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Garrahy D, Doran S, O'Neill H, Dennan S, Beddy P. Towards 24/7 MRI: the effect of routine weekend inpatient MRI scanning on patient waiting times. Ir J Med Sci 2024; 193:1697-1701. [PMID: 38461226 PMCID: PMC11294432 DOI: 10.1007/s11845-024-03647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/12/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Demand for inpatient MRI outstrips capacity which results in long waiting lists. The hospital commenced a routine weekend MRI service in January 2023. AIM The aim of this study was to investigate the effect of a limited routine weekend MRI service on MRI turnaround times. METHODS Waiting times for inpatient MRI scans performed before and after the introduction of weekend MRI from January 1 to August 31, 2022, and January 1 to August 31, 2023, were obtained. The turnaround time (TAT) and request category for each study were calculated. Category 1 requests were required immediately, category 2 requests were urgent and category 3 requests were routine. RESULTS There was a 6% (n = 128) increase in MRI inpatient scanning activity in 2023 (n = 2449) compared to 2022 (n = 2322). There was a significant improvement in overall mean TAT for inpatient MRIs (p < .001) in 2023 (mean 65.2 h, range 0-555 h) compared to 2022 (mean 98.3 h, range 0-816 h). There was no significant difference in the mean waiting time for category 1 MRIs between 2022 and 2023. There was a significant improvement (p < .001) in mean waiting time in 2023 (mean 37.2 h, range 0-555) compared to 2022 (mean 55.4 h, range 0-816) for category 2 MRI. The mean waiting time for category 3 studies also significantly improved (p < .001) in 2023 (mean 93.4 h, range 1-2663) when compared to 2022 (mean 154.8, range 1-1706). CONCLUSION Routine weekend inpatient MRI significantly shortens inpatient waiting times.
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Affiliation(s)
- Darragh Garrahy
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Simon Doran
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Hazel O'Neill
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Suzanne Dennan
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland
| | - Peter Beddy
- Department of Radiology, St James's Hospital and Trinity College Dublin, James's St, Dublin 8, Ireland.
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2
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Matsumoto AH, Dake MD. Implications of IR Being a Primary Specialty on the Professional Organizational Relationship between Interventional and Diagnostic Radiology. J Vasc Interv Radiol 2023; 34:2080-2084. [PMID: 38008543 DOI: 10.1016/j.jvir.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/12/2023] [Indexed: 11/28/2023] Open
Abstract
The recent awarding of primary specialty status to interventional radiology (IR) invites a re-examination of the long-standing relationship between IR and diagnostic radiology (DR). In this new era, it is important to evaluate how the organizations that represent these 2 specialties can best contribute to strengthening a growth in collaborations and partnerships that will benefit their members and patients. Areas of organizational focus with the potential to enhance the future for both groups include combining efforts directed toward advocacy and government relations, developing practice models to create successful IR and DR working relationships, and providing more data to demonstrate the value of IR above and beyond the work relative value units and professional revenues that IR generates.
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Affiliation(s)
- Alan H Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia.
| | - Michael D Dake
- Department of Medical Imaging, Surgery and Medicine, University of Arizona Health Sciences, Tucson Campus, Health Sciences Innovation Building, Tucson, Arizona
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3
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Dako F, Cook T, Zafar H, Schnall M. Population Health Management in Radiology: Economic Considerations. J Am Coll Radiol 2023; 20:962-968. [PMID: 37597716 DOI: 10.1016/j.jacr.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/21/2023]
Abstract
There is a growing emphasis on population health management (PHM) in the United States, in part because it has the worst health outcomes indices among high-income countries despite spending by far the most on health care. Successful PHM is expected to lead to a healthier population with reduced health care utilization and cost. The role of radiology in PHM is increasingly being recognized, including efforts in care coordination, secondary prevention, and appropriate imaging utilization, among others. To further discuss economic considerations for PHM, we must understand the evolving health care payer environment, which combines fee-for-service and increasingly, an alternative payment model framework developed by the Health Care Payment Learning and Action Network. In considering the term "value-based care," perceived value needs to accrue to those who ultimately pay for care, which is more commonly employers and the government. This perspective drives the design of alternative payment models and thus should be taken into consideration to ensure sustainable practice models.
