The effect of imaging guidelines on the number and quality of outpatient radiographic examinations

OBJECTIVE. A significant percentage of outpatient diagnostic radiology is p erformed by nonradiologists. Studies have shown nonradiologists have higher utilization and cost, as well as quality problems. We sought to determine if, in a managed care environment, a set of guidelines limiting imaging pri vileges of nonradiologist physicians could decrease imaging costs while ens uring that equipment and personnel providing imaging were of the highest qu ality. MATERIALS AND METHODS, We determined the number and type of radiographic im aging studies performed the year after these guidelines were set in place ( 1997) and compared these findings with those of the year before the guideli nes were established (1995) and with preguideline trends, We established qu ality criteria and, based thereon, inspected imaging offices. RESULTS. The number of radiographic examinations per 1000 enrollees decreas ed 20-25% from the previous trend. Nonradiologists' share of the total fell from 39% to 15%, No deficiencies were found in the inspection of five radi ologists' offices, whereas significant deficiencies of equipment, equipment maintenance, or documentation of the examinations performed were found in 78% of nonradiologists' offices. None of the quality indicators monitored b y the health plan showed significant change. CONCLUSION. Specific guidelines can effect change in the location and numbe r of radiologic examinations performed, with an improvement in the quality of the studies and a decrease in radiation dose and cost. No decline in qua lity of care appears to result, despite claims by opponents to such changes that widespread serious quality impairment would occur.