Original Articles: PDF OnlyQuantifying Utilization and Practice Variation of Electroconvulsive TherapyWestphal, James R. M.D.; Horswell, Ronald Ph.D.*; Kumar, Sanjaya M.D., M.Sc., M.P.H.*; Rush, Jill M.D., Dr.P.H.Author Information Department of Psychiatry, Louisiana State University Medical Center at Shreveport, and the *Quality Department and the Center for Health Information and Evaluation, Louisiana Health Care Review, Inc. (LHCR), Baton Rouge, Louisiana, U.S.A. Received October 1, 1996; accepted June 2, 1997. Address for correspondence and reprints: Dr. J. R. Westphal, Department of Psychiatry, Louisiana State University Medical Center, 1501 Kings Highway, P.O. Box 33932. Shreveport, LA 71130-3932. Part of the methodology and results presented as a poster at the 1996 Annual Meeting of the Association for Convulsive Therapy, May 5. 1996, New York, New York: Inpatient Electro-Convulsive Therapy Practice Variation in the Louisiana Medicare Population. The analyses upon which this publication is based were performed under contract no. 500-96-P707, entitled, “Utilization and Quality Control Peer Review Organization for the State of Louisiana,” sponsored by the Health Care Financing Administration (HCFA), Department of Health and Human Services. The content of this publication does not necessarily reflect the view or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by HCFA, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore, required no special funding on the part of this Contractor. Ideas and contributions to the author(s) concerning experience in engaging with issues presented are welcomed. Convulsive Therapy: Volume 13 - Issue 4 - p 242-252 Buy Abstract The objective of this study was to quantify inpatient electroconvulsive therapy (ECT) utilization and its practice variation within the State of Louisiana using Medicare data for beneficiaries age 65 years and older. The Louisiana Medicare claims (MedPar) history and the Medicare beneficiary denominator files for fiscal years 1993 and 1994 were used for analysis. Statistical techniques used were: Χ2 to determine significance of the proposed null hypothesis, and the modified systemic component of variance (SCV) to determine the magnitude of variation between the individual parish utilization rates for ECT. The ECT utilization rate for the Louisiana Medicare population was found to be 2.38 per 10,000 person-years, falling well within the range of previous ECT utilization studies in the United States. The Χ2 value was 0.0003 when comparing parishes, indicating the presence of significant nonrandom variation. The SCVs of inpatient treatment for major depression and inpatient ECT were 0.47 and 1.34, respectively. Inpatient ECT in this population demonstrates high geographic variability. Further research is required to determine and quantitate the factors responsible for the geographic variation in inpatient ECT utilization within the Louisiana Medicare population. © Lippincott-Raven Publishers.