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Affiliation(s)
- Farouk Dako
- Director of the Center for Global and Population Health Research in Radiology, Department of Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Tessa Cook
- Vice Chair, Practice Transformation, Department of Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Hanna Zafar
- Vice Chair, Quality, Department of Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mitchell Schnall
- Chairman and Eugene P. Pendergrass Professor of Radiology, Department of Radiology, Senior Fellow, Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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4
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Calvillo AÁG, Kodaverdian LC, Garcia R, Lichtensztajn DY, Bucknor MD. Patient-level factors influencing adherence to follow-up imaging recommendations. Clin Imaging 2022; 90:5-10. [PMID: 35907273 DOI: 10.1016/j.clinimag.2022.07.006] [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: 04/29/2022] [Revised: 07/09/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine which, if any, patient-level factors were associated with differences in completion of follow-up imaging recommendations at a tertiary academic medical center. METHODS In this IRB-approved, retrospective cohort study, approximately one month of imaging recommendations were reviewed from 2017 at a single academic institution that contained key words recommending follow-up imaging. Age, gender, race/ethnicity, insurance, smoking history, primary language, BMI, and home address were recorded via chart extraction. Home addresses were geocoded to Census Block Groups and assigned to a quintile of neighborhood socioeconomic status. A multivariate logistic regression model was used to evaluate each predictor variable with significance set to p = 0.05. RESULTS A total of 13,421 imaging reports that included additional follow-up recommendations were identified. Of the 1013 included reports that recommended follow-up, 350 recommended additional imaging and were analyzed. Three hundred eight (88.00%) had corresponding follow-up imaging present and the insurance payor was known for 266 (86.36%) patients: 146 (47.40%) had commercial insurance, 35 (11.36%) had Medicaid, and 85 (27.60%) had Medicare. Patients with Medicaid had over four times lower odds of completing follow-up imaging compared to patients with commercial insurance (OR 0.24, 95% CI 0.06-0.88, p = 0.032). Age, gender, race/ethnicity, smoking history, primary language, BMI, and neighborhood socioeconomic status were not independently associated with differences in follow-up imaging completion. CONCLUSION Patients with Medicaid had decreased odds of completing follow-up imaging recommendations compared to patients with commercial insurance.
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Affiliation(s)
- Andrés Ángel-González Calvillo
- University of California San Francisco School of Medicine, 513 Parnassus Ave., Suite S-245, San Francisco, CA 94143, USA.
| | | | - Roxana Garcia
- University of California San Francisco School of Medicine, 513 Parnassus Ave., Suite S-245, San Francisco, CA 94143, USA.
| | - Daphne Y Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd floor, San Francisco, CA 94158, USA.
| | - Matthew D Bucknor
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 185 Berry St., Suite 350, Lobby 6, San Francisco, CA 94107, USA.
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5
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Schnitzer ML, Kremer C, Hertel A, Haselmann V, von Münchhausen N, Schoenberg SO, Froelich MF. Economic assessment of molecular imaging in the oncology treatment process. Eur J Radiol 2021; 146:110105. [PMID: 34920293 DOI: 10.1016/j.ejrad.2021.110105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/08/2021] [Indexed: 11/19/2022]
Abstract
The development towards targeted treatments in oncology has been accompanied by significant improvements in molecular imaging. Yet, broad application of novel imaging techniques has partly been slowed down due to economical considerations. Building on the broad positive evidence of its diagnostic accuracy, modelling of effects on long-term costs and effectiveness may help to foster a broader application and acceptance of comprehensive molecular imaging techniques, such as PET/MRI. In this article, common economic evaluation techniques and cost-effectiveness analysis (CEA) evaluation methods will be introduced including Markov models and incremental cost-effectiveness ratios (ICER). This is complemented with a review of literature on recently published cost-effectiveness of molecular imaging. Additionally, the strategic relevance of CEAs for the molecular imaging community is discussed and combined with a global outlook.
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Affiliation(s)
- Moritz L Schnitzer
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Christophe Kremer
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Alexander Hertel
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Verena Haselmann
- Department of Clinical Chemistry, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Niklas von Münchhausen
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stefan O Schoenberg
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Robinson NB, Gao M, Patel PA, Davidson KW, Peacock J, Herron CR, Baker AC, Hentel KA, Oh PS. Secondary review reduced inpatient MRI orders and avoidable hospital days. Clin Imaging 2021; 82:156-160. [PMID: 34844100 DOI: 10.1016/j.clinimag.2021.11.014] [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: 05/28/2021] [Revised: 10/21/2021] [Accepted: 11/09/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Medical centers have dramatically increased the use of magnetic resonance imaging (MRI). At 2 large academic tertiary care centers in New York City, nearly half of inpatient MRI orders took more than 12 h to complete, delaying patient discharge and increasing avoidable hospital days. We posited that transitioning inpatient MRIs to outpatient facilities, when safe and appropriate, could reduce inpatient MRI orders and avoidable hospital days. METHODS We manually reviewed 59 inpatient MRI orders delayed on the estimated date of discharge (EDD). These orders were often delayed due to no standard process to escalate orders for medical reasons or no system to coordinate outpatient orders. We developed a revised workflow involving an automation platform that flagged inpatient MRI orders requested within 24 h of the EDD and emailed the care team to request a second review of the order. The care team reconsidered whether the order was (1) required for discharge, (2) non-urgent and could be converted to an outpatient order, or (3) unnecessary and could be canceled. RESULTS Over 9 months, the automation platform flagged 618 inpatient MRI orders, of which 53.9% (333/618) were reviewed by the care team. Among the orders, 24.0% (80/333) of reviewed orders and 12.9% (80/618) of all orders were transitioned to either outpatient or canceled orders. These transitioned orders were associated with 267 fewer avoidable hospital days and a cost savings of $199,194. CONCLUSION A standardized process and second review of inpatient MRI orders on the EDD can reduce inappropriate orders and more effectively use inpatient imaging resources. PRECIS A standardized workflow and automation platform encouraged a second review of inpatient MRI orders to reduce inappropriate orders, avoidable hospital days, and hospital costs.
