Variation in Ultrasound Utilization by Region and System of Care in the U.S. Military [30M]

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ACOG recommends up to two ultrasounds (USGs) in low-risk pregnancies. We sought to examine the proportion of women using TRICARE (insurance for US Armed Services members and their dependents) who received more than 2 USGs per pregnancy and variation across geographical regions and systems of care (direct/salary-based vs purchased/fee-for-service).


We used TRICARE (2006–2010) claims data to identify deliveries and created a low-risk cohort by excluding women aged 35 and above, twin and preterm deliveries, and women with prior cesarean or co-morbidities. CPT codes were used to determine the number of USGs per pregnancy for all women and low-risk women. The proportion of women who received more than 2 USGs/pregnancy were compared across four US regions and between two systems of care.


Among 268,975 total deliveries, 50.94% were in the direct system, 49.06% were in the purchased system and 49.1% were identified as low-risk pregnancies. Overall, 137,168 (51%) received more than 2 USGs/pregnancy. Higher proportion of low-risk deliveries in the Northeast (48.67%) received more than 2 USGs screening during pregnancy compared to South (43.59%), Mid-west (36.54%) and West (39.58%) (P=.001). The purchased system had a higher proportion of low-risk women receiving more than 2 USGs/pregnancy compared to the direct system (46.05% vs. 37.93%; P<.001).


There was wide variation in frequency of USG screening during pregnancy across regions and systems of care. Low-risk pregnancies in the direct/salary-based system received fewer ultrasounds than in the purchased/fee-for-service system. These findings suggest that reimbursement structures may impact USG utilization.

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