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Ho ML, Arnold CW, Decker SJ, Hazle JD, Krupinski EA, Mankoff DA. Institutional Strategies to Maintain and Grow Imaging Research During the COVID-19 Pandemic. Acad Radiol 2023; 30:631-639. [PMID: 36764883 PMCID: PMC9816088 DOI: 10.1016/j.acra.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 01/09/2023]
Abstract
Understanding imaging research experiences, challenges, and strategies for academic radiology departments during and after COVID-19 is critical to prepare for future disruptive events. We summarize key insights and programmatic initiatives at major academic hospitals across the world, based on literature review and meetings of the Radiological Society of North America Vice Chairs of Research (RSNA VCR) group. Through expert discussion and case studies, we provide suggested guidelines to maintain and grow radiology research in the postpandemic era.
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Affiliation(s)
- Mai-Lan Ho
- Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.
| | | | | | - John D. Hazle
- The University of Texas MD Anderson Cancer Center, Houston, Texas
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Hofmann B, Andersen ER, Kjelle E. What can we learn from the SARS-COV-2 pandemic about the value of specific radiological examinations? BMC Health Serv Res 2021; 21:1158. [PMID: 34702243 PMCID: PMC8546787 DOI: 10.1186/s12913-021-07190-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The SARS-COV-2 pandemic provides a natural intervention to assess practical priority setting and internal evaluation of specific health services, such as radiological services. Norway makes an excellent case as it had a very low infection rate and very few cases of COVID-19. Accordingly, the objective of this study is to use the changes in performed outpatient radiological examinations during the first stages of the SARS-COV-2 pandemic to assess the practical evaluation of specific radiological examinations in Norway. METHODS Data was collected retrospectively from the Norwegian Health Economics Administration (HELFO) in the years 2015-2020. Data included the number of performed outpatient imaging examinations at public hospitals and private imaging centers in Norway and was divided in to three periods based on the level of restrictions on elective health services. Results were analyzed with descriptive statistics. RESULTS In the first period there was a 45% reduction in outpatient radiology compared to the same time period in 2015-2019 while in period 2 and 3 there was a 25 and 6% reduction respectively. The study identified a list of specific potential low-value radiological examinations. While some of these are covered by the Choosing Wisely campaign, others are not. CONCLUSION By studying the priority setting practice during the initial phases of the pandemic this study identifies a set of potential low value radiological examinations during the initial phases of the SARS-COV-2 pandemic. These examinations are candidates for closer assessments for health services quality improvement.
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Affiliation(s)
- Bjørn Hofmann
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 191, N-2802, Gjøvik, Norway.
- Centre of Medical Ethics at the University of Oslo, Oslo, Norway.
| | - Eivind Richter Andersen
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 191, N-2802, Gjøvik, Norway
| | - Elin Kjelle
- Institute for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, PO Box 191, N-2802, Gjøvik, Norway
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Hashmi A, Parikh K, Al-Natour M, Azar N, Sutter C, Ramaiya N, Davidson J, Tavri S. Interventional radiology procedural volume changes during COVID-19 initial phase: A tertiary level Midwest health system experience. Clin Imaging 2021; 72:31-36. [PMID: 33202292 PMCID: PMC7654291 DOI: 10.1016/j.clinimag.2020.10.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/29/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND To evaluate Interventional Radiology (IR) procedural volume changes at a large Midwest health system between March 17, 2020 and April 30, 2020 following a state-mandated shutdown of nonessential procedures during the initial phase of COVID-19. METHODS IR procedural volumes were compiled, stratified by location and compared with Diagnostic Radiology (DR) volumes during the same timeframe. Procedure volume was categorized by type, including oncology, dialysis interventions, and drainage procedures with comparisons made using Z-score test for proportions. IR and system-wide surgical procedural volume was compared with baseline values. RESULTS System-wide IR procedural volume decreased by 35%, with a 41% decrease in outpatient and a 25% decrease in inpatient volume during the state-mandated order. DR volume decreased by 45%, with a 57% decrease in outpatient and a 22% decrease in inpatient volume. Total IR procedural volume during the mandate was 1077 versus 1518 during the preceding six weeks. The proportion of Interventional Oncology and dialysis interventions showed no significant change (p > 0.05) while that of drainage procedures increased (p < 0.05). Compared to baseline values, system-wide procedural volumes for IR, Vascular Surgery, Urology, General Surgery, Gastroenterology and Gynecology decreased by 3%, 11%, 25%, 20%, 38% and 31% in March 2020 and 25%, 47%, 68%, 63%, 79% and 73% in April 2020 respectively. CONCLUSION Outpatient IR volumes were less impacted compared to DR during the initial phase of COVID-19. Oncology, dialysis and drainage interventions may be considered essential procedures due to their stability. IR volumes were less affected compared to other procedural specialties.