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Affiliation(s)
- N Bryce Robinson
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065, United States of America.
| | - Michael Gao
- Department of Medicine, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY, United States of America.
| | - Parimal A Patel
- Department of Medicine, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY, United States of America.
| | - Karina W Davidson
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, United States of America.
| | - James Peacock
- Department of Medicine, White Plains Hospital, 41 East Post Road, White Plains, NY 10601, United States of America.
| | - Crystal R Herron
- Center for Personalized Health, Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, United States of America.
| | - Alexandra C Baker
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065, United States of America
| | - Keith A Hentel
- Department of Radiology, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY, United States of America.
| | - P Stephen Oh
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065, United States of America.
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Radiologists' Increasing Role in Population Health Management: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2021; 218:7-18. [PMID: 34286592 DOI: 10.2214/ajr.21.26030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Population health management (PHM) is the holistic process of improving health outcomes of groups of individuals through the support of appropriate financial and care models. Radiologists' presence at the intersection of many aspects of healthcare, including screening, diagnostic imaging, and image-guided therapies, provides significant opportunity for increased radiologist engagement in PHM. Further, innovations in artificial intelligence and imaging informatics will serve as critical tools to improve value in healthcare through evidence-based and equitable approaches. Given radiologists' limited engagement in PHM to date, it is imperative to define the specialty's PHM priorities so that the radiologists' full value in improving population health is realized. In this expert review, we explore programs and future directions for radiology in PHM.
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8
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Sandoval GA, Brown AD, Wodchis WP, Anderson GM. The relationship between hospital adoption and use of high technology medical imaging and in-patient mortality and length of stay. J Health Organ Manag 2019; 33:286-303. [PMID: 31122120 DOI: 10.1108/jhom-08-2018-0232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI) machines and in-patient mortality and length of stay. DESIGN/METHODOLOGY/APPROACH This study used panel data (2007-2010) from 124 hospital corporations operating in Ontario, Canada. Imaging use focused on medical patients accounting for 25 percent of hospital discharges. Main outcomes were in-hospital mortality rates and average length of stay. A model for each outcome-technology combination was built, and controlled for hospital structural characteristics, market factors and patient characteristics. FINDINGS In 2010, 36 and 59 percent of hospitals had adopted MRI machines and CT scanners, respectively. Approximately 23.5 percent of patients received CT scans and 3.5 percent received MRI scans during the study period. Adoption of these technologies was associated with reductions of up to 1.1 percent in mortality rates and up to 4.5 percent in length of stay. The imaging use-mortality relationship was non-linear and varied by technology penetration within hospitals. For CT, imaging use reduced mortality until use reached 19 percent in hospitals with one scanner and 28 percent in hospitals with 2+ scanners. For MRI, imaging use was largely associated with decreased mortality. The use of CT scanners also increased length of stay linearly regardless of technology penetration (4.6 percent for every 10 percent increase in use). Adoption and use of MRI was not associated with length of stay. RESEARCH LIMITATIONS/IMPLICATIONS These results suggest that there may be some unnecessary use of imaging, particularly in small hospitals where imaging is contracted out. In larger hospitals, the results highlight the need to further investigate the use of imaging beyond certain thresholds. Independent of the rate of imaging use, the results also indicate that the presence of CT and MRI devices within a hospital benefits quality and efficiency. ORIGINALITY/VALUE To the authors' knowledge, this study is the first to investigate the combined effect of adoption and use of medical imaging on outcomes specific to CT scanners and MRI machines in the context of hospital in-patient care.
