Health atlas radiology - part 2

This health atlas looks at the use of outpatient MRIs of the vertebral column (the spine) on residents in the 21 hospital referral areas in Norway. In each figure, it is possible to highlight referral areas of interest by clicking on the corresponding referral area.

The atlas is comprised of three topics. The first is a pooled analysis for MRIs including the whole or parts of the vertebral column. The other two provide more specialized explorations of the most common MRIs of areas of vertebral column – lumbar spine (base of the spine) and cervical spine (neck).

MRI of the vertebral column (the spine)

Main findings

• 62% more outpatient MRIs of the vertebral column were performed per 10, 000 population in referral area Østfold compared to referral area Førde.
• It is likely that there was unwarranted variation in the use of MRIs of the vertebral column among the elderly.
• There was an overuse of MRIs of the vertebral column. As many as 57, 000 MRIs per year were categorized as examinations suspected to be unnecessary.

MRI of the lumbar spine

Main findings

• 75% more outpatient MRIs of the lumbar spine per 10 000 population were performed in referral area Østfold compared to referral area Førde.
• There was large geographic variation in the use of x-ray of the lumbar spine before conducting an MRI.

MRI of the cervical spine

Main findings

• 84% more outpatient MRIs of the cervical spine per 10 000 population were carried out in referral area Østfold compared with referral area Førde.
• There were signs of differences in the practice of simultaneous diagnostic imaging of the shoulder.

Definitions and methodology

Definitions

Secondary examinations

The examinations which include NCRP code ZTX0BC for secondary examinations are excluded from the analyses. Secondary examinations mean that an earlier radiological examination is reconsidered/reexamined. This amounts to 50-63 000 invoices per year in the period between 2018 and 2022. A large proportion of the invoices with this code come from Radiumhospitalet.

Public and private

“Public” refers to radiology departments at hospitals. This includes nonprofit organizations with long term contracts with regional health trusts.

“Private” refers to private imaging clinics: Aleris/Evidia, Unilabs and Helsehuset røntgen.

Diagnostic imaging for inpatients

For alle undersøkelsene er det lite variasjon mellom de fire opptaksområdene i Helse Nord RHF, og andelen er stabil for årene 2018–2022.

Data for use of MRIs for inpatients is not available for some parts of the country yet. This atlas therefore only pertains to outpatient diagnostic imaging.

MRI of the vertebral column (the spine) is an examination typically performed in outpatient clinics. To get an overview of examinations carried out for outpatients and inpatients, SKDE has received access to an aggregated data set containing all radiological diagnostic imaging tests for patients treated in referral areas in northern Norway (Helse Nord). For MRIs of the cervical and lumbar spine, 95% of the activity was carried out in outpatient clinics.

For all examinations, there was little variation between the four referral areas in Helse Nord health trust, and the proportion remains stable for the period 2018-2022.

Reimbursements of expenditure

Reimbursements of expenditure are defined in the current atlas as “payments from the National Insurance scheme to healthcare providers for patient treatment and performed health services” (sources: Helfo).

All NCRP codes are linked to reimbursements categories and rates specified by HELFO (https://www.helfo.no/Sykehus-poliklinikk/regelverk-og-takster-for-sykehus-poliklinikk/regelverk-og-refusjon-for-sjukehus-og-poliklinikk). Note that the actual reimbursement for a patient contact might be higher than the rate as additional examinations might be carried out at the same patient contact.

In the calculations of the financial effects, the average actual reimbursements in 2022 for the diagnostic test under consideration is used.

About the atlas

Data set

The atlas uses data delivered by KUHR (Kontroll og utbetaling av helserefusjoner) on outpatient radiology funded by the public health care system from 2018 to 2022. Radiological examinations that are not funded by the public health care system (e.g., the patients pay themselves, private health insurance) are not included in this atlas. The Norwegian Directorate of Health indicates that 9% of the activity at private imaging clinics in 2017 was paid for privately.

In addition, we have activity data for patients undergoing MRIs of the whole or parts of the vertebral column for the period of one year before and one year after the MRI. This includes data from KUHR containing activity in the primary healthcare service and data from NPR (Norwegian Patient Registry) with activity in the specialist healthcare service.

Information about indications and referrals is not available or of poor quality in the data from KUHR.

Number of residents is collected from Statistics Norway.

Disclaimer: The health atlas uses data from KUHR and NPR, but the authors/SKDE are solely responsible for the interpretation and presentation of the data. KUHR/NRP do not have any responsibility for the analyses or interpretations of the data set.

Division of referral areas

The regional health trusts have a responsibility to ensure quality, equal and timely specialist health services for anyone who needs it, regardless of their place of residence, cf. the Health Trust Act section 1. In practice, it is the individual health trusts and private providers under a contract with a regional health authority that provide and perform the public health services. Each health trust has a hospital referral area that includes specific municipalities or city districts. Different disciplines can have different hospital referral areas, and for some services, functions are divided between different health trusts and/or private providers. In the health atlases from SKDE, it is the hospital referral areas for specialist health services for medical emergency care that are used.

The size of the healthcare institutions' referral areas varies considerably, as shown in the figure.

There are also differences in the composition of the population in these referral areas, particularly when it comes to the age of the population. The median age varies from 44 years for residents in the referral areas Innlandet and Helgeland to 32 years for residents in the referral area Lovisenberg. All rates and proportions calculated in the atlas are therefore sex- and age-adjusted so that they are comparable (standardised against Norway's population in 2020).

The list below shows the health trusts or hospitals for which hospital referral areas have been defined and the short versions of the names used in this healthcare atlas.

How the work is grounded the medical community

Working with the atlas we have benefited greatly from discussing sample definitions and analyses with the reference group; Panchakulasingam Kandiah (assistant Director of Medical Strategy and Development Helse Vest RHF), Aslak Bjarne Aslaksen (Clinical Executive of Helse Bergen and head of the Radiology Network in Helse Vest), Bjørn Hofman (professor at the Department of Health Sciences, NTNU Gjøvik), Elin Kjelle (Post doc at the Department of Health Sciences, NTNU Gjøvik) and Fredrik Nomme (head of the Radiological Society and medical director of Unilabs).

In addition, we have received valuable comments and feedback from Peder A. Halvorsen (general practice specialist and professor at the Research group for General Practice, UiT), Normund Svoen (municipal doctor/general practitioner, Florø), Marit Herder (specialist in radiology, UNN HF), Janna Berg (specialist in internal medicine and lung diseases, Vestfold Hospital), Tor Ingebrigtsen (specialist in neurosurgery UNN HF, professor at UiT), and Tore Kristian Solberg (specialist in neurosurgery UNN HF, professor at UiT, and clinical leader of the National Quality Register for Spine Surgery)).

Questions?

Do you have questions, comments or feedback? Please get in touch!

You can contact us by sending an email to helseatlas@skde.no.