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Affiliation(s)
- Ahmad Hashmi
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Keval Parikh
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Mohammed Al-Natour
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Nami Azar
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Christopher Sutter
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Jon Davidson
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America
| | - Sidhartha Tavri
- Department of Radiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, BSH 5056, Cleveland, OH 44106, United States of America.
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Carlon T, Finkelstein M, Maron SZ, Goldman D, Kihira S, Marinelli B, Dayan E, Sullivan N, Hart J, Doshi AH, Delman BN, Lookstein R, Drayer BP. Sources of Revenue Loss and Recovery in Radiology Practices During the Coronavirus Disease 2019 (COVID-19) Pandemic. Acad Radiol 2021; 28:447-456. [PMID: 33495075 PMCID: PMC7813500 DOI: 10.1016/j.acra.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 02/06/2023]
Abstract
Rationale and Objectives This study seeks to quantify the financial impact of COVID-19 on radiology departments, and to describe the structure of both volume and revenue recovery. Materials and Methods Radiology studies from a large academic health system were retrospectively studied from the first 33 weeks of 2020. Volume and work relative value unit (wRVU) data were aggregated on a weekly basis for three periods: Presurge (weeks 1–9), surge (10–19), and recovery (20–33), and analyzed compared to the pre-COVID baseline stratified by modality, specialty, patient service location, and facility type. Mean and median wRVU per study were used as a surrogate for case complexity. Results During the pandemic surge, case volumes fell 57%, while wRVUs fell by 69% relative to the pre-COVID-19 baseline. Mean wRVU per study was 1.13 in the presurge period, 1.03 during the surge, and 1.19 in the recovery. Categories with the greatest mean complexity declines were radiography (−14.7%), cardiothoracic imaging (−16.2%), and community hospitals overall (−15.9%). Breast imaging (+6.5%), interventional (+5.5%), and outpatient (+12.1%) complexity increased. During the recovery, significant increases in complexity were seen in cardiothoracic (0.46 to 0.49), abdominal (1.80 to 1.91), and neuroradiology (2.46 to 2.56) at stand-alone outpatient centers with similar changes at community hospitals. At academic hospitals, only breast imaging complexity remained elevated (1.32 from 1.17) during the recovery. Conclusion Reliance on volume alone underestimates the financial impact of the COVID-19 pandemic as there was a disproportionate loss in high-RVU studies. However, increased complexity of outpatient cases has stabilized overall losses during the recovery.
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Affiliation(s)
- Timothy Carlon
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029.
