title: Neuroimaging overuse is more common in Medicare compared with the VA.
abstract: OBJECTIVE
  To inform initiatives to reduce overuse, we compared neuroimaging appropriateness in a large Medicare cohort with a Department of Veterans Affairs (VA) cohort.
  
  
  METHODS
  Separate retrospective cohorts were established in Medicare and in VA for headache and neuropathy from 2004 to 2011. The Medicare cohorts included all patients enrolled in the Health and Retirement Study (HRS) with linked Medicare claims (HRS-Medicare; n = 1,244 for headache and 998 for neuropathy). The VA cohorts included all patients receiving services in the VA (n = 93,755 for headache and 183,642 for neuropathy). Inclusion criteria were age over 65 years and an outpatient visit for incident neuropathy or a primary headache. Neuroimaging use was measured with Current Procedural Terminology codes and potential overuse was defined using published criteria for use with administrative data. Increasingly specific appropriateness criteria excluded nontarget conditions for which neuroimaging may be appropriate.
  
  
  RESULTS
  For both peripheral neuropathy and headache, potentially inappropriate imaging was more common in HRS-Medicare compared with the VA. Forty-nine percentage of all headache patients received neuroimaging in HRS-Medicare compared with 22.1% in the VA (p < 0.001) and differences persist when analyzing more specific definitions of overuse. A total of 23.7% of all HRS-Medicare incident neuropathy patients received neuroimaging compared with 9.0% in the VA (p < 0.001), and the difference persisted after excluding nontarget conditions.
  
  
  CONCLUSIONS
  Overuse of neuroimaging is likely less common in the VA than in a Medicare population. Better understanding the reasons for the more selective use of neuroimaging in the VA could help inform future initiatives to reduce overuse of diagnostic testing.
authors.affiliation: From the Department of Neurology (J.F.B., B.C.C.), Department of Internal Medicine (E.A.K., R.J.M., K.M.L.), Institute for Healthcare Policy and Innovation (J.F.B., E.A.K., K.M.L., B.C.C.), and Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor; and Neurology Section (J.F.B., B.C.C.) and Center for Clinical Management and Research (E.A.K., R.H., K.M.L.), VA Ann Arbor Healthcare System, MI. jamesbur@med.umich.edu.
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.affiliation: From the Department of Neurology (J.F.B., B.C.C.), Department of Internal Medicine (E.A.K., R.J.M., K.M.L.), Institute for Healthcare Policy and Innovation (J.F.B., E.A.K., K.M.L., B.C.C.), and Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor; and Neurology Section (J.F.B., B.C.C.) and Center for Clinical Management and Research (E.A.K., R.H., K.M.L.), VA Ann Arbor Healthcare System, MI.
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
authors.affiliation: From the Department of Neurology (J.F.B., B.C.C.), Department of Internal Medicine (E.A.K., R.J.M., K.M.L.), Institute for Healthcare Policy and Innovation (J.F.B., E.A.K., K.M.L., B.C.C.), and Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor; and Neurology Section (J.F.B., B.C.C.) and Center for Clinical Management and Research (E.A.K., R.H., K.M.L.), VA Ann Arbor Healthcare System, MI.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: McCammon
authors.affiliation: From the Department of Neurology (J.F.B., B.C.C.), Department of Internal Medicine (E.A.K., R.J.M., K.M.L.), Institute for Healthcare Policy and Innovation (J.F.B., E.A.K., K.M.L., B.C.C.), and Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor; and Neurology Section (J.F.B., B.C.C.) and Center for Clinical Management and Research (E.A.K., R.H., K.M.L.), VA Ann Arbor Healthcare System, MI.
authors.forename: Rob
authors.initials: R
authors.lastname: Holleman
authors.affiliation: From the Department of Neurology (J.F.B., B.C.C.), Department of Internal Medicine (E.A.K., R.J.M., K.M.L.), Institute for Healthcare Policy and Innovation (J.F.B., E.A.K., K.M.L., B.C.C.), and Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor; and Neurology Section (J.F.B., B.C.C.) and Center for Clinical Management and Research (E.A.K., R.H., K.M.L.), VA Ann Arbor Healthcare System, MI.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.affiliation: From the Department of Neurology (J.F.B., B.C.C.), Department of Internal Medicine (E.A.K., R.J.M., K.M.L.), Institute for Healthcare Policy and Innovation (J.F.B., E.A.K., K.M.L., B.C.C.), and Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor; and Neurology Section (J.F.B., B.C.C.) and Center for Clinical Management and Research (E.A.K., R.H., K.M.L.), VA Ann Arbor Healthcare System, MI.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D051270:Headache Disorders, Primary / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D059906:Neuroimaging / Q000706:statistics & numerical data*; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*