title: How does management of echocardiography affect use across risk groups? UM for outpatient discretionary echocardiography appeared to reduce testing rates significantly.
abstract: OBJECTIVE
  This study evaluated the impact of an outpatient echocardiography utilization management (UM) program relative to a matched control (non-UM) group by measuring changes in utilization rates overall and within specific cardiac-risk subgroups.
  
  
  METHODS
  Administrative claims data for enrollees from five states were queried from the Health-Core Integrated Research Database (HIRD). Inclusion required continuous eligibility from Oct. 1, 2008, through Sept. 30, 2009, for pre-UM implementation and from Oct. 1, 2010, through Sept. 30, 2011, for post-UM implementation. Members were followed for one year before and one year after the implementation period; propensity-score matched; categorized as low, medium or high-risk for a cardiac event; and stratified into UM and non-UM cohorts. Changes in utilization rates were compared among the matched cohorts using the difference-in-difference approach; generalized estimating equations were used to adjust for relevant factors including age, gender and cardiac risk score.
  
  
  RESULTS
  Members (N=2.5 million) were propensity-score matched (1:1) into UM and non-UM cohorts. Post- vs. pre-UM implementation, unadjusted utilization rates (echocardiography tests per 1,000 members) decreased for both the UM (16.9 percent) and non-UM (1.51 percent) cohorts, a difference of -15.42 points; the low risk subgroup had the greatest difference between UM and non-UM trends (-20.14 points) followed by the medium (-17.32 points) and high risk (-12.5 points) subgroups. Post implementation, 4.46 tests were avoided per 1,000 members in the UM cohort. After adjusting for relevant factors, the reduction in the UM group was estimated at -15.7% or 3.05 avoided tests per 1,000 members. In the low risk subgroup, 2,102 (49 percent of total) echocardiographs were avoided, followed by 1,302 (30%) in the medium and 917 (21%) in the high risk subgroups.
  
  
  CONCLUSIONS
  UM for outpatient discretionary echocardiography appeared to reduce testing rates significantly after controlling for factors including age, gender, and risk score. Utilization avoidance was greatest in the low and medium risk groups. These findings add new insights in a field where there is a lack of knowledge regarding appropriate utilization by risk category.
mesh_terms: D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging; D015331:Cohort Studies; D004452:Echocardiography / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D014481:United States