Cost analysis of mobile radiography services for nursing home residents in Southeast Norway

Beyond the Clinic Walls: Examining Radiology Technicians' Experiences in Home-Based Radiography

In recent years, the landscape of diagnostic imaging has undergone a significant transformation with the emergence of home radiology, challenging the traditional paradigm. This shift, bringing diagnostic imaging directly to patients, has gained momentum and has been further accelerated by the global COVID-19 pandemic, highlighting the increasing importance and convenience of decentralized healthcare services. This study aims to offer a nuanced understanding of the attitudes and experiences influencing the integration of in-home radiography into contemporary healthcare practices. The research methodology involves a survey administered through Computer-Aided Web Interviewing (CAWI) tools, enabling real-time engagement with a diverse cohort of medical radiology technicians in the health domain. A second CAWI tool is submitted to experts to assess their feedback on the methodology. The survey explores key themes, including perceived advantages and challenges associated with domiciliary imaging, its impact on patient care, and the technological intricacies specific to conducting radiologic procedures outside the conventional clinical environment. Findings from a sample of 26 medical radiology technicians (drawn from a larger pool of 186 respondents) highlight a spectrum of opinions and constructive feedback. Enthusiasm is evident for the potential of domiciliary imaging to enhance patient convenience and provide a more patient-centric approach to healthcare. Simultaneously, this study suggests areas of intervention to improve the diffusion of home-based radiology. The methodology based on CAWI tools proves instrumental in the efficiency and depth of data collection, as evaluated by 16 experts from diverse professional backgrounds. The dynamic and responsive nature of this approach allows for a more allocated exploration of technicians' opinions, contributing to a comprehensive understanding of the evolving landscape of medical imaging services. Emphasis is placed on the need for national and international initiatives in the field, supported by scientific societies, to further explore the evolving landscape of teleradiology and the integration of artificial intelligence in radiology. This study encourages expansion involving other key figures in this practice, including, naturally, medical radiologists, general practitioners, medical physicists, and other stakeholders.

Mobile imaging trailers: A scoping review of CT and MRI modalities

INTRODUCTION

Mobile Imaging Trailers enable moving diagnostic imaging equipment between locations requiring very little setup and configuration, example given CT-scanners and MRI-scanners. However, despite the apparent benefits of utilising these imaging capabilities, very little research on the subject exists. This study aims at gaining an overview of the current state of the literature, using the scoping review methodology.

METHODS

The systematic literature search was conducted in three databases: Scopus, Embase and PubMed. Included sources were extracted based on the objectives of the scoping review, and inspired by the by PRISMA-ScR.

RESULTS

29 papers were included.

CONCLUSION

The results of the review showed that three general categories of research on this subject exist - trailers used in research, trailers as the object of research and trailers as an element or tool of the research. Of these, the most prevalent one used is the latter - trailers used as an element or tool of the research. This; however, is an issue for the use of trailers in a clinical setting, as very little research has been conducted on how they might be used and how they compare to fixed installations. As seen during the recent COVID-19 pandemic, the potentials for the use of MITs are immense; however, with the current lack of knowledge and understanding, the full potential has not been realised, suggesting further research should be focused in this area.

IMPLICATIONS FOR PRACTICE

This study has shown that the limited research in the area does point towards a few benefits of MITs; however, there is a clear lack of sufficient research on the field to say this with confidence.

Reimagining Radiology: A Comprehensive Overview of Reviews at the Intersection of Mobile and Domiciliary Radiology over the Last Five Years