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Affiliation(s)
- Guillermo A Sandoval
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
| | - Adalsteinn D Brown
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto, Canada
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Sandoval GA, Brown AD, Wodchis WP, Anderson GM. Adoption of high technology medical imaging and hospital quality and efficiency: Towards a conceptual framework. Int J Health Plann Manage 2018; 33. [PMID: 29770971 DOI: 10.1002/hpm.2547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 04/20/2018] [Indexed: 11/11/2022] Open
Abstract
Measuring the value of medical imaging is challenging, in part, due to the lack of conceptual frameworks underlying potential mechanisms where value may be assessed. To address this gap, this article proposes a framework that builds on the large body of literature on quality of hospital care and the classic structure-process-outcome paradigm. The framework was also informed by the literature on adoption of technological innovations and introduces 2 distinct though related aspects of imaging technology not previously addressed specifically in the literature on quality of hospital care: adoption (a structural hospital characteristic) and use (an attribute of the process of care). The framework hypothesizes a 2-part causality where adoption is proposed to be a central, linking factor between hospital structural characteristics, market factors, and hospital outcomes (ie, quality and efficiency). The first part indicates that hospital structural characteristics and market factors influence or facilitate the adoption of high technology medical imaging within an institution. The presence of this technology, in turn, is hypothesized to improve the ability of the hospital to deliver high quality and efficient care. The second part describes this ability throughout 3 main mechanisms pointing to the importance of imaging use on patients, to the presence of staff and qualified care providers, and to some elements of organizational capacity capturing an enhanced clinical environment. The framework has the potential to assist empirical investigations of the value of adoption and use of medical imaging, and to advance understanding of the mechanisms that produce quality and efficiency in hospitals.
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Affiliation(s)
- Guillermo A Sandoval
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Adalsteinn D Brown
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
| | - Geoffrey M Anderson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Ontario, Canada
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10
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Heller RE. An Analysis of Quality Measures in Diagnostic Radiology with Suggestions for Future Advancement. J Am Coll Radiol 2016; 13:1182-1187. [DOI: 10.1016/j.jacr.2016.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 05/23/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
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Cournane S, Conway R, Creagh D, Byrne DG, Sheehy N, Silke B. Radiology imaging delays as independent predictors of length of hospital stay for emergency medical admissions. Clin Radiol 2016; 71:912-8. [PMID: 27210242 DOI: 10.1016/j.crad.2016.03.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/04/2016] [Accepted: 03/10/2016] [Indexed: 11/28/2022]
Abstract
AIM To investigate the extent to which the time to completion for computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound could be shown to influence the length of stay and costs incurred while in hospital, while accounting for patient acuity. MATERIALS AND METHODS All emergency admissions, totalling 25,326 imaging investigations between 2010-2014 were evaluated. The 50(th), 75(th), and 90(th) centiles of completion times for each imaging type was entered into a multivariable truncated Poisson regression model predicting the length of hospital stay. Estimates of risk (odds or incidence rate ratios [IRRs]) of the regressors were adjusted for acute illness severity, Charlson comorbidity index, chronic disabling disease score, and sepsis status. Quantile regression analysis was used to examine the impact of imaging on total hospital costs. RESULTS For all imaging examinations, longer hospital lengths of stay were shown to be related to delays in imaging time. Increased delays in CT and MRI were shown to be associated with increased hospital episode costs, while ultrasound did not independently predict increased hospital costs. The magnitude of the effect of imaging delays on episode costs were equivalent to some measures of illness severity. CONCLUSION CT, MRI, and ultrasound are undertaken in patients with differing clinical complexity; however, even with adjustment for complexity, the time delay in a more expeditious radiological service could potentially shorten the hospital episode and reduce costs.
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Affiliation(s)
- S Cournane
- Medical Physics and Bioengineering Department, St James's Hospital, Dublin 8, Ireland.
| | - R Conway
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - D Creagh
- Information Management Systems, St James's Hospital, Dublin 8, Ireland
| | - D G Byrne
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
| | - N Sheehy
- Diagnostic Imaging Department, St James's Hospital, Dublin 8, Ireland
| | - B Silke
- Department of Internal Medicine, St James's Hospital, Dublin 8, Ireland
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12
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Allen B. Improving our patients' experience in their radiological care. J Am Coll Radiol 2016; 12:767-8. [PMID: 26250969 DOI: 10.1016/j.jacr.2015.06.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 01/17/2023]
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13
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Liu D, Weil J, Boughey M, Sutherland T. A tertiary hospital audit of the use of medical imaging in the 24 h preceding death. Intern Med J 2016; 46:220-2. [PMID: 26899888 DOI: 10.1111/imj.12976] [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: 05/07/2015] [Revised: 07/25/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Abstract
This study aims to investigate the number, modality and indication for imaging studies performed on acute hospital inpatients in the 24 h prior to death. Data were obtained from retrospective analysis of deceased patients from a university affiliated tertiary hospital over a 2-year period and it was found that around one in five inpatients received medical imaging in the last 24 h of their life (364 of 1855, 19.6%).
