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Rahimi S, Ononogbu O, Mohan A, Moussa D, Abughosh S, Trivedi MV. Adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status before and during the COVID-19 pandemic. Int J Clin Pharm 2023; 45:1396-1404. [PMID: 37380914 PMCID: PMC10682303 DOI: 10.1007/s11096-023-01609-6] [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: 12/14/2022] [Accepted: 05/21/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in the prevention and treatment of hormone receptor-positive (HR +) breast cancer (BC). Medication use behavior is suboptimal especially in racial/ethnic minorities with lower socioeconomic status (SES). AIM We aimed to assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on OET adherence and identify demographic and/or clinical characteristics associated with nonadherence in racial/ethnic minorities with lower SES. METHOD A retrospective study was conducted at the Harris Health System in Houston, Texas. Data were collected during the 6 months before and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. A multivariable logistic regression model was used to identify demographic/clinical characteristics associated with nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included. RESULTS In 258 patients, adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The demographic/clinical characteristics associated with OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent. CONCLUSION OET adherence was significantly reduced during the COVID-19 pandemic in racial/ethnic minority patients with low SES. Patient-centered interventions are necessary to improve OET adherence in these patients.
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Affiliation(s)
- Sama Rahimi
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Onyebuchi Ononogbu
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Anjana Mohan
- Department of Pharmaceutical Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Daniel Moussa
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA
| | - Susan Abughosh
- Department of Pharmaceutical Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA
| | - Meghana V Trivedi
- Department of Pharmacy Practice and Translational Research, University of Houston, College of Pharmacy, Health 2, 4349 Martin Luther King Blvd, Houston, TX, 77204-5000, USA.
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Rahimi S, Ononogbu O, Mohan A, Moussa D, Abughosh S, Trivedi M. Identifying the predictors of adherence to oral endocrine therapy in racial/ethnic minority patients with low socioeconomic status. RESEARCH SQUARE 2022:rs.3.rs-2379786. [PMID: 36597529 PMCID: PMC9810231 DOI: 10.21203/rs.3.rs-2379786/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Adherence to oral endocrine therapy (OET) is crucial in ensuring its maximum benefit in prevention and treatment of hormone receptor-positive (HR+) breast cancer (BC) in patients. Medication use behavior is suboptimal especially in racial/ethnic minorities of lower socioeconomic status (SES). We aimed to assess the OET adherence and its predictors in racial/ethnic minority patients of lower SES. Aim We aimed to assess the OET adherence and determine the predictors of OET nonadherence in racial/ethnic minority patients of lower SES. Method A retrospective study was conducted at the Harris Health System in Houston, Texas. Since the study period included the COVID-19 pandemic, data was collected during the 6 months prior and 6 months after the start of the pandemic. The adherence was assessed using the prescription refill data using the proportion of days covered. Multivariable logistic regression model was used to identify predictors of nonadherence. Eighteen years or older patients on appropriate doses of OET for prevention or treatment of BC were included. Result In 258 patients, the adherence was significantly lower during the pandemic (44%) compared to before the pandemic (57%). The predictors of OET nonadherence before the pandemic were Black/African American, obesity/extreme obesity, prevention setting, tamoxifen therapy, and 4 or more years on OET. During the pandemic, prevention setting and those not using home delivery were more likely to be nonadherent. Conclusion Racial/ethnic minority patients of lower SES, especially African Americans and those using OET for prevention of BC, require individualized interventions to improve adherence.
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Brown SD, Hardy SM, Bruno MA. Rationing and Disparities in Health Care: Implications for Radiology Clinical Practice Guidelines. J Am Coll Radiol 2021; 19:84-89. [PMID: 34687667 DOI: 10.1016/j.jacr.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 12/26/2022]
Abstract
We examine the relationship between the rationing of health care resources and disparities in health care delivery and the specific implications for radiologic resource allocation frameworks such as the ACR Appropriateness Criteria. We explore what rationing is in this context and how it is manifested in radiology. We review how rationing has taken many forms and how rationing has influenced the development of disparities in access and outcomes within health care and specifically within the context of radiology. We describe how the relationship between rationing and health care delivery disparities manifested during the coronavirus disease 2019 pandemic and the corrective measures that were proposed to established rationing frameworks to facilitate more equitable pandemic-related resource distribution. We offer suggestions regarding how such solutions might be brought into radiologic resource allocation schemes to help mitigate disparities in radiologic care in the future.