(Background) Domiciliary radiology, which originated in pioneering studies in 1958, has transformed healthcare, particularly during the COVID-19 pandemic, through advancements such as miniaturization and digitization. This evolution, driven by the synergy of advanced technologies and robust data networks, reshapes the intersection of domiciliary radiology and mobile technology in healthcare delivery. (Objective) The objective of this study is to overview the reviews in this field with reference to the last five years to face the state of development and integration of this practice in the health domain. (Methods) A review was conducted on PubMed and Scopus, applying a standard checklist and a qualification process. The outcome detected 21 studies. (Key Content and Findings) The exploration of mobile and domiciliary radiology unveils a compelling and optimistic perspective. Notable strides in this dynamic field include the integration of Artificial Intelligence (AI), revolutionary applications in telemedicine, and the educational potential of mobile devices. Post-COVID-19, telemedicine advances and the influential role of AI in pediatric radiology signify significant progress. Mobile mammography units emerge as a solution for underserved women, highlighting the crucial importance of early breast cancer detection. The investigation into domiciliary radiology, especially with mobile X-ray equipment, points toward a promising frontier, prompting in-depth research for comprehensive insights into its potential benefits for diverse populations. The study also identifies limitations and suggests future exploration in various domains of mobile and domiciliary radiology. A key recommendation stresses the strategic prioritization of multi-domain technology assessment initiatives, with scientific societies' endorsement, emphasizing regulatory considerations for responsible and ethical technology integration in healthcare practices. The broader landscape of technology assessment should aim to be innovative, ethical, and aligned with societal needs and regulatory standards. (Conclusions) The dynamic state of the field is evident, with active exploration of new frontiers. This overview also provides a roadmap, urging scholars, industry players, and regulators to collectively contribute to the further integration of this technology in the health domain.

Economic and cost considerations of delivering and using mobile X-ray services in residential aged care facilities: A qualitative study

OBJECTIVE

To describe the economic and cost considerations of mobile X-ray services (MXS) in residential aged care facilities (RACFs), according to stakeholders (involved in residents' healthcare), residents living in RACFs and informal carers (ICs) of residents.

METHODS

Semistructured interviews were conducted with 20 residents and 27 ICs recruited from six RACFs across metropolitan Adelaide (South Australia, Australia), and 22 stakeholders, on their perspectives of using MXS in RACFs. Data relating to economic and cost considerations were extracted and analysed using thematic analysis.

RESULTS

Residents' mean age was 85 years, 60% were women and 40% had experienced an MXS in the last 12 months. Most ICs were daughters (70%) and wives (11%) and 30% had a family member who had experienced an MXS in the last 12 months. Stakeholders included RACF staff, GPs, a hospital avoidance program clinician, paramedics, emergency department clinicians, MXS radiographers and manager, and a radiologist. Four themes were presented: (1) business considerations, where private providers found it necessary to charge residents a co-payment to deliver MXS; (2) cost and payment process as a potential barrier to using MXS, with varied willingness and ability to pay for an MXS co-payment, and equity concerns; (3) overcoming cost and payment barriers, with staff and consumers sometimes using strategies to overcome cost barriers; and (4) perceived cost benefits of MXS to the healthcare system, residents and ICs.

CONCLUSIONS

Mobile X-ray services providers charge residents an upfront co-payment for business viability, which can be a barrier to some residents wishing to access MXS.

Clinical Significance of Action Research-Based Seamless Care to Improve Imaging Efficiency and Patients' Cognition, and Alleviate Patient Anxiety

Objective

The present study was undertaken to assess the clinical significance of action research-based seamless care to improve imaging efficiency and alleviate patient anxiety.

Methods

A total of eighty patients who underwent imaging examinations in our hospital between May 2019 and November 2020 were recruited for this study. The patients were randomly assigned to two groups: the control group receiving routine care and the observation group receiving seamless care based on action research. The random assignment was conducted using a simple random sampling technique, ensuring an equal allocation of participants to each group at a 1:1 ratio, resulting in 40 cases in each group. Outcome measures included imaging examination duration, mean nursing duration, examination cognition, and negative emotion scores.

Results

Seamless care provided shorter imaging examination duration and nursing duration, and better ensured uneventful examinations than routine care (P<0.05). Patients given seamless care exhibited higher examination cognition versus those receiving routine care (P<0.05). Seamless care offered more mitigation of negative emotions for patients than routine care (P<0.05).

Conclusion

Action research-based seamless care effectively improves imaging efficiency and patients' awareness of imaging examinations and contributes to alleviating patients' adverse events.

Mobile X-ray services in nursing homes as an enabler to healthcare-in-place for residents: informal carers' views

BACKGROUND

Informal carers (ICs) of residents living in nursing homes (NH) have a key role in the care of residents, including making decisions about and providing care. As radiology has a role in decision making about care, it is important to understand IC's perspectives about resident's use of mobile X-ray services (MXS). The aim was to explore the perspectives of ICs of residents living in nursing homes about the use of MXS.

