title: Variations in Radiographic Procedure Use for Medicare Patients With Rheumatoid Arthritis.
abstract: In 2013, the American College of Rheumatology published its Choosing Wisely list, which identified 2 radiographic procedures (peripheral joint magnetic resonance imaging [MRI] and dual x-ray absorptiometry [DXA] scans) that were at risk for overuse.
  
  
  
  We performed a retrospective cross-sectional cohort study to measure the use of peripheral joint MRI, peripheral joint radiographs, and DXA scans in a national cohort of Medicare patients with rheumatoid arthritis (RA) during 2008-2009, before the start of the Choosing Wisely campaign. Diagnoses were identified via International Classification of Diseases, Ninth Revision, codes; utilization was calculated using Current Procedural Terminology codes. Utilization was analyzed at the individual level and at the regional level (by hospital referral region [HRR]).
  
  
  
  There were 8,051 patients with RA who were included: 81% were women, and the mean age was 76 years. Over a 2-year period, the mean number of peripheral joint MRIs per beneficiary was 0.3 (median 0 [range 0-50]), peripheral joint radiographs per beneficiary was 2.6 (median 1 [range 0-33]), and DXA scans per beneficiary was 0.7 (median 0 [range 0-11]). Only 6.8% of patients received >1 peripheral joint MRI, and 6% of HRRs had a mean number of peripheral joint MRIs >1.
  
  
  
  There is variation in the use of peripheral joint MRI, peripheral joint radiographs, and DXA scans among Medicare patients with RA, although only a small number of HRRs have consistently high utilization. Although we cannot judge the appropriateness of each procedure, variation in use across regions signals the need for investigations to examine potential overutilization.
authors.affiliation: Veterans Affairs Medical Center and University of California, San Francisco.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Schmajuk
authors.affiliation: Institute for Health Policy Studies, University of California, San Francisco.
authors.forename: Chris
authors.initials: C
authors.lastname: Tonner
authors.affiliation: Institute for Health Policy Studies, University of California, San Francisco.
authors.forename: Laura
authors.initials: L
authors.lastname: Trupin
authors.affiliation: Institute for Health Policy Studies, University of California, San Francisco.
authors.forename: Jinoos
authors.initials: J
authors.lastname: Yazdany
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data*; D011859:Radiography / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States