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Affiliation(s)
- Stephen D Brown
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts; and Center for Bioethics, Harvard Medical School, Boston, Massachusetts.
| | - Seth M Hardy
- Department of Radiology, The Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Michael A Bruno
- Vice-Chair, Quality and Chief, Emergency Radiology, The Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Primary Care and Telehealth Spending Differed Across Primary Care Specialties During COVID-19 Stay-at-Home Order. J Gen Intern Med 2021; 36:2191-2193. [PMID: 33963506 PMCID: PMC8104036 DOI: 10.1007/s11606-021-06853-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022]
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Automated tracking of emergency department abdominal CT findings during the COVID-19 pandemic using natural language processing. Am J Emerg Med 2021; 49:52-57. [PMID: 34062318 PMCID: PMC8154187 DOI: 10.1016/j.ajem.2021.05.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/08/2021] [Accepted: 05/18/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE During the COVID-19 pandemic, emergency department (ED) volumes have fluctuated. We hypothesized that natural language processing (NLP) models could quantify changes in detection of acute abdominal pathology (acute appendicitis (AA), acute diverticulitis (AD), or bowel obstruction (BO)) on CT reports. METHODS This retrospective study included 22,182 radiology reports from CT abdomen/pelvis studies performed at an urban ED between January 1, 2018 to August 14, 2020. Using a subset of 2448 manually annotated reports, we trained random forest NLP models to classify the presence of AA, AD, and BO in report impressions. Performance was assessed using 5-fold cross validation. The NLP classifiers were then applied to all reports. RESULTS The NLP classifiers for AA, AD, and BO demonstrated cross-validation classification accuracies between 0.97 and 0.99 and F1-scores between 0.86 and 0.91. When applied to all CT reports, the estimated numbers of AA, AD, and BO cases decreased 43-57% in April 2020 (first regional peak of COVID-19 cases) compared to 2018-2019. However, the number of abdominal pathologies detected rebounded in May-July 2020, with increases above historical averages for AD. The proportions of CT studies with these pathologies did not significantly increase during the pandemic period. CONCLUSION Dramatic decreases in numbers of acute abdominal pathologies detected by ED CT studies were observed early on during the COVID-19 pandemic, though these numbers rapidly rebounded. The proportions of CT cases with these pathologies did not increase, which suggests patients deferred care during the first pandemic peak. NLP can help automatically track findings in ED radiology reporting.
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Yacoub JH, Swanson CE, Jay AK, Cooper C, Spies J, Krishnan P. The Radiology Virtual Reading Room: During and Beyond the COVID-19 Pandemic. J Digit Imaging 2021; 34:308-319. [PMID: 33620622 PMCID: PMC7901504 DOI: 10.1007/s10278-021-00427-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic has disrupted the radiology reading room with a potentially lasting impact. This disruption could introduce the risk of obviating the need for the reading room, which would be detrimental to many of the roles of radiology that occur in and around the reading room. This disruption could also create the opportunity for accelerated evolution of the reading room to meet the strategic needs of radiology and health care through thoughtful re-design of the virtual reading room. In this article, we overview the impact of the COVID-19 pandemic on radiology in our institution and across the country, specifically on the dynamics of the radiology reading room. We introduce the concept of the virtual reading room, which is a redesigned alternative to the physical reading room that can serve the diverse needs of radiology and healthcare during and beyond the pandemic.