| | - Mark Finkelstein
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Samuel Z Maron
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York
| | - Daryl Goldman
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Shingo Kihira
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Brett Marinelli
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Etan Dayan
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Nisha Sullivan
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - John Hart
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Amish H Doshi
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Bradley N Delman
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Robert Lookstein
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
| | - Burton P Drayer
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY USA 10029
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Chang G, Doshi A, Chandarana H, Recht M. Impact of COVID-19 Workflow Changes on Patient Throughput at Outpatient Imaging Centers. Acad Radiol 2021; 28:297-306. [PMID: 33516590 PMCID: PMC7831631 DOI: 10.1016/j.acra.2020.12.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 01/04/2023]
Abstract
Rationale and Objectives To determine the impact of COVID-19 workflow changes on patient throughput at the outpatient imaging facilities of a large healthcare system in New York City. Materials and Methods COVID-19 workflow changes to permit social distancing and patient and staff safety included screening at the time of scheduling, encouraging patients to use our digital platform to complete registration/safety forms prior to appointments, stationing screeners at all entrances, limiting waiting room capacity, implementing a texting system to notify patients of delays, limiting dressing room use by encouraging patients to wear exam-appropriate clothing, and accelerating MRI protocols without reducing image quality. We assessed patients’ pre-exam wait times, MR exam times, overall time spent on site, and registration for and use of the digital portal before (February 2020) and after (June 2020) implementation of these measures. Results Across 17 outpatient imaging centers, workflow changes resulted in a 23.1% reduction (-6.8 minutes) in all patients’ pre-exam wait times (p <0.00001). Pre-exam wait times for MRI, CT, ultrasound, x-ray, and mammography decreased 28.4% (-10.3 minutes), 16.5% (-6.7 minutes), 25.3% (-7.7 minutes), 22.8% (-3.7 minutes), and 23.9% (-5.0 minutes), respectively (p < 0.00001 for all). MR exam times decreased 9.7% (-3.5 minutes) and patients’ overall time on site decreased 15.2% (-8.0 minutes). The proportions of patients actively using the digital patient portal (56.1%–70.1%) and completing forms electronically prior to arrival (24.9%–47.1%) increased (p < 0.0001 for both). Conclusion Workflow changes necessitated by the COVID-19 pandemic to ensure safety of patients and staff have permitted higher outpatient throughput.
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González-Ortiz S, Medrano S, Maiques JM, Capellades J. Challenges in Neuroimaging in COVID-19 Pandemia. Front Neurol 2020; 11:579079. [PMID: 33329320 PMCID: PMC7734130 DOI: 10.3389/fneur.2020.579079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Sofía González-Ortiz
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Santiago Medrano
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - José María Maiques
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Jaume Capellades
- Neuroradiology Section, Radiology Department, Hospital del Mar, Barcelona, Spain
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Imaging Utilization During the COVID-19 Pandemic Highlights Socioeconomic Health Disparities. J Am Coll Radiol 2020; 18:554-565. [PMID: 33220184 PMCID: PMC7598682 DOI: 10.1016/j.jacr.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/27/2022]
Abstract
Objective The devastating impact from the coronavirus disease 2019 (COVID-19) pandemic highlights long-standing socioeconomic health disparities in the United States. The purpose of this study was to evaluate socioeconomic factors related to imaging utilization during the pandemic. Methods Retrospective review of consecutive imaging examinations was performed from January 1, 2019, to May 31, 2020, across all service locations (inpatient, emergency, outpatient). Patient level data were provided for socioeconomic factors (age, sex, race, insurance status, residential zip code). Residential zip code was used to assign median income level. The weekly total imaging volumes in 2020 and 2019 were plotted from January 1 to May 31 stratified by socioeconomic factors to demonstrate the trends during the pre-COVID-19 (January 1 to February 28) and post-COVID-19 (March 1 to May 31) periods. Independent-samples t tests were used to statistically compare the 2020 and 2019 socioeconomic groups. Results Compared with 2019, the 2020 total imaging volume in the post-COVID-19 period revealed statistically significant increased imaging utilization in patients who are aged 60 to 79 years (P = .0025), are male (P < .0001), are non-White (Black, Asian, other, unknown; P < .05), are covered by Medicaid or uninsured (P < .05), and have income below $80,000 (P < .05). However, there was a significant decrease in imaging utilization among patients who are younger (<18 years old; P < .0001), are female (P < .0001), are White (P = .0003), are commercially insured (P < .0001), and have income ≥$80,000 (P < .05). Discussion During the pandemic, there was a significant change in imaging utilization varying by socioeconomic factors, consistent with the known health disparities observed in the prevalence of COVID-19. These findings could have significant implications in directing utilization of resources during the pandemic and subsequent recovery.
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