1
|
Heinz SA, Yakar D, Dierckx RAJO, Kwee TC. Point-of-care ultrasonography: Downstream utilization of and diagnostic (dis)agreements with additional cross-sectional imaging. Eur J Radiol 2022; 152:110344. [PMID: 35561645 DOI: 10.1016/j.ejrad.2022.110344] [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: 01/19/2022] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Point-of-care ultrasonography (POCUS), defined as ultrasonography (US) performed and interpreted by the clinician, is increasingly performed. This study aimed to determine the frequency of and reasons why clinicians of the emergency department request cross-sectional imaging after POCUS and how often radiologists experience diagnostic (dis)agreements. METHODS This retrospective study included a consecutive series of 503 patients who underwent POCUS at the emergency department of a tertiary care center. RESULTS Downstream cross-sectional imaging was performed in 77 (15.3%) of 503 POCUS examinations. Reasons for additional cross-sectional imaging were, in order of decreasing frequency: suspicion of pathology that was not assessed with POCUS in 46 cases (59.7%), confirmation of conclusive POCUS findings in 21 cases (27.3%), inconclusive POCUS (i.e. insufficient visualization of the structure of interest to make a diagnosis, despite an attempt of the POCUS operator) in 7 cases (9.6%), a combination of inconclusive POCUS and suspicion of pathology that was not assessed with POCUS in 2 cases (2.6%), and clarification of incidental findings on POCUS in 1 case (1.3%). In the 21 cases that underwent additional cross-sectional imaging to confirm POCUS findings, POCUS agreed with additional cross-sectional imaging in 19 (90.5%) and disagreed in 2 (9.5%) cases. CONCLUSIONS The use of POCUS appears to not cause any considerable downstream overutilization of cross-sectional imaging. In addition, radiologists experience few diagnostic disagreements when asked to perform second opinion cross-sectional imaging. Future studies with more homogeneous datasets in terms of POCUS operators are required to confirm our results.
Collapse
Affiliation(s)
- Sabine A Heinz
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| |
Collapse
|
2
|
Lentz B, Fong T, Rhyne R, Risko N. A systematic review of the cost-effectiveness of ultrasound in emergency care settings. Ultrasound J 2021; 13:16. [PMID: 33687607 PMCID: PMC7943664 DOI: 10.1186/s13089-021-00216-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/19/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The use of ultrasound (US) in emergency departments (ED) has become widespread. This includes both traditional US scans performed by radiology departments as well as point-of-care US (POCUS) performed by bedside clinicians. There has been significant interest in better understanding the appropriate use of imaging and where opportunities to enhance cost-effectiveness may exist. The purpose of this systematic review is to identify published evidence surrounding the cost-effectiveness of US in the ED and to grade the quality of that evidence. METHODS We performed a systematic review of the literature following Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies were considered for inclusion if they were: (1) economic evaluations, (2) studied the clinical use of ultrasound, and (3) took place in an emergency care setting. Included studies were critically appraised using the Consolidated Health Economic Evaluation Reporting Standards checklist. RESULTS We identified 631 potentially relevant articles. Of these, 35 studies met all inclusion criteria and were eligible for data abstraction. In general, studies were supportive of the use of US. In particular, 11 studies formed a strong consensus that US enhanced cost-effectiveness in the investigation of pediatric appendicitis and 6 studies supported enhancements in the evaluation of abdominal trauma. Across the studies, weaknesses in methodology and reporting were common, such as lack of sensitivity analyses and inconsistent reporting of incremental cost-effectiveness ratios. CONCLUSIONS The body of existing evidence, though limited, generally demonstrates that the inclusion of US in emergency care settings allows for more cost-effective care. The most definitive evidence for improvements in cost-effectiveness surround the evaluation of pediatric appendicitis, followed by the evaluation of abdominal trauma. POCUS outside of trauma has had mixed results.