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Affiliation(s)
- Joseph H Yacoub
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA.
| | - Carl E Swanson
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Ann K Jay
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Cirrelda Cooper
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - James Spies
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
| | - Pranay Krishnan
- Medstar Georgetown University Hospital, 3800 Reservoir Rd NW Washington, 20007, Georgetown, DC, USA
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Miglioretti DL, Bissell MCS, Kerlikowske K, Buist DSM, Cummings SR, Henderson LM, Onega T, O’Meara ES, Rauscher GH, Sprague BL, Tosteson ANA, Wernli KJ, Lee JM, Lee CI. Assessment of a Risk-Based Approach for Triaging Mammography Examinations During Periods of Reduced Capacity. JAMA Netw Open 2021; 4:e211974. [PMID: 33764423 PMCID: PMC7994953 DOI: 10.1001/jamanetworkopen.2021.1974] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/26/2021] [Indexed: 12/19/2022] Open
Abstract
Importance Breast cancer screening, surveillance, and diagnostic imaging services were profoundly limited during the initial phase of the coronavirus disease 2019 (COVID-19) pandemic. Objective To develop a risk-based strategy for triaging mammograms during periods of decreased capacity. Design, Setting, and Participants This population-based cohort study used data collected prospectively from mammography examinations performed in 2014 to 2019 at 92 radiology facilities in the Breast Cancer Surveillance Consortium. Participants included individuals undergoing mammography. Data were analyzed from August 10 to November 3, 2020. Exposures Clinical indication for screening, breast symptoms, personal history of breast cancer, age, time since last mammogram/screening interval, family history of breast cancer, breast density, and history of high-risk breast lesion. Main Outcomes and Measures Combinations of clinical indication, clinical history, and breast cancer risk factors that subdivided mammograms into risk groups according to their cancer detection rate were identified using classification and regression trees. Results The cohort included 898 415 individuals contributing 1 878 924 mammograms (mean [SD] age at mammogram, 58.6 [11.2] years) interpreted by 448 radiologists, with 1 722 820 mammograms in individuals without a personal history of breast cancer and 156 104 mammograms in individuals with a history of breast cancer. Most individuals were aged 50 to 69 years at imaging (1 113 174 mammograms [59.2%]), and 204 305 (11.2%) were Black, 206 087 (11.3%) were Asian or Pacific Islander, 126 677 (7.0%) were Hispanic or Latina, and 40 021 (2.2%) were another race/ethnicity or mixed race/ethnicity. Cancer detection rates varied widely based on clinical indication, breast symptoms, personal history of breast cancer, and age. The 12% of mammograms with very high (89.6 [95% CI, 82.3-97.5] to 122.3 [95% CI, 108.1-138.0] cancers detected per 1000 mammograms) or high (36.1 [95% CI, 33.1-39.3] to 47.5 [95% CI, 42.4-53.3] cancers detected per 1000 mammograms) cancer detection rates accounted for 55% of all detected cancers and included mammograms to evaluate an abnormal mammogram or breast lump in individuals of all ages regardless of breast cancer history, to evaluate breast symptoms other than lump in individuals with a breast cancer history or without a history but aged 60 years or older, and for short-interval follow-up in individuals aged 60 years or older without a breast cancer history. The 44.2% of mammograms with very low cancer detection rates accounted for 13.1% of detected cancers and included annual screening mammograms in individuals aged 50 to 69 years (3.8 [95% CI, 3.5-4.1] cancers detected per 1000 mammograms) and all screening mammograms in individuals younger than 50 years regardless of screening interval (2.8 [95% CI, 2.6-3.1] cancers detected per 1000 mammograms). Conclusions and Relevance In this population-based cohort study, clinical indication and individual risk factors were associated with cancer detection and may be useful for prioritizing mammography in times and settings of decreased capacity.
