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Pelzl CE, Rosenkrantz AB, Rula EY, Christensen EW. The Neiman Imaging Comorbidity Index: Development and Validation in a National Commercial Claims Database. J Am Coll Radiol 2024; 21:869-877. [PMID: 38276924 DOI: 10.1016/j.jacr.2023.12.003] [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: 08/30/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To build the Neiman Imaging Comorbidity Index (NICI), based on variables available in claims datasets, which provides good discrimination of an individual's chance of receiving advanced imaging (CT, MR, PET), and thus, utility as a control variable in research. METHODS This retrospective study used national commercial claims data from Optum's deidentified Clinformatics Data Mart database from the period January 1, 2018 to December 31, 2019. Individuals with continuous enrollment during this 2-year study period were included. Lasso (least absolute shrinkage and selection operator) regression was used to predict the chance of receiving advanced imaging in 2019 based on the presence of comorbidities in 2018. A numerical index was created in a development cohort (70% of the total dataset) using weights assigned to each comorbidity, based on regression β coefficients. Internal validation of assigned scores was performed in the remaining 30% of claims, with comparison to the commonly used Charlson Comorbidity Index. RESULTS The final sample (development and validation cohorts) included 10,532,734 beneficiaries, of whom 2,116,348 (20.1%) received advanced imaging. After model development, the NICI included nine comorbidities. In the internal validation set, the NICI achieved good discrimination of receipt of advanced imaging with a C statistic of 0.709 (95% confidence interval [CI] 0.708-0.709), which predicted advanced imaging better than the CCI (C 0.692, 95% CI 0.691-0.692). Controlling for age and sex yielded better discrimination (C 0.748, 95% CI 0.748-0.749). DISCUSSION The NICI is an easily calculated measure of comorbidity burden that can be used to adjust for patients' chances of receiving advanced imaging. Future work should explore external validation of the NICI.
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Affiliation(s)
- Casey E Pelzl
- The Harvey L. Neiman Health Policy Institute, Reston, Virginia.
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University (NYU) Grossman School of Medicine, New York, New York; and Editor-in-Chief, American Journal of Roentgenology
| | - Elizabeth Y Rula
- The Harvey L. Neiman Health Policy Institute, Reston, Virginia; Executive Director, Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Eric W Christensen
- The Harvey L. Neiman Health Policy Institute, Reston, Virginia; Health Services Management, University of Minnesota, St. Paul, Minnesota; Director of Economic and Health Services Research, Harvey L. Neiman Health Policy Institute, Reston, Virginia
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2
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Lang M, Conklin J. Triage of Patients With Acute Stroke for Endovascular Therapy: Point-Moving Toward MRI-Based Acute Stroke Triage With Ultrafast Protocols. AJR Am J Roentgenol 2024. [PMID: 38691413 DOI: 10.2214/ajr.24.31303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Welch TR, Yaqub A, Aiti D, Prevedello LM, Ajam ZA, Nguyen XV. Quantifying effects of blood pressure control on neuroimaging utilization in a large multi-institutional healthcare population. PLoS One 2024; 19:e0298685. [PMID: 38687816 PMCID: PMC11060572 DOI: 10.1371/journal.pone.0298685] [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: 08/11/2023] [Accepted: 01/30/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES Essential hypertension is a common chronic condition that can exacerbate or complicate various neurological diseases that may necessitate neuroimaging. Given growing medical imaging costs and the need to understand relationships between population blood pressure control and neuroimaging utilization, we seek to quantify the relationship between maximum blood pressure recorded in a given year and same-year utilization of neuroimaging CT or MR in a large healthcare population. METHODS A retrospective population-based cohort study was performed by extracting aggregate data from a multi-institutional dataset of patient encounters from 2016, 2018, and 2020 using an informatics platform (Cosmos) consisting of de-duplicated data from over 140 academic and non-academic health systems, comprising over 137 million unique patients. A population-based sample of all patients with recorded blood pressures of at least 50 mmHg DBP or 90 mmHg SBP were included. Cohorts were identified based on maximum annual SBP and DBP meeting or exceeding pre-defined thresholds. For each cohort, we assessed neuroimaging CT and MR utilization, defined as the percentage of patients undergoing ≥1 neuroimaging exam of interest in the same calendar year. RESULTS The multi-institutional population consisted of >38 million patients for the most recent calendar year analyzed, with overall utilization of 3.8-5.1% for CT and 1.5-2.0% for MR across the study period. Neuroimaging utilization increased substantially with increasing annual maximum BP. Even a modest BP increase to 140 mmHg systolic or 90 mmHg diastolic is associated with 3-4-fold increases in MR and 5-7-fold increases in CT same-year imaging compared to BP values below 120 mmHg / 80 mmHg. CONCLUSION Higher annual maximum recorded blood pressure is associated with higher same-year neuroimaging CT and MR utilization rates. These observations are relevant to public health efforts on hypertension management to mitigate costs associated with growing imaging utilization.
