA.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Liebeskind
authors.forename: Peter H
authors.initials: PH
authors.lastname: Arger
authors.forename: Amy
authors.initials: A
authors.lastname: Liebeskind
authors.forename: Keith
authors.initials: K
authors.lastname: Maston
authors.forename: Curtis
authors.initials: C
authors.lastname: Langlotz
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging / Q000473:pathology; D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000328:Adult; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D010388:Pelvis / Q000000981:diagnostic imaging / Q000473:pathology; D010818:Practice Patterns, Physicians'; D011860:Radiography, Abdominal / Q000706:statistics & numerical data; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data*