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Affiliation(s)
- Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Michael C. S. Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Steven R. Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco
| | | | - Tracy Onega
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Garth H. Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago
| | - Brian L. Sprague
- Office of Health Promotion Research, University of Vermont Cancer Center, Department of Surgery, Larner College of Medicine at the University of Vermont, Burlington
| | - Anna N. A. Tosteson
- Norris Cotton Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Janie M. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
- Department of Health Services, University of Washington School of Public Health, Seattle
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Parikh KD, Ramaiya NH, Kikano EG, Tirumani SH, Pierce J, Butcher C, Sunshine JL, Plecha DM. Quantifying the decrease in emergency department imaging utilization during the COVID-19 pandemic at a multicenter healthcare system in Ohio. Emerg Radiol 2020; 27:765-772. [PMID: 32870462 PMCID: PMC7459244 DOI: 10.1007/s10140-020-01848-4] [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: 05/20/2020] [Accepted: 08/25/2020] [Indexed: 11/30/2022]
Abstract
Purpose To illustrate the change in emergency department (ED) imaging utilization at a multicenter health system in the state of Ohio during the COVID-19 pandemic. Methods A retrospective observational study was conducted assessing ED imaging volumes between March 1, 2020, and May 11, 2020, during the COVID-19 crisis. A rolling 7-day total value was used for volume tracking and comparison. Total imaging utilization in the ED was compared with new COVID-19 cases in our region. Utilization was first categorized by modality and then by plain films and computed tomography (CT) scans grouped by body part. CT imaging of the chest was specifically investigated by assessing both CT chest only exams and CT chest, abdomen, and pelvis (C/A/P) exams. Ultimately, matching pair-wise statistical analysis of exam volumes was performed to assess significance of volume change. Results Our multicenter health system experienced a 46% drop in imaging utilization (p < 0.0001) during the pandemic. Matching pair-wise analysis showed a statistically significant volume decrease by each modality and body part. The exceptions were non-contrast chest CT, which increased (p = 0.0053), and non-trauma C/A/P CT, which did not show a statistically significant volume change (p = 0.0633). Conclusion ED imaging utilization trends revealed through actual health system data will help inform evidence-based decisions for more accurate volume predictions and therefore institutional preparedness for current and future pandemics.
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Affiliation(s)
- Keval D Parikh
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Elias G Kikano
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jonathan Pierce
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Carl Butcher
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jeffrey L Sunshine
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Donna M Plecha
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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Parikh KD, Ramaiya NH, Kikano EG, Tirumani SH, Pandya H, Stovicek B, Sunshine JL, Plecha DM. COVID-19 Pandemic Impact on Decreased Imaging Utilization: A Single Institutional Experience. Acad Radiol 2020; 27:1204-1213. [PMID: 32665091 PMCID: PMC7340053 DOI: 10.1016/j.acra.2020.06.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES Predictive models and anecdotal articles suggest radiology practices were losing 50%-70% of their normal imaging volume during the COVID-19 pandemic. Using actual institutional data, we investigated the change in imaging utilization and revenue during this public health crisis. MATERIALS AND METHODS Imaging performed within the 8-week span between March 8 and April 30, 2020 was categorized into the COVID-19 healthcare crisis timeframe. The first week of this date range and the 10 weeks prior were used to derive the normal practice expected volume. A rolling 7-day total value was used for volume tracking and comparison. Total imaging utilization was derived and organized by patient setting (outpatient, inpatient, emergency) and imaging modality (X-ray, CT, Mammography, MRI, Nuclear Medicine/PET, US). The three highest volume hospitals were analyzed. Revenue information was collected from the hospital billing system. RESULTS System-wide imaging volume decreased by 55% between April 7 and 13, 2020. Outpatient exams decreased by 68% relative to normal practice. Emergency exams decreased by 48% and inpatient exams declined by 31%. Mammograms and nuclear medicine scans were the most affected modalities, decreasing by 93% and 61%, respectively. The main campus hospital experienced less relative imaging volume loss compared to the other smaller and outpatient-driven hospitals. At its lowest point, the technical component revenue from main campus imaging services demonstrated a 49% negative variance from normal practice. CONCLUSION The trends and magnitude of the actual imaging utilization data presented will help inform evidence-based decisions for more accurate volume predictions, policy changes, and institutional preparedness for current and future pandemics.