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Affiliation(s)
- Theodore R. Welch
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Aliza Yaqub
- Bahria University Medical and Dental College, Karachi, Pakistan
| | - Danny Aiti
- Canton Medical Education Foundation, Canton, Ohio, United States of America
| | - Luciano M. Prevedello
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Zarar A. Ajam
- The Ohio State University, Columbus, Ohio, United States of America
| | - Xuan V. Nguyen
- Department of Radiology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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4
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Kumar M, Beyea S, Hu S, Kamal N. Exploring the role of in-patient magnetic resonance imaging use among admitted ischemic stroke patients in improving patient outcomes and reducing healthcare resource utilization. Front Neurol 2024; 15:1305514. [PMID: 38562429 PMCID: PMC10983768 DOI: 10.3389/fneur.2024.1305514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Despite the diagnostic and etiological significance of in-patient MRI in ischemic stroke (IS), its utilization is considered resource-intensive, expensive, and thus limiting feasibility and relevance. This study investigated the utilization of in-patient MRI for IS patients and its impact on patient and healthcare resource utilization outcomes. Methods This retrospective registry-based study analyzed 1,956 IS patients admitted to Halifax's QEII Health Centre between 2015 and 2019. Firstly, temporal trends of MRI and other neuroimaging utilization were evaluated. Secondly, we categorized the cohort into two groups (MRI vs. No MRI; in addition to a non-contrast CT) and investigated adjusted differences in patient outcomes at admission, discharge, and post-discharge using logistic regression. Additionally, we analyzed healthcare resource utilization using Poisson log-linear regression. Furthermore, patient outcomes significantly associated with MRI use underwent subgroup analysis for stroke severity (mild stroke including transient ischemic attack vs. moderate and severe stroke) and any acute stage treatment (thrombolytic or thrombectomy or both vs. no treatment) subgroups, while using an age and sex-adjusted logistic regression model. Results MRI was used in 40.5% patients; non-contrast CT in 99.3%, CT angiogram in 61.8%, and CT perfusion in 50.3%. Higher MRI utilization was associated with male sex, younger age, mild stroke, wake-up stroke, and no thrombolytic or thrombectomy treatment. MRI use was independently associated with lower in-hospital mortality (adjusted OR, 0.23; 95% CI, 0.15-0.36), lower symptomatic neurological status changes (0.64; 0.43-0.94), higher home discharge (1.32; 1.07-1.63), good functional outcomes at discharge (mRS score 0-2) (1.38; 1.11-1.72), lower 30-day stroke re-admission rates (0.48; 0.26-0.89), shorter hospital stays (regression coefficient, 0.92; 95% CI, 0.90-0.94), and reduced direct costs of hospitalization (0.90; 0.89-0.91). Subgroup analysis revealed significantly positive association of MRI use with most patient outcomes in moderate and severe strokes subgroup and non-acutely treated subgroup. Conversely, outcomes in mild strokes (including TIAs) subgroup and acute treatment subgroup were comparable regardless of MRI use. Conclusion A substantial proportion of admitted IS patients underwent MRI, and MRI use was associated with improved patient outcomes and reduced healthcare resource utilization. Considering the multifactorial nature of IS patient outcomes, further randomized controlled trials are suggested to investigate the role of increased MRI utilization in optimizing in-patient IS management.