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Affiliation(s)
- D Liu
- Department of Radiology, Alfred Hospital, Bulleen, Victoria, Australia
| | - J Weil
- Palliative Care, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - M Boughey
- Palliative Care, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - T Sutherland
- Department of Radiology, St. Vincent's Hospital, Melbourne, Victoria, Australia
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14
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Khaliq AA, Deyo D, Duszak R. The Impact of Hospital Characteristics on the Availability of Radiology Services at Critical Access Hospitals. J Am Coll Radiol 2015; 12:1351-6. [DOI: 10.1016/j.jacr.2015.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 09/05/2015] [Indexed: 10/22/2022]
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15
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Rawson JV. Radiology Testing in Population Health. Acad Radiol 2015; 22:805-6. [PMID: 25979590 DOI: 10.1016/j.acra.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- James V Rawson
- Department of Radiology and Imaging, Medical College of Georgia, Georgia Regents University, 1120 15th Street, Augusta, GA 30912.
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Nazarian S, Reynolds MR, Ryan MP, Wolff SD, Mollenkopf SA, Turakhia MP. Utilization and likelihood of radiologic diagnostic imaging in patients with implantable cardiac defibrillators. J Magn Reson Imaging 2015; 43:115-27. [PMID: 26118943 PMCID: PMC4755166 DOI: 10.1002/jmri.24971] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/26/2015] [Accepted: 05/27/2015] [Indexed: 12/02/2022] Open
Abstract
Purpose To examine imaging utilization in a matched cohort of patients with and without implantable cardioverter defibrillators (ICD) and to project magnetic resonance imaging (MRI) utilization over a 10‐year period. Materials and Methods The Truven Health MarketScan Commercial claims and Medicare Supplemental health insurance claims data were used to identify patients with continuous health plan enrollment in 2009–2012. Patients with ICDs were identified using ICD‐9 and CPT codes, and matched to patients with the same demographic and comorbidity profile, but no record of device implantation. Diagnostic imaging utilization was compared across the matched cohorts, in total, by imaging categories, and in subpopulations of stroke, back pain, and joint pain. MRI use in the nonimplant group over the 4‐year period was extrapolated out to 10 years for ICD‐indicated patients. Results A cohort of 18,770 matched patients were identified; average age 65.5 ± 13.38 and 21.9% female. ICD patients had significantly less MRI imaging (0.23 0.70 SD vs. 0.00 0.08 SD, P < 0.0001) than nonimplant patients. Among patients with records of stroke/transient ischemic attack (TIA) (ICD 5%, nonimplant 4%) and accompanying diagnostic imaging, 44% of nonimplant patients underwent MRI vs. 1% of ICD patients (P < 0.0001). Forecast models estimated that 53% to 64% of ICD‐eligible patients may require an MRI within 10 years. Conclusion MRI utilization is lower in ICD patients compared to nonimplant patients, yet the burden of incident stroke/TIA, back, and joint pain suggests an unmet need for MR‐conditional devices. J. MAGN. RESON. IMAGING 2016;43:115–127.
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Affiliation(s)
- Saman Nazarian
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Michael P Ryan
- CTI Clinical Trial and Consulting Services, Cincinnati, Ohio, USA
| | | | | | - Mintu P Turakhia
- Stanford University School of Medicine, Palo Alto VA Healthcare System, Palo Alto, California, USA
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Pattern of Investigation Reflects Risk Profile in Emergency Medical Admissions. J Clin Med 2015; 4:1113-25. [PMID: 26239468 PMCID: PMC4470220 DOI: 10.3390/jcm4051113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 05/15/2015] [Indexed: 11/23/2022] Open
Abstract
Demand for hospital resources may increase over time; we have examined all emergency admissions (51,136 episodes) from 2005 to 2013 for underlying trends and whether resource utilization and clinical risk are correlated. We used logistic regression of the resource indicator against 30-day in-hospital mortality and adjusted this risk estimate for other outcome predictors. Generally, resource indicators predicted an increased risk of a 30-day in-hospital death. For CT Brain the Odds Ratio (OR) was 1.37 (95% CI: 1.27, 1.50), CT Abdomen 3.48 (95% CI: 3.02, 4.02) and CT Chest, Thorax, Abdomen and Pelvis 2.50 (95% CI: 2.10, 2.97). Services allied to medicine including Physiotherapy 2.57 (95% CI: 2.35, 2.81), Dietetics 2.53 (95% CI: 2.27, 2.82), Speech and Language 5.29 (95% CI: 4.57, 6.05), Occupational Therapy 2.65 (95% CI: 2.38, 2.94) and Social Work 1.65 (95% CI: 1.48, 1.83) all predicted an increased risk. The in-hospital 30-day mortality increased with resource utilization, from 4.7% (none) to 27.0% (five resources). In acute medical illness, the use of radiological investigations and allied professionals increased over time. Resource utilization was calibrated from case complexity/30-day in-hospital mortality suggesting that complexity determined the need for and validated the use of these resources.