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Affiliation(s)
- Keval D Parikh
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106.
| | - Nikhil H Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106
| | - Elias G Kikano
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106
| | - Himanshu Pandya
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106
| | - Bart Stovicek
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106
| | - Jeffrey L Sunshine
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106
| | - Donna M Plecha
- Department of Radiology, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106
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Maizlin NN, Ohorodnyk P. Investigating the initial effect of COVID-19 on the functioning of outpatient diagnostic imaging facilities. J Med Imaging Radiat Sci 2020; 51:574-578. [PMID: 33121887 PMCID: PMC7425712 DOI: 10.1016/j.jmir.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION As a result of the COVID-19 pandemic, outpatient diagnostic imaging (DI) facilities experienced decreased operations and even unprecedented closures. The purpose of this study was to examine the impact of COVID-19 on the practices of DI clinics, and investigate the reasons for the change in their operations during the initial period of the pandemic starting in mid-March 2020. MATERIALS AND METHODS A questionnaire was created and distributed to the managers of eighteen outpatient DI clinics in London, Hamilton, and Halton, Ontario, Canada. The managers indicated whether their clinics had closed or decreased operations, the reasons for closure, and the types of imaging examinations conducted in the initial period of the COVID-19 pandemic. RESULTS Fifty percent of the DI clinics surveyed (9/18) closed as a result of COVID-19, and those that remained open had decreased hours of operation. The clinics that closed indicated decreased referrals as the primary reason for closure, followed by staff shortage, concerns for safety, and suspension of elective imaging. Chest radiography and obstetric ultrasound were the most commonly conducted examinations. Clinics that were in close geographical proximity were able to redistribute imaging examinations amongst themselves. All DI clinics had suspended BMD examinations and elective breast screening, and some transitioned to booked appointments only. CONCLUSION Many DI clinics needed to close or decrease operations as a result of COVID-19, a phenomenon that is unprecedented in radiological practice. The results of this study can assist outpatient DI clinics in preparing for subsequent waves of COVID-19, future pandemics, and other periods of crisis.
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Affiliation(s)
- Nick N Maizlin
- Schulich School of Medicine and Dentistry (NNM), Department of Radiology (PO), Western University, London, Ontario, Canada.
| | - Pavlo Ohorodnyk
- Schulich School of Medicine and Dentistry (NNM), Department of Radiology (PO), Western University, London, Ontario, Canada
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Liao JM. COVID-19 Recovery Will Involve Strategy, Not Just Operational Effectiveness. J Am Coll Radiol 2020; 17:1334-1336. [PMID: 32659228 PMCID: PMC7351058 DOI: 10.1016/j.jacr.2020.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 12/02/2022]
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Norbash AM, Moore AV, Recht MP, Brink JA, Hess CP, Won JJ, Jain S, Sun X, Brown M, Enzmann D. Early-Stage Radiology Volume Effects and Considerations with the Coronavirus Disease 2019 (COVID-19) Pandemic: Adaptations, Risks, and Lessons Learned. J Am Coll Radiol 2020; 17:1086-1095. [PMID: 32717183 PMCID: PMC7346772 DOI: 10.1016/j.jacr.2020.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic resulted in significant loss of radiologic volume as a result of shelter-at-home mandates and delay of non-time-sensitive imaging studies to preserve capacity for the pandemic. We analyze the volume-related impact of the COVID-19 pandemic on six academic medical systems (AMSs), three in high COVID-19 surge (high-surge) and three in low COVID-19 surge (low-surge) regions, and a large national private practice coalition. We sought to assess adaptations, risks of actions, and lessons learned. Methods Percent change of 2020 volume per week was compared with the corresponding 2019 volume calculated for each of the 14 imaging modalities and overall total, outpatient, emergency, and inpatient studies in high-surge AMSs and low-surge AMSs and the practice coalition. Results Steep examination volume drops occurred during week 11, with slow recovery starting week 17. The lowest total AMS volume drop was 40% compared with the same period the previous year, and the largest was 70%. The greatest decreases were seen with screening mammography and dual-energy x-ray absorptiometry scans, and the smallest decreases were seen with PET/CT, x-ray, and interventional radiology. Inpatient volume was least impacted compared with outpatient or emergency imaging. Conclusion Large percentage drops in volume were seen from weeks 11 through 17, were seen with screening studies, and were larger for the high-surge AMSs than for the low-surge AMSs. The lowest drops in volume were seen with modalities in which delays in imaging had greater perceived adverse consequences.