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Affiliation(s)
- Mukesh Kumar
- Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada
| | - Steven Beyea
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
- IWK Health, Halifax, NS, Canada
| | - Sherry Hu
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Noreen Kamal
- Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada
- Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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5
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Flores A, Garcia-Tornel A, Seró L, Ustrell X, Requena M, Pellisé A, Rodriguez P, Monterde A, Lara L, Gonzalez-de-Echavarri JM, Molina CA, Doncel-Moriano A, Dorado L, Cardona P, Cánovas D, Krupinski J, Más N, Purroy F, Zaragoza-Brunet J, Palomeras E, Cocho D, Garcia J, Colom C, Silva Y, Gomez-Cocho M, Jiménez X, Ros-Roig J, Abilleira S, Pérez de la Ossa N, Ribo M. Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis. J Neurointerv Surg 2024; 16:143-150. [PMID: 37068936 DOI: 10.1136/jnis-2023-020125] [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: 01/25/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
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Affiliation(s)
- Alan Flores
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | | | - Laia Seró
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Xavier Ustrell
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Anna Pellisé
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Paula Rodriguez
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Angela Monterde
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Lidia Lara
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Jose María Gonzalez-de-Echavarri
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Doncel-Moriano
- Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Laura Dorado
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Pedro Cardona
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - David Cánovas
- Department of Neurology, Consorci Sanitari Parc Taulí, Barcelona, Spain
| | | | - Natalia Más
- Department of Neurology, Hospital Althaia, Manresa, Manresa, Catalunya, Spain
| | | | - Jose Zaragoza-Brunet
- Stroke Unit, Department of Neurology, Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
| | - Ernesto Palomeras
- Department of Neurology, Hospital de Mataró, Mataro, Catalunya, Spain
| | - Dolores Cocho
- Department of Neurology, Hospital General de Granollers, Granollers, Catalunya, Spain
| | - Jessica Garcia
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedes, Catalunya, Spain
| | - Carla Colom
- Department of Neurology, Hospital Universitario de Igualada, Igualada, Catalunya, Spain
| | - Yolanda Silva
- Neurology Department, Stroke Unit, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain
| | - Manuel Gomez-Cocho
- Department of Neurology, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Josep Ros-Roig
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Sonia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
- Catalan Stroke Program, Barcelona, Spain
| | - Marc Ribo
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Chung KJ, Pandey SK, Khaw AV, Lee TY. Multiphase CT angiography perfusion maps for predicting target mismatch and ischemic lesion volumes. Sci Rep 2023; 13:21976. [PMID: 38081878 PMCID: PMC10713587 DOI: 10.1038/s41598-023-48832-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
The complexity of CT perfusion (CTP) acquisition protocols may limit the availability of target mismatch assessment at resource-limited hospitals. We compared CTP mismatch with a mismatch surrogate generated from a simplified dynamic imaging sequence comprising widely available non-contrast CT (NCCT) and multiphase CT angiography (mCTA). Consecutive patients with anterior circulation acute ischemic stroke who received NCCT, mCTA, and CTP were retrospectively included in this study. An mCTA-perfusion (mCTA-P) dynamic series was formed by co-registering NCCT and mCTA. We simulated an ideal mCTA-P study by down-sampling CTP (dCTP) dynamic images according to mCTA timing. Ischemic core and penumbra volumes were estimated by cerebral blood flow and Tmax thresholding, respectively, on perfusion maps calculated independently for CTP, dCTP, and mCTA-P by deconvolution. Concordance in target mismatch (core < 70 ml, penumbra ≥ 15 ml, mismatch ratio ≥ 1.8) determination by dCTP and mCTA-P versus CTP was assessed. Of sixty-one included patients, forty-six had a CTP target mismatch. Concordance with CTP profiles was 90% and 82% for dCTP and mCTA-P, respectively. Lower mCTA-P concordance was likely from differences in collimation width between NCCT and mCTA, which worsened perfusion map quality due to a CT number shift at mCTA. Moderate diagnostic agreement between CTP and mCTA-P was found and may improve with optimal mCTA scan parameter selection as simulated by dCTP. mCTA-P may be a pragmatic alternative where CTP is unavailable or the risks of additional radiation dose, contrast injections, and treatment delays outweigh the potential benefit of a separate CTP scan.
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Affiliation(s)
- Kevin J Chung
- Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada
- Robarts Research Institute and Lawson Health Research Institute, London, ON, Canada
| | - Sachin K Pandey
- Department of Medical Imaging, The University of Western Ontario, RRI 1200D, 1151 Richmond Street N, London, ON, N6A 5B7, Canada
| | - Alexander V Khaw
- Department of Clinical Neurological Sciences, The University of Western Ontario, London, ON, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, The University of Western Ontario, London, ON, Canada.