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18
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Allen B. Changing Headwinds to Tailwinds. J Am Coll Radiol 2014; 11:837-8. [DOI: 10.1016/j.jacr.2014.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 11/16/2022]
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19
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Cournane S, Creagh D, O'Hare N, Sheehy N, Silke B. MRI in Acutely Ill Medical Patients in an Irish Hospital: Influence on Outcomes and Length of Hospital Stay. J Am Coll Radiol 2014; 11:698-702. [DOI: 10.1016/j.jacr.2014.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
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Balancing the three missions and the impact on academic radiology. Acad Radiol 2013; 20:1190-4. [PMID: 24029050 DOI: 10.1016/j.acra.2013.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/12/2013] [Accepted: 04/19/2013] [Indexed: 11/21/2022]
Abstract
The three missions of academic radiology compete with one another for time and funding. Revenue for the clinical mission often subsidizes education and research. Given the internal and external drivers/pressures on health care and, more particularly, on academic health centers, the current model is unsustainable. Trends seen in other industries are entering academic health care. The radiology department of the future will need to be more efficient with increasingly fewer resources while meeting its missions at higher levels of expectation.
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21
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Impact of Patient Protection and Affordable Care Act on academic radiology departments' clinical, research, and education missions. Acad Radiol 2013; 20:1213-7. [PMID: 24029052 DOI: 10.1016/j.acra.2013.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/15/2013] [Accepted: 05/21/2013] [Indexed: 01/11/2023]
Abstract
The Patient Protection and Affordable Care Act (ACA) generated significant media attention since its inception. When the law was approved in 2010, the U.S. health care system began facing multiple changes to adapt and to incorporate measures to meet the new requirements. These mandatory changes will be challenging for academic radiology departments (ARDs) since they will need to promote a shift from a volume-focused to a value-focused practice. This will affect all components of the mission of ARDs, including clinical practice, education, and research. A unique key element to success in this transition is to focus on both quality and safety, thus improving the value of radiology in the post-ACA era. Given the changes ARDs will face during the implementation of ACA, suggestions are provided on how to adapt ARDs to this new environment.
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22
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Brand CA, Barker AL, Morello RT, Vitale MR, Evans SM, Scott IA, Stoelwinder JU, Cameron PA. A review of hospital characteristics associated with improved performance. Int J Qual Health Care 2012; 24:483-94. [PMID: 22871420 DOI: 10.1093/intqhc/mzs044] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance. DATA SOURCES The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles. STUDY SELECTION and data extraction Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume. CONCLUSION There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are indicated.
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Affiliation(s)
- Caroline A Brand
- Centre for Research Excellence in Patient Safety, Monash University, The Alfred Centre, Prahran Victoria, Australia.
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23
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Abstract
The growth of molecular imaging heightens the promise of clinical nuclear medicine as a tool for individualization of patient care and for improvement of health-care outcomes. Together with greater use of integrated structure-function imaging, clinical nuclear medicine reaches beyond traditional specialty borders into diagnostic radiology and oncology. Yet, there are concerns about the future of nuclear medicine, including progressively declining reimbursement, the competitive advantages of diagnostic radiology, limited translation of research accomplishments to clinical diagnostic imaging and patient care, and an insufficient pool of incoming highly qualified nuclear medicine clinicians. Thus, nuclear medicine views itself as being at a critical crossroads. What will be important is for nuclear medicine to be positioned as the quintessential molecular imaging modality more centrally within medical imaging and for the integration of nuclear medicine with primary care specialties to be driven more by patient needs than by specialty needs. In this way, the full potential of nuclear medicine as an effective and efficient tool for improving patient outcomes can be realized.
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Affiliation(s)
- Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA.
