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Mitchell found that there was a significant increase in the rate of IMRT use by self-referring urologists in private practice, from 13.1 to 32.3 percent (P < 0.001). The rate of IMRT use increased from 14.3 to 15.6 percent (P = 0.05) among non-self-referring urologists (unadjusted difference-in-differences effect, 17.9 percentage points). There was a significant regression-adjusted increase in IMRT use of 16.4 percentage points associated with self-referral. The rate of IMRT use remained stable at 8.0 percent among urologists working at National Comprehensive Cancer Network centers, but an increase of 33.0 percentage points was noted among the matched self-referring groups.
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