- Robarts Research Institute and Lawson Health Research Institute, London, ON, Canada.
- Department of Medical Imaging, The University of Western Ontario, RRI 1200D, 1151 Richmond Street N, London, ON, N6A 5B7, Canada.
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7
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Poyiadji N, Beauchamp N, Myers DT, Krupp S, Griffith B. Diagnostic Imaging Utilization in the Emergency Department: Recent Trends in Volume and Radiology Work Relative Value Units. J Am Coll Radiol 2023; 20:1207-1214. [PMID: 37543154 DOI: 10.1016/j.jacr.2023.06.033] [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: 03/16/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE The aim of this study was to quantify and characterize the recent trend in emergency department (ED) imaging volumes and radiology work relative value units (wRVUs) at level I and level III trauma centers. METHODS Total annual diagnostic radiology imaging volumes and wRVUs were obtained from level I and level III trauma centers from January 2014 to December 2021. Imaging volumes were analyzed by modality type, examination code, and location. Total annual patient ED encounters (EDEs), annual weighted Emergency Severity Index, and patient admissions from the ED were obtained. Data were analyzed using annual imaging volume or wRVUs per EDE, and percentage change was calculated. RESULTS At the level I trauma center, imaging volumes per EDE increased for chest radiography (5.5%), CT (35.5%), and MRI (56.3%) and decreased for ultrasound (-5.9%) from 2014 to 2021. Imaging volumes per EDE increased for ultrasound (10.4%), CT (74.6%), and MRI (2.0%) and decreased for chest radiography (-4.4%) at the level III trauma center over the same 8-year period. Total wRVUs per EDE increased at both the level I (34.9%) and level III (76.6%) trauma centers over the study period. CONCLUSIONS ED imaging utilization increased over the 8-year study period at both level I and level III trauma centers, with an increase in total wRVUs per EDE. There was a disproportionate increased utilization of advanced imaging, such as CT, over time. ED utilization trends suggest that there will be a continued increase in demand for advanced imaging interpretation, including at lower acuity hospitals, so radiology departments should prepare for this increased work demand.
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Affiliation(s)
- Neo Poyiadji
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan. https://twitter.com/NeoPoyiadji
| | | | - Daniel T Myers
- Vice Chair, Department of Radiology, Henry Ford Hospital, Detroit, Michigan
| | - Seth Krupp
- Vice Chair of Operations, Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michgan
| | - Brent Griffith
- Vice Chair, Division Chief of Neuroradiology, Diagnostic Radiology Residency Program Director, Department of Radiology, Henry Ford Hospital, Detroit, Michigan.
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8
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Patel K, Hamedani AG, Taneja K, Koneru M, Wolfe J, Sprankle K, Patel P, Mullen MT, Siegler JE. Differential thrombectomy utilization across hospital classifications in the United States. J Stroke Cerebrovasc Dis 2023; 32:107401. [PMID: 37897885 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107401] [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: 06/21/2023] [Revised: 09/11/2023] [Accepted: 09/29/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVES To determine hospital-level factors associated with thrombectomy uptake. MATERIALS AND METHODS The Nationwide Emergency Department Sample was retrospectively queried to determine the total number of thrombectomies performed based on different hospital characteristics. Joint point analysis was used to determine which years were associated with significant increases in the number of high-volume thrombectomy centers (ostensibly defined as >50 thrombectomies/year), thrombectomy-capable centers (>15 thrombectomies/year), and total number of thrombectomies performed. Multivariable logistic regression was used to determine hospital factors associated with having an increased odds of performing thrombectomies, and of being classified as a high-volume thrombectomy or a thrombectomy-capable center. RESULTS Between 2007-2020 there was a stepwise increase in the number of thrombectomy-capable and high-volume thrombectomy centers in the United States. In 2020, there were a total of 15,705 thrombectomies performed, with 89 high-volume thrombectomy centers, and 359 thrombectomy-capable centers. The number of thrombectomy-capable centers significantly increased after 2011. After 2013 and 2016 there was a significant change in the growth rate of high-volume thrombectomy centers. There was also a significant increase in the total number of thrombectomies performed after 2016. Hospital characteristics that were associated with an increased likelihood of being classified as thrombectomy-capable or high-volume included trauma level 1 and 2 hospitals. CONCLUSIONS Between 2007 and 2020, there was a marked growth in thrombectomy utilization for acute ischemic stroke. This growth outpaced new diagnoses of ischemic stroke, and was driven largely by certain hospital types, with the greatest rises following seminal publications of positive randomized thrombectomy trials.