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24
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Abstract
The chest is the most frequently evaluated region of the body in children. The majority of thoracic diagnostic imaging, namely "conventional" radiography (film screen, computed radiography and direct/digital radiography), fluoroscopy and angiography, and computed tomography, depends on ionizing radiation. Since errors, oversights, and inattention to radiation exposure continue to be extremely visible issue for radiology in the public eye it is incumbent on the imaging community to maximize the yield and minimize both the real and potential radiation risks with diagnostic imaging. Technical (e.g. equipment and technique) strategies can reduce exposure risk and improve study quality, but these must be matched with efforts to optimize appropriate utilization for safe and effective healthcare in thoracic imaging in children. To these ends, material in this chapter will review practice patterns, dose measures and modality doses, radiation biology and risks, and radiation risk reduction strategies for thoracic imaging in children.
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Affiliation(s)
- Donald P Frush
- Pediatric Radiology, Department of Radiology, 1905 Children's Health Center, Duke University Medical Center, Durham, NC 27710, USA.
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Rawson JV. Comparative effectiveness research in radiology: patients, physicians and policy makers. Acad Radiol 2011; 18:1067-71. [PMID: 21420332 DOI: 10.1016/j.acra.2011.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/15/2010] [Accepted: 01/14/2011] [Indexed: 10/18/2022]
Abstract
Health care costs continue to rise, with significant geographic differences in spending on health care and outcomes within the United States. The goal of comparative effectiveness research is to reduce health care spending without adversely effecting overall health according to the Congressional Budget Office. There are unique challenges and barriers to applying comparative effectiveness research to radiology, including rapidly changing technology, complex multistep care processes, and the burden of proving the impact of a diagnostic exam on patient outcome. Radiology shares other challenges of acceptance of comparative effectiveness research results (diffusion of new knowledge and successful implementation of changes in clinical practice) with all of health care, but with the added complication that radiologists do not order radiology exams.
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Arnold RW, Graham DA, Melvin PR, Taylor GA. Variability in imaging utilization in U.S. pediatric hospitals. Pediatr Radiol 2011; 41:867-74. [PMID: 21301826 DOI: 10.1007/s00247-011-1998-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Revised: 12/15/2010] [Accepted: 12/17/2010] [Indexed: 11/24/2022]
Abstract
BACKGROUND Use of medical imaging is under scrutiny because of rising costs and radiation exposure. We compare imaging utilization and costs across pediatric hospitals to determine their variability and potential determinants. MATERIALS AND METHODS Data were extracted from the Pediatric Health Information System (PHIS) database for all inpatient encounters from 40 U.S. children's hospitals. Imaging utilization and costs were compared by insurance type, geographical region, hospital size, severity of illness, length of stay and type of imaging, all among specific diagnoses. RESULTS The hospital with the highest utilization performed more than twice as many imaging studies per patient as the hospital with the lowest utilization. Similarly, imaging costs ranged from $154 to $671/patient. Median imaging-utilization rate was 1.7 exams/patient on the ward and increased significantly in the PICU (11.8 exams/patient) and in the NICU (17.7 exams per patient, (P < 0.001). Considerable variability in imaging utilization persisted despite adjustment for case mix index (CMI, range in variation 16.6-25%). We found a significant correlation between imaging utilization and both CMI and length of stay, P < 0.0001). However, only 36% of the variation in imaging utilization could be explained by CMI. CONCLUSION Diagnostic imaging utilization and costs vary widely in pediatric hospitals.
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Affiliation(s)
- Ryan W Arnold
- Department of Radiology, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA
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Agarwal R, Bergey M, Sonnad S, Butowsky H, Bhargavan M, Bleshman MH. Inpatient CT and MRI utilization: trends in the academic hospital setting. J Am Coll Radiol 2011; 7:949-55. [PMID: 21129686 DOI: 10.1016/j.jacr.2010.08.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 08/16/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to determine trends in the utilization of inpatient CT and MRI at academic medical centers. METHODS Surveys requesting inpatient CT volumes, inpatient MRI volumes, discharges excluding newborns, and case-adjusted mix index from 2002 to 2007 were e-mailed to all 123 members of the Society of Chairmen of Academic Radiology Departments. CT and MRI studies per discharge were adjusted using the case mix index (CMI) provided by each hospital to adjust for the differences in patient mix at participating institutions. Trends in adjusted inpatient imaging utilization were compared over time and across responding institutions. RESULTS Twenty-two of 123 chairs (17.9%) of academic radiology departments, representing all geographic regions and a wide variability in National Institutes of Health research funding ranking, provided responses to our survey. Between 2002 and 2007, there was an increase in median CMI-adjusted CT studies per discharge of 28.0% and an increase in median CMI-adjusted MRI studies per discharge of 19.8%. The largest annual percentage increase in CT utilization (20.2%) occurred from 2003 to 2004, and there was negative growth between 2006 and 2007 of -3.74%. The largest annual percentage increase in MRI utilization (13.9%) occurred from 2006 to 2007, with 3 years of negative growth from 2002 to 2003, 2004 to 2005, and 2005 to 2006. In 2007, there was a wide range in CMI-adjusted CT studies per discharge between institutions from 0.16 to 0.75, with a mean of 0.40 ± 0.18, with a corresponding wide range in CMI-adjusted MRI studies per discharge of 0.04 to 0.16, with a mean of 0.09 ± 0.03. CONCLUSION There has been large growth in inpatient CT and MRI utilization at academic medical centers. This growth is variable over time and between institutions. Practice leaders can use this information to compare themselves with their peers and to monitor the impact of programmatic improvements on inpatient imaging utilization and in discussions with health system leaders who would like to improve system profitability by decreasing costly inpatient imaging procedures.