Collapse
Affiliation(s)
- Brian Lentz
- Department of Emergency Medicine, Highland Hospital-Alameda Health System, 1411 E. 31st Street, QIC 22123, Oakland, CA, 94602, USA
| | - Tiffany Fong
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Randall Rhyne
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA
| | - Nicholas Risko
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD, 21287, USA.
| |
Collapse
|
3
|
Kaplan SL, Chen AE, Rempell RG, Brown N, Velez-Florez MC, Khwaja A. Impact of Emergency Medicine Point-of-Care Ultrasound on Radiology Ultrasound Volumes in a Single Pediatric Emergency Department. J Am Coll Radiol 2020; 17:1555-1562. [PMID: 32735917 DOI: 10.1016/j.jacr.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Point-of-care ultrasound (POCUS) is growing, but few data exist regarding its effects on radiology ultrasound (Rad US) volumes. The authors studied changes in Rad US ordered by emergency medicine (EM) as POCUS began and grew at their pediatric hospital. METHODS This retrospective study included EM POCUS and EM-ordered Rad US volumes between 2011 and 2017, during three 2-year intervals: before POCUS, early POCUS, and expanded POCUS. Changes in overall Rad US and POCUS volumes per visit during these intervals were studied. Changes in skin and soft tissue infection (SSTI) US per SSTI visit, an examination performed diagnostically by both radiology and EM, were also assessed. Volume differences were examined using the Mann-Whitney U test (significance threshold, P < .05), and process control charts were used to identify nonrandom variations. RESULTS The study included 49,908 Rad US and 2,772 POCUS examinations during 647,890 emergency department visits. Rad US volumes per visit remained unchanged during early POCUS (P = .858) but increased with expanded POCUS (P < .005). A transient nonrandom increase in Rad US occurred as POCUS began. SSTI Rad US per SSTI visit significantly increased (P < .001) during early POCUS but did not change with expanded POCUS (P = .143). An SSTI management pathway in the emergency department before expanded POCUS may have affected ordering. Other variation occurred in proximity to practice changes and seasonal patterns. CONCLUSIONS Rad US overall and specifically for SSTI increased or remained stable during the introduction and growth of EM POCUS. Rather than decreasing Rad US, EM POCUS had a complementary role.
Collapse
Affiliation(s)
- Summer L Kaplan
- Director of Emergency Radiology, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Aaron E Chen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Director of Emergency Point-of-Care Ultrasound, Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rachel G Rempell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Director of Emergency Ultrasound Fellowship, Associate Medical Director for Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Nafis Brown
- Center for Healthcare Quality and Analytics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maria C Velez-Florez
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Asef Khwaja
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Director of Off-Site Imaging, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
4
|
Radiology Practice Consolidation: Fewer but Bigger Groups Over Time. J Am Coll Radiol 2020; 17:340-348. [DOI: 10.1016/j.jacr.2019.02.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 12/20/2022]
|
5
|
Diagnostic Radiologists' Participation in the American Board of Radiology Maintenance of Certification Program. AJR Am J Roentgenol 2019; 213:1284-1290. [PMID: 31532255 DOI: 10.2214/ajr.19.21724] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Physicians across specialties have expressed concerns about Maintenance of Certification (MOC) programs of American Board of Medical Specialties member boards, calling for research about MOC acceptance, adoption, and value. The purpose of this study was to characterize diagnostic radiologists' participation in the American Board of Radiology (ABR) MOC program, the framework for its new Online Longitudinal Assessment program. MATERIALS AND METHODS. Practicing U.S. radiologists were identified from the Centers for Medicare & Medicaid Services Physician and Other Supplier Public Use File. Corresponding ABR diplomate certification information was obtained through the ABR public search engine. Focused on diagnostic radiologists (defined as those whose only ABR certificate is in diagnostic radiology), MOC participation rates were calculated across various physician characteristics for those whose participation was mandated by the ABR (time-limited certificates) and for those whose participation was not mandated (lifetime certificates). RESULTS. Among 20,354 included diagnostic radiologists, 11,479 (56.4%) participated in MOC. Participation rates were 99.6% (10,058/10,099) among those whose MOC was ABR mandated and 13.9% (1421/10,225) among those whose participation was not mandated (p < 0.001). The rates of nonmandated participation were higher (all p < 0.001) for academic than for non-academic radiologists (28.0% vs 11.3%), subspecialists than for generalists (17.0% vs 11.5%), and those in larger practice groups (< 10 members, 5.0%; 10-49 members, 12.6%; ≥ 50 members, 20.7%). State-level rates of nonmandated participation varied from 0.0% (South Dakota, Montana) to 32.6% (Virginia) and positively correlated with state population density (r = 0.315). CONCLUSION. Although diagnostic radiologists with time-limited certificates nearly universally participate in MOC, those with lifetime certificates (particularly general radiologists and those in smaller and nonacademic practices) participate infrequently. Low rates of nonmandated participation may reflect diplomate dissatisfaction or negative perceptions about MOC.