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Affiliation(s)
- Alexander M Norbash
- Chair, Department of Radiology, University of California, San Diego, California.
| | - Arl Van Moore
- Chair, Chief Executive Officer, Strategic Radiology, LLC, Palmetto, Florida
| | - Michael P Recht
- Chair, Department of Radiology, New York University, Grossman School of Medicine, New York, New York
| | - James A Brink
- Chair, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher P Hess
- Chair, Department of Radiology, University of California, San Francisco, California
| | - Jay J Won
- University of California, Los Angeles, California
| | - Sonia Jain
- University of California, San Diego, California
| | | | - Manuel Brown
- Chair, Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Dieter Enzmann
- Chair, Department of Radiology, University of California, Los Angeles, California
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Romero J, Valencia S, Guerrero A. Acute Appendicitis During Coronavirus Disease 2019 (COVID-19): Changes in Clinical Presentation and CT Findings. J Am Coll Radiol 2020; 17:1011-1013. [PMID: 32610104 PMCID: PMC7321660 DOI: 10.1016/j.jacr.2020.06.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023]
Abstract
Background Quarantine and stay-at-home orders are strategies that many countries used during the acute pandemic period of coronavirus disease 2019 (COVID-19) to prevent disease dissemination, health system overload, and mortality. However, there are concerns that patients did not seek necessary health care because of these mandates. Purpose To evaluate the differences in the clinical presentation of acute appendicitis and CT findings related to these cases between the COVID-19 acute pandemic period and nonpandemic period. Materials and Methods A retrospective observational study was performed to compare the acute pandemic period (March 23, 2020, to May 4, 2020) versus the same period the year before (March 23, 2019, to May 4, 2019). The proportion of appendicitis diagnosed by CT and level of severity of the disease were reviewed in each case. Univariate and bivariate analyses were performed to identify significant differences between the two groups. Results A total of 196 abdominal CT scans performed due to suspected acute appendicitis were evaluated: 55 from the acute pandemic period and 141 from the nonpandemic period. The proportion of acute appendicitis diagnosed by abdominal CT was higher in the acute pandemic period versus the nonpandemic period: 45.5% versus 29.8% (P = .038). The severity of the diagnosed appendicitis was higher during the acute pandemic period: 92% versus 57.1% (P = .003). Conclusion During the acute COVID-19 pandemic period, fewer patients presented with acute appendicitis to the emergency room, and those who did presented at a more severe stage of the disease.
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Carlos RC, Lowry KP, Sadigh G. The Coronavirus Disease 2019 (COVID-19) Pandemic: A Patient-Centered Model of Systemic Shock and Cancer Care Adherence. J Am Coll Radiol 2020; 17:927-930. [PMID: 32631494 PMCID: PMC7266758 DOI: 10.1016/j.jacr.2020.05.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Ruth C Carlos
- University of Michigan, Rogel Cancer Center, Ann Arbor, Michigan.
| | - Kathryn P Lowry
- University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
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Carlos RC. Pandemic. J Am Coll Radiol 2020; 17:691-692. [PMID: 32498794 PMCID: PMC7174191 DOI: 10.1016/j.jacr.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Ruth C. Carlos
- Ruth C. Carlos, MD, MS: University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109.
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Quraishi MI, Rizvi AA, Heidel RE. Off-Site Radiology Workflow Changes Due to the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Radiol 2020; 17:878-881. [PMID: 32425711 PMCID: PMC7231727 DOI: 10.1016/j.jacr.2020.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/17/2022]
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