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Affiliation(s)
- Karan Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA.
| | - Ali G Hamedani
- Departments of Neurology and Ophthalmology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kamil Taneja
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Manisha Koneru
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Jared Wolfe
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Pratit Patel
- Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
| | - Michael T Mullen
- Department of Neurology, Lewis Katz School of Medicine at Temple University, USA
| | - James E Siegler
- Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper Neurological Institute, Cooper University Hospital, Camden, NJ, USA
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9
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Buch K, Berlyand Y, Prabhakar A, Grimaldi PJ, Shea MD, Gupta R, Paul A. An ultrafast brain MRI technique for evaluating acute neurologic deficits in the emergency department. Emerg Radiol 2023; 30:391-393. [PMID: 37086336 DOI: 10.1007/s10140-023-02133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/03/2023] [Indexed: 04/23/2023]
Abstract
Herein we share our preliminary experience with an ultrafast brain MRI technique for use in the ED consisting of axial T1-weighted (40 s), axial T2-weighted (62 s), axial diffusion-weighted (80 s), axial FLAIR (96 s), axial T2* (6 s), and axial susceptibility-weighted (108 s) imaging for a total scan time of 6 min and 53 s. Utilization of this ultrafast technique yields an efficient assessment of the brain, decreases ED length of stay and inpatient observation admissions, and may obviate the need for vascular imaging with either CTA or MRA in the ED.
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Affiliation(s)
- Karen Buch
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Yosef Berlyand
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Anand Prabhakar
- Department of Radiology, Newton Wellesley Hospital, Newton, MA, 02468, USA
- Division of Emergency Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Philip J Grimaldi
- Department of Radiology, Newton Wellesley Hospital, Newton, MA, 02468, USA
| | - Michael D Shea
- Department of Radiology, Newton Wellesley Hospital, Newton, MA, 02468, USA
| | - Rajiv Gupta
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Aaron Paul
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
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10
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Wang JJ, Pelzl CE, Boltyenkov A, Katz JM, Hemingway J, Christensen EW, Rula E, Sanelli PC. Response to Granja et al Letter, "Increased Versus Appropriate Neuroimaging Utilization in Stroke: A Complex Matter.". J Am Coll Radiol 2022; 19:1300-1301. [PMID: 36002057 DOI: 10.1016/j.jacr.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Affiliation(s)
- Jason J Wang
- Imaging Clinical Effectiveness and Outcomes Research, Health System Science Institute, Feinstein Institutes for Medical Research, Manhasset, New York; and Associate Professor and Health Economist, Director of Data Analytics, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, 600 Community Drive, Suite 403, Manhasset, NY 11030.
| | - Casey E Pelzl
- Biostatistician, The Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Artem Boltyenkov
- Visiting Scholar, Imaging Clinical Effectiveness and Outcomes Research, Health System Science Institute, Feinstein Institutes for Medical Research, Manhasset, New York; and Siemens Medical Solutions USA Inc, Malvern, Pennsylvania
| | - Jeffrey M Katz
- Chief, Neurovascular Services; Neurology Service Line Director, Neuroendovascular Surgery; Director, Comprehensive Stroke Center and Stroke Unit, North Shore University Hospital; Director, Neuroendovascular Surgery, South Shore University Hospital; Associate Professor of Neurology & Radiology, Department of Radiology, and Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Jennifer Hemingway
- Senior Research Associate, The Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Eric W Christensen
- Principal Research Scientist, The Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Elizabeth Rula
- Executive Director, The Harvey L. Neiman Health Policy Institute, Reston, Virginia
| | - Pina C Sanelli
- Imaging Clinical Effectiveness and Outcomes Research, Health System Science Institute, Feinstein Institutes for Medical Research, Manhasset, New York; and Vice Chair of Research, Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Guarnizo Á, Romero J, Bermúdez S, Granja MF. Increased Versus Appropriate Neuroimaging Utilization in Stroke: A Complex Matter. J Am Coll Radiol 2022; 19:1300. [PMID: 35922019 DOI: 10.1016/j.jacr.2022.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Ángela Guarnizo
- Neuroradiologist, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Javier Romero
- Radiologist, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sonia Bermúdez
- Neuroradiologist, Fundación Santa Fe de Bogotá, Diagnostic and Interventional Imaging Department, Calle 116 No. 9-02, Bogotá DC, Colombia 110111.