Collapse
|
6
|
Degnan AJ, Yi PH, Kim N, Swietlik J, Huh E, Nguyen JC. Diagnostic and Interventional Imaging Services are Significant Sources of Medicare Revenue for Highly Reimbursed Nonradiologist Providers. Curr Probl Diagn Radiol 2018; 49:17-22. [PMID: 30466795 DOI: 10.1067/j.cpradiol.2018.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nonradiologist providers increasingly perform diagnostic imaging examinations and imaging-guided interventions traditionally performed by radiologists, which have raised concerns regarding appropriate utilization and self-referral. The purpose of this study was to assess the contribution of imaging studies to Medicare reimbursements for highly compensated nonradiologist providers in specialties often performing imaging studies. METHODS The Medicare Provider Utilization and Payment Database was queried for provider information regarding overall reimbursement for providers in anesthesiology, cardiology, emergency medicine, neurology, obstetrics and gynecology, orthopedic surgery, neurology, and vascular surgery. Information regarding imaging studies reported and payment amounts were extracted for the 25 highest-reimbursed providers. Data were analyzed for relative contribution of imaging payments to overall medical Medicare payments. RESULTS Significant differences between numbers of imaging studies, types of imaging, and payment amounts were noted based on provider specialty (p < 0.001). Highest-reimbursed cardiologists received the greatest percentage of Medicare payments from imaging (18.3%) followed by vascular surgery (11.6%), obstetrics and gynecology (10.9%), orthopedic surgery (9.6%), emergency medicine (8.7%), neurology (7.8%), and anesthesiology (3.2%) providers. Mean imaging payments amongst highly reimbursed nonradiologists were greatest for cardiology ($578,265), vascular surgery ($363,912), and orthopedic surgery ($113,634). Amongst highly reimbursed specialists, most common nonradiologist imaging payments were from ultrasound (45%) and cardiac nuclear medicine studies (40%). CONCLUSIONS Nonradiologist performed imaging payments comprised substantial proportions of overall Medicare reimbursement for highly reimbursed physicians in several specialties, especially cardiology, vascular surgery, and orthopedic surgery. Further investigation is needed to better understand the wider economic implications of nonradiologist imaging study performance and self-referral beyond the Medicare population.
