Use of Diagnostic Tests and Therapeutic Procedures in a Changing Health Care Environment

Two articles in this week's issue ofTHE JOURNAL, both based on large-scale administrative data, examine the links between use of diagnostic tests and subsequent use of related surgical procedures. Wennberg et al¹examined data from small areas in New England and showed that use of imaging stress electrocardiograms is closely related to subsequent use of angiography and use of stress electrocardiograms and angiography is strongly related to subsequent use of revascularization. Verilli and Welch²used national Medicare claims data to show similar linkage for five diagnostic-therapeutic pairs: cardiac catheterization with cardiac revascularization, imaging of the spine with back surgery, swallowing studies with percutaneous gastroscopy, mammography with breast biopsy/excision, and prostate biopsy with prostatectomy. Together these two articles provide convincing evidence that increased use of a range of therapeutic procedures is strongly associated with prior use of related diagnostic tests. See also pp 1161 and 1189. The association