Downward trends in bronchoscopies performed between 1991 and 1997

Study objective: To examine the frequency of bronchoscopy performance in a large tertiary medical center over a period of 8 years. Design: Retrospective data analysis. Setting: Academic medical center, Materials and methods: Using a computerized database of all bronchoscopies performed between 1991 and 1997, we analyzed trends in (1) the total number of bronchoscopies; and (2) the numbers of bronchoscopies performed for pat ients on the basis of the postbronchoscopic diagnosis in the following thre e main disease groups: AIDS, interstitial lung disease (ILD), and lung canc er. We measured the following outcomes in the patients of high-volume and l ow-volume bronchoscopists: procedure length (time to perform procedure), no ndiagnostic rate, and repeat-bronchoscopy rate. In addition, we compared to tal admissions, outpatient visits, and insurance status of the patients dur ing the same period. Results: In total, 5,580 bronchoscopies were performed. A 17% decline in th e number of procedures was noted between 1991 and 1997 (from 943 to 783, re spectively; p < 0.05). The number of AIDS-related bronchoscopies fell from 235 (25% of 943) to 96 (12% of 783), a 59% decline during this period (p < 0.05), There was a corresponding 76% decrease in the number of bronchoscopi es associated with a diagnosis of Pneumocystis carinii pneumonia (PCP; p < 0.05). During the same period, no similar decrease was noted in the number of bronchoscopies associated with a diagnosis of ILD or lung cancer. Moreov er, no significant differences were noted in the procedure length, nondiagn ostic rate, or repeat-bronchoscopy rate between high-volume and low-volume bronchoscopists. Although there was no significant change in the number of total admissions between 1991 and 1997, there was a 48% increase in the num ber of managed-care patients and a 25.4% increase in the number of Medicaid health insurance program for California patients between 1991 and 1997. Conclusions: We noted a significant decline in the number of bronchoscopies performed between 1991 and 1997. The significant reduction in the number o f AIDS-associated bronchoscopies accounted for 87% of the decline. Other po ssible factors include the introduction of a management pathway for the emp iric treatment of PCP in 1996, a reduction in the number of pulmonary admis sions, an increase in the number of managed care patients, and a reduction in the remuneration for the performance of bronchoscopy.