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Affiliation(s)
- Rajan Agarwal
- Department of Radiology, University of Pennsylvania Health System, Philadelphia, PA, USA.
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Rettenmaier NB, Rettenmaier CR, Wojciechowski T, Abaid LN, Brown JV, Micha JP, Goldstein BH. The utility and cost of routine follow-up procedures in the surveillance of ovarian and primary peritoneal carcinoma: a 16-year institutional review. Br J Cancer 2010; 103:1657-62. [PMID: 21045830 PMCID: PMC2994227 DOI: 10.1038/sj.bjc.6605963] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The purpose of this study was to evaluate the number of ovarian cancer and primary peritoneal cancer (PPC) progressive disease cases identified via routine follow-up procedures and the corresponding cost throughout a 16-year period at a single medical institution. Methods: Previously undiagnosed epithelial ovarian (n=241), PPC (n=23), and concurrent ovarian and uterine (n=24) cancer patients were treated and then followed via CA-125, imaging (e.g., CT scan, chest X-ray), physical examination and vaginal cytology. Results: In the group of 287 patients, there were 151 cases of disease progression. Serial imaging detected the highest number of progressive disease cases (66 initial and 45 confirmatory diagnoses), but the cost was rather high ($13 454 per patient recurrence), whereas CA-125 testing (74 initial and 20 corroborative diagnoses) was the least expensive ($3924) per recurrent diagnosis. The total cost of surveillance during the 16-year period was nearly $2 400 000. Conclusion: Ultimately, serial imaging and the CA-125 assay detected the highest number of ovarian cancer and PCC progressive disease cases in comparison to physical examination and vaginal cytology, but nevertheless, all of the procedures were conducted at a considerable financial expense.
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Affiliation(s)
- N B Rettenmaier
- Department of Molecular, Cell and Developmental Biology, UCLA College of Letters and Science, Los Angeles, CA, USA
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Hendee WR, Becker GJ, Borgstede JP, Bosma J, Casarella WJ, Erickson BA, Maynard CD, Thrall JH, Wallner PE. Addressing overutilization in medical imaging. Radiology 2010; 257:240-5. [PMID: 20736333 DOI: 10.1148/radiol.10100063] [Citation(s) in RCA: 389] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The growth in medical imaging over the past 2 decades has yielded unarguable benefits to patients in terms of longer lives of higher quality. This growth reflects new technologies and applications, including high-tech services such as multisection computed tomography (CT), magnetic resonance (MR) imaging, and positron emission tomography (PET). Some part of the growth, however, can be attributed to the overutilization of imaging services. This report examines the causes of the overutilization of imaging and identifies ways of addressing the causes so that overutilization can be reduced. In August 2009, the American Board of Radiology Foundation hosted a 2-day summit to discuss the causes and effects of the overutilization of imaging. More than 60 organizations were represented at the meeting, including health care accreditation and certification entities, foundations, government agencies, hospital and health systems, insurers, medical societies, health care quality consortia, and standards and regulatory agencies. Key forces influencing overutilization were identified. These include the payment mechanisms and financial incentives in the U.S. health care system; the practice behavior of referring physicians; self-referral, including referral for additional radiologic examinations; defensive medicine; missed educational opportunities when inappropriate procedures are requested; patient expectations; and duplicate imaging studies. Summit participants suggested several areas for improvement to reduce overutilization, including a national collaborative effort to develop evidence-based appropriateness criteria for imaging; greater use of practice guidelines in requesting and conducting imaging studies; decision support at point of care; education of referring physicians, patients, and the public; accreditation of imaging facilities; management of self-referral and defensive medicine; and payment reform.
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Affiliation(s)
- William R Hendee
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI 53226-4801, USA.
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