| | - Manuel Felipe Granja
- Radiology Resident, Univerisdad El Bosque Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
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Christensen EW, Pelzl CE, Hemingway J, Wang JJ, Sanmartin MX, Naidich JJ, Rula EY, Sanelli PC. Drivers of Ischemic Stroke Hospital Cost Trends Among Older Adults in the United States. J Am Coll Radiol 2022; 20:411-421. [PMID: 36357310 DOI: 10.1016/j.jacr.2022.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE The increased use of neuroimaging and innovations in ischemic stroke (IS) treatment have improved outcomes, but the impact on median hospital costs is not well understood. METHODS A retrospective study was conducted using Medicare 5% claims data for 75,525 consecutive index IS hospitalizations for patients aged ≥65 years from 2012 to 2019 (values in 2019 dollars). IS episode cost was calculated in each year for trend analysis and stratified by cost components, including neuroimaging (CT angiography [CTA], CT perfusion [CTP], MRI, and MR angiography [MRA]), treatment (endovascular thrombectomy [EVT] and/or intravenous thrombolysis), and patient sociodemographic factors. Logistic regression was performed to analyze the drivers of high-cost episodes and median regression to assess drivers of median costs. RESULTS The median IS episode cost increased by 4.9% from $9,509 in 2012 to $9,973 in 2019 (P = .0021). Treatment with EVT resulted in the greatest odds of having a high-cost (>$20,000) hospitalization (odds ratio [OR], 71.86; 95% confidence interval [CI], 54.62-94.55), as did intravenous thrombolysis treatment (OR, 3.19; 95% CI, 2.90-3.52). Controlling for other factors, neuroimaging with CTA (OR, 1.72; 95% CI, 1.58-1.87), CTP (OR, 1.32; 95% CI, 1.14-1.52), and/or MRA (OR, 1.26; 95% CI, 1.15-1.38) had greater odds of having high-cost episodes than those without CTA, CTP, and MRA. Length of stay > 4 days (OR, 4.34; 95% CI, 3.99-4.72) and in-hospital mortality (OR, 1.85; 95% CI, 1.63-2.10) were also associated with high-cost episodes. CONCLUSIONS From 2012 to 2019, the median IS episode cost increased by 4.9%, with EVT as the main cost driver. However, the increasing treatment cost trends have been partially offset by decreases in median length of stay and in-hospital mortality.
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Sadigh G, Baradaran H, Weinberg B. Upward Utilization Rates of Neuroimaging in Ischemic Stroke in the Last Two Decades: Improving Patients’ Outcomes or Increasing Health Care Cost? J Am Coll Radiol 2022; 19:1015-1017. [DOI: 10.1016/j.jacr.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022]
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14
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Bammer R, Amukotuwa SA. Navigating Supply Chain Disruptions of Iodinated Contrast Agent for Neuroimaging and How Business Intelligence Can Help the Decision Process. AJNR Am J Neuroradiol 2022; 43:944-950. [PMID: 35649725 DOI: 10.3174/ajnr.a7544] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/07/2022]
Abstract
A recent coronavirus disease 2019-related shutdown of the main production facility of iohexol in China has led to massive shortages of iodinated contrast material across the globe. This shortage has also jeopardized neuroimaging. In this article, we describe remedies to reduce iodinated contrast material use for stroke imaging, which is its primary use in neuroimaging, that we have implemented in our hospital network.
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Affiliation(s)
- R Bammer
- From Monash Imaging, Monash Health, Clayton, Victoria, Australia; and Department of Radiology, Monash University, Clayton, Victoria, Australia
| | - S A Amukotuwa
- From Monash Imaging, Monash Health, Clayton, Victoria, Australia; and Department of Radiology, Monash University, Clayton, Victoria, Australia
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