Use of imaging for staging of XXXX in two integrated health care systems: adherence with a choosing wisely recommendation.

@entity1 @entity0
PURPOSE: Advanced imaging is commonly used for staging of @entity0 , despite recommendations against this practice. The objective of this study was to evaluate and compare use of imaging for staging of @entity0 in two integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was routine or used for diagnostic purposes. METHODS: We identified @entity1 with stages 0 to IIB @entity0 diagnosed between 2010 and 2012. Using KP and IH electronic health records, we identified use of computed tomography, positron emission tomography, or bone scintigraphy 30 days before diagnosis to 30 days postsurgery. We performed chart abstraction on a random sample of @entity1 who received a presurgical imaging test to identify indication. RESULTS: For the sample of 10,010 @entity1 , mean age at diagnosis was 60 years (range, 22 to 99 years); with 21% stage 0, 47% stage I, and 32% stage II. Overall, 15% of @entity1 (n = 1,480) received at least one imaging test during the staging window, 15% at KP and 14% at IH (P = .5). Eight percent of @entity1 received imaging before surgery, and 7% postsurgery. We found significant intraregional variation in imaging use. Chart abstraction (n = 129, 16% of @entity1 who received presurgical imaging) revealed that 48% of presurgical imaging was diagnostic. CONCLUSION: Use of imaging for staging of low-risk @entity0 was similar in both systems, and slightly lower than has been reported in the literature. Approximately half of imaging tests were ordered in response to a sign or symptom.
