目的:利用国家门诊医疗护理调查(NAMCS)数据库评估50及以上无创伤髋部或膝部疼痛患者的MRI使用情况。
方法:获得了NAMCS加权调查数据(2007-2019年),用于50岁及以上无创伤髋关节或膝关节疼痛患者的门诊就诊。结果变量是MRI排序状态,分析特征包括患者年龄,种族/民族,付款人,专科医师,大都市统计区,和共存的射线照片顺序。多变量逻辑回归评估了MRI排序状态与分析的患者特征之间的关联。所有测试都是双侧的(P值为0.05)。
结果:分析了88,978,804膝痛和28,675,725例髋痛患者就诊(调查加权),4,690,943(5.3%)和2,023,226(7.1%)有膝盖或臀部MRI顺序,分别。总的来说,2,454,433(2.8%)的膝关节疼痛访视和575,155(2.0%)的髋部疼痛访视均具有MRI和X光片的顺序。黑人患者(p=0.03)和80岁及以上的患者(p=0.04)不太可能进行膝关节MRI检查,而未投保的患者不太可能进行髋关节MRI排序(p=0.01)。如果由外科专家观察,髋部疼痛患者更有可能进行髋部MRI检查(p=0.01)。
结论:对于50岁及以上患有无损伤性髋关节或膝关节疼痛的患者,要求进行MRI检查的比例较低。医疗保健准入较低的群体不太可能获得MRI命令,强调医疗保健公平方面的已知差距。
OBJECTIVE: To utilize the National Ambulatory Medical Care Survey (NAMCS) Database to assess MRI utilization in patients 50 and above with atraumatic hip or knee pain.
METHODS: NAMCS weighted survey data were obtained (2007-2019) for ambulatory visits in patients aged 50 and above with atraumatic hip or knee pain. The outcome variable was MRI ordering status, and analyzed characteristics included patient age, race/ethnicity, payor, physician specialty, metropolitan statistical area, and a coexistent radiograph order. Multivariable logistic regressions assessed the association between MRI ordering status and the analyzed patient characteristics. All tests were two-sided (p-value of 0.05).
RESULTS: 88,978,804 knee pain and 28,675,725 hip pain patient visits (survey-weighted) were analyzed, with 4,690,943 (5.3%) and 2,023,226 (7.1%) having a knee or hip MRI order, respectively. Overall, 2,454,433(2.8%) of knee pain visits and 575,155 (2.0%) of hip pain visits had orders both for MRI and radiographs. Black patients (p=0.03) and patients aged 80 and above (p=0.04) were less likely to have a knee MRI ordered, while uninsured patients were less likely to have a hip MRI ordered (p=0.01). Patients with hip pain were more likely to have a hip MRI ordered if seen by a surgical subspecialist(p=0.01).
CONCLUSIONS: A low proportion of MRI exams were ordered for patient visits in the aged 50 and above population with atraumatic hip or knee pain. Groups with lower healthcare access were less likely to have an MRI order, highlighting known disparities in healthcare equity.