Collapse
Affiliation(s)
- Andrew J Degnan
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Paul H Yi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nathan Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - John Swietlik
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Eric Huh
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
7
|
Li D, Patlas M, Mclean K, Duszak R. Relative diagnostic utility of radiologist-recommended abdominal ultrasound following emergency department abdominal and pelvic computed tomography. Abdom Radiol (NY) 2018; 43:3176-3183. [PMID: 29582124 DOI: 10.1007/s00261-018-1576-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To retrospectively assess the relative diagnostic utility of radiologist-recommended ultrasound (US) following emergency department (ED) abdominal and pelvic computed tomography (CT) in patients with non-traumatic abdominal and/or pelvic pain. METHODS Blinded to clinical outcomes, two radiology residents and an attending radiologist reviewed radiology reports and relevant medical records for all adult patients from EDs at two academic medical centers from one institution over a 3-year time period, who underwent abdominal/pelvic US within 72 h of an initial IV contrast-enhanced abdominal and pelvic CT for non-traumatic abdominal and/or pelvic pain. Incremental diagnostic utility of subsequent US was deemed present when (1) US findings were discordant with those at CT, or (2) findings were concordant, but US yielded additional relevant diagnostic information. Diagnostic utility was stratified by whether examinations were radiologist-recommended or independently ordered by treating physicians. RESULTS 319 encounters satisfied the inclusion criteria, including 194 female patients (18-98 years of age, mean of 59.8 years) and 125 male patients (20-90 years of age, mean of 63.2 years). 7 (2.2%) subsequent US examinations were discordant with the initial CT, 100 (31.3%) were concordant but provided relevant additional information, and 212 (66.5%) were concordant without providing additional information, for an overall diagnostic utility of 33.5%. Of subsequent radiologist-recommended US examinations, 70.0% (63/90) yielded incremental diagnostic utility vs. 19.2% (44/229) ordered independently by treating physicians (OR 3.65; 95% CI 2.31-5.75). For those encounters in which US provided incremental diagnostic utility, the most commonly assessed anatomical areas were the biliary system and the female adnexal region. CONCLUSION In ED patients with non-traumatic abdominal and/or pelvic pain undergoing abdominal and pelvic CT, follow-up US examinations recommended by radiologists are more likely to provide incremental diagnostic utility than those independently ordered by their treating physicians. In order to optimize the value of advanced imaging, radiologists should assume greater roles in team-based utilization management.
Collapse
Affiliation(s)
- David Li
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Michael Patlas
- Department of Radiology, Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada.
| | | | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| |
Collapse
|
8
|
Rosenkrantz AB, Friedberg EB, Prologo JD, Everett C, Duszak R. Generalist versus Subspecialist Workforce Characteristics of Invasive Procedures Performed by Radiologists. Radiology 2018; 289:140-147. [DOI: 10.1148/radiol.2018180761] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew B. Rosenkrantz
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - Eric B. Friedberg
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - J. David Prologo
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - Catherine Everett
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| | - Richard Duszak
- From the Department of Radiology, Center for Biomedical Imaging, NYU Langone Health, 660 First Ave, New York, NY 10016 (A.B.R.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.B.F., J.D.P., R.D.); and Coastal Radiology Associates, PLLC, New Bern, NC (C.E.)
| |
Collapse
|
9
|
Allen B, Chatfield M, Burleson J, Thorwarth WT. Improving diagnosis in health care: perspectives from the American College of Radiology. ACTA ACUST UNITED AC 2018. [PMID: 29536934 DOI: 10.1515/dx-2017-0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In September of 2014, the American College of Radiology joined a number of other organizations in sponsoring the 2015 National Academy of Medicine report, Improving Diagnosis In Health Care. Our presentation to the Academy emphasized that although diagnostic errors in imaging are commonly considered to result only from failures in disease detection or misinterpretation of a perceived abnormality, most errors in diagnosis result from failures in information gathering, aggregation, dissemination and ultimately integration of that information into our patients' clinical problems. Diagnostic errors can occur at any point on the continuum of imaging care from when imaging is first considered until results and recommendations are fully understood by our referring physicians and patients. We used the concept of the Imaging Value Chain and the ACR's Imaging 3.0 initiative to illustrate how better information gathering and integration at each step in imaging care can mitigate many of the causes of diagnostic errors. Radiologists are in a unique position to be the aggregators, brokers and disseminators of information critical to making an informed diagnosis, and if radiologists were empowered to use our expertise and informatics tools to manage the entire imaging chain, diagnostic errors would be reduced and patient outcomes improved. Heath care teams should take advantage of radiologists' ability to fully manage information related to medical imaging, and simultaneously, radiologists must be ready to meet these new challenges as health care evolves. The radiology community stands ready work with all stakeholders to design and implement solutions that minimize diagnostic errors.
