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Access Type

WSU Access

Date of Award

January 2021

Degree Type


Degree Name




First Advisor

Gail Summers


INAPPROPRIATE DIAGNOSTIC IMAGING IN THE EMERGENCY DEPARTMENTBy DEREK JENKINS DISSERTATION August 2020 Advisor: Dr. Gail Jensen Summers Major: Economics Degree: Doctor of Philosophy This paper analyzes the utilization of inappropriate diagnostic imaging procedures in the Emergency Department (ED), and estimates the effect of managed care on preventing them. We analyze ED discharge data from Florida, Maryland, Kentucky, Iowa, and Nevada for the Statewide Emergency Department Database (SEDD) maintained by the Healthcare Cost and Utilization Project (HCUP). We consider four diagnostic scenarios. Namely, diagnostic imaging of non-specific lower back pain, headache, syncope, and rhinosinusitis. Using the appropriateness criterion from the American College of Radiology (ACR) we report how many inappropriate procedures who were performed in EDs in these five states. we find substantial utilization of these procedures and next we estimate the effect of managed care at limiting these procedures. We find a statistically significant 1 percentage point decrease in the probability of inappropriate imaging for patients presenting with headache and non-specific lower back pain. We also estimate the spillover effects onto the non-managed care population for inappropriate imaging of the lower back. We find compositional changes in the treatment mix of Medicare Advantage enrollees, and that these compositional changes spillover onto non-managed care patients.

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