title: Ordering of CT by emergency department provider type: analysis of a nationally representative sample.
abstract: OBJECTIVE
  Given the growing concern about CT overutilization, we provide a descriptive trend analysis of CT studies ordered in U.S. emergency departments by nonphysician health care providers and examine whether there is a significant difference in ordering patterns between nonphysicians and physicians.
  
  
  METHODS
  We used a nationally representative data sample for 2001-2008 to describe trends in CT studies ordered in U.S. emergency departments by nonphysician health care providers. We performed a multivariate logistic regression with hospital fixed effects on the most recently available data to determine whether there is a difference in ordering patterns between the two provider groups.
  
  
  RESULTS
  From 2001 to 2008, the number of emergency department visits associated with CT studies managed solely by nonphysician health care providers increased from 100,626 to 620,296. Over this same period, the proportion of emergency department visits associated with CT managed solely by nonphysician providers grew from 1.5% to 3.6%. Controlling for hospital-level and patient-level variables, patient visits managed solely by nonphysician providers had 0.38 times the odds of CT utilization compared with patient visits managed by physicians.
  
  
  CONCLUSIONS
  Although both the total number and the proportion of emergency department visits managed independently by nonphysician providers and associated with CT have grown rapidly in the past decade, nonphysician health care providers are less likely to order CT compared with physicians. The types of ordering providers and their differing practices should become part of the discourse regarding appropriate CT utilization.
authors.affiliation: Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave E, G-3-200, Seattle, WA 98109-1023, USA. stophlee@gmail.com
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
authors.forename: Ninez A
authors.initials: NA
authors.lastname: Ponce
authors.forename: Susan L
authors.initials: SL
authors.lastname: Ettner
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Kahn
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Bassett
authors.forename: Howard P
authors.initials: HP
authors.lastname: Forman
mesh_terms: D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014218:Triage; D014481:United States; D000078329:Workforce