Collapse
Affiliation(s)
- Bibb Allen
- Department of Radiology, Grandview Medical Center, 3690 Grandview Parkway, Birmingham, AL 35243, USA, Phone: +(205) 591 1257
| | | | | | | |
Collapse
|
10
|
Day of Week, Site of Service, and Patient Complexity Differences in Venous Ultrasound Interpreted by Radiologists Versus Nonradiologists. J Am Coll Radiol 2018; 15:1698-1703. [PMID: 29748081 DOI: 10.1016/j.jacr.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/05/2018] [Accepted: 03/02/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Nationally, nonradiologists interpret an increasing proportion of lower extremity venous duplex ultrasound (LEVDU) examinations. We aimed to study day of week, site of service, and patient complexity differences in LEVDU services interpreted by radiologists versus nonradiologists. MATERIALS AND METHODS Using carrier claims files for a 5% national sample of Medicare beneficiaries from 2012 to 2015, we retrospectively classified all LEVDU examinations by physician specialty (radiologist versus nonradiologist), day of week (weekday versus weekend), site of service, and patient Charlson Comorbidity Index (CCI) scores. Pearson's χ2 was used to test statistical significance. RESULTS Of 760,433 LEVDU examinations for which provider specialty could be determined, 439,964 (58%) were interpreted by radiologists and 320,469 (42%) by nonradiologists. On weekends, radiologists interpreted 75% (66,094 of 88,244) and nonradiologists 25% (22,150 of 88,244) (P < .0001). Of LEVDU examinations interpreted by radiologists, 57% were performed in the inpatient or emergency department settings, and 70% of LEVDU examinations interpreted by nonradiologists were performed in the private office or outpatient hospital setting. Radiologists interpreted a slightly larger proportion (17%) of their examinations on patients with more comorbidities (CCI of ≥3) than nonradiologists (15%) (P < .0001). CONCLUSION Compared with nonradiologists, radiologists interpret a disproportionately larger share of weekend (versus weekday) LEVDU examinations and a considerably larger proportion in higher acuity settings. Additionally, the patients on whom they render services have more comorbidities. To optimize around-the-clock patient access to necessary imaging, emerging quality payment programs should consider the timing and sites of service, as well as patient complexity.
Collapse
|
11
|
Rosenkrantz AB, Wang W, Hughes DR, Duszak R. A County-Level Analysis of the US Radiologist Workforce: Physician Supply and Subspecialty Characteristics. J Am Coll Radiol 2018; 15:601-606. [DOI: 10.1016/j.jacr.2017.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/02/2017] [Indexed: 12/01/2022]
|
12
|
Re: Re: Downstream Imaging Utilization After Emergency Department Ultrasound Interpreted by Radiologists Versus Nonradiologists: A Medicare Claims-Based Study. J Am Coll Radiol 2018; 15:236. [DOI: 10.1016/j.jacr.2017.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/18/2017] [Indexed: 11/17/2022]
|
13
|
Re: Downstream Imaging Utilization After Emergency Department Ultrasound Interpreted by Radiologists Versus Nonradiologists: A Medicare Claims-Based Study. J Am Coll Radiol 2018; 15:235-236. [DOI: 10.1016/j.jacr.2017.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 11/24/2022]
|
14
|
Re: “Re: ‘Downstream Imaging Utilization After Emergency Department Ultrasound Interpreted by Radiologists Versus Nonradiologists: A Medicare Claims-Based Study’”. J Am Coll Radiol 2017; 14:1268. [DOI: 10.1016/j.jacr.2017.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/09/2017] [Indexed: 11/20/2022]
|