METHODS

From November 2020 to February 2021, twenty ICs of residents living in four nursing homes in different areas of one Australian city participated. Their perspectives of MXS, including benefits and barriers, were explored in semi-structured interviews. Data were analysed using thematic analysis.

RESULTS

ICs were resident's children (80%) and spouses (20%). One resident had received a MXS. Four themes were developed: (1) a priority for resident well-being, where ICs were positive about using MXS, because residents could receive healthcare without transfer; (2) MXS could reduce carer burden; (3) economic considerations, where MXS could reduce health system burden but the MXS call-out fee could result in health inequities; and (4) pathways to translation, including the need to improve consumer awareness of MXS, ensure effective processes to using MXS,, consider nursing home staff levels to manage MXS and ICs expectations about quality and availability of MXS.

CONCLUSIONS

ICs consider MXS can benefit resident well-being by potentially reducing transfers to hospital or radiology facilities and advocated equitable access. ICs cautioned that the quality and safety of healthcare delivered in nursing homes should equal what they would receive in hospitals.

How to set up a mobile X-ray unit in the community - Implementation initiatives for patient-centred care

BACKGROUND

Mobile X-ray unit have previously been widely used within hospitals in general, predominately for imaging patients admitted to intensive care units or for patients who cannot tolerate a visit to the radiology department. It is now possible to have an X-ray examination outside the hospital in nursing homes or to bring the service to frail, vulnerable or disabled patients. A visit to the hospital can be a frightening experience for vulnerable patients living with dementia or other neurological disorder. It can potentially have a long-term impact on the patient's recovery or behaviour. This technical note aimed to provide insight into the planning and running of a mobile X-ray unit in a Danish setting.

METHODS

This technical note draws on the lived experiences of radiographers operating and managing a mobile X-ray service, sharing experiences with the implementation process and the challenges and successes of a mobile X-ray unit.

RESULTS AND KEY FINDINGS

Successes include that frail patient, especially those with dementia, benefit from mobile X-ray examinations, as they can remain in familiar surroundings during an X-ray procedure. In general, patients experienced an increased quality of life and less need for sedation medication due to anxiety. Also, working within a mobile X-ray unit is meaningful work for radiographers. Challenges included increased physicality of work, the funding required for the mobile unit, planning a communication strategy to the referring general practitioners, and permission from authorities to perform mobile examinations.

CONCLUSION

We have successfully implemented a mobile radiography unit that provides a better service for vulnerable patients through learning from successes and challenges.

IMPLICATIONS FOR PRACTICE

The mobile radiography setup can benefit vulnerable patients and provide meaningful work for the radiographers. However, transportation of mobile radiography equipment outside the hospital includes many considerations and challenges.

Mobile X-ray outside the hospital: a scoping review

BACKGROUND

For several years mobile X-ray equipment has been routinely used for imaging in patients too unwell within the hospital, when transportation to the radiology department was inadvisable. Now, mobile X-ray examinations are also used outside the hospital. The literature describes that fragile patients may benefit from mobile X-ray, but we need to provide insights into the breadth, depth and gaps in a body of literature.

METHODS

The scoping review was performed by searching PubMed, Cinahl, Embase, EconLit and Health Technology Assessment. English-, Danish-, Norwegian-, German-, Italian-, French- and Swedish-language studies, published 1.1.2009-1.5.2020 about mobile X-ray outside the hospital were included. Participants were patients examined using mobile X-ray as the intervention. PRISMA was used when eligible to build up the review. To extract data from the selected articles, we used a structured summary table.

RESULTS

We included 12 studies in this scoping review. The results were divided into four topics:1. Target population 2. Population health 3. Experience of care and 4. Cost effectiveness. The main findings are that target population could be larger for instance including hospice patients for palliative care, group dwelling for people with intellectual disabilities, or psychiatric patients, population health may be improved, image quality seems to be good and mobile X-ray may be cost effective. Limitations of language, databases and grey literature may have resulted in studies being missed.

CONCLUSIONS

Mobile X-ray may be used outside hospital. There seems to be potential benefits to both patients and health care staff. Based on the published studies it is not possible to draw a final conclusion if mobile X-ray examination is a relevant diagnostic offer and for whom. Further studies are needed to assess the feasibility of use in fragile patients, also regarding staff, relatives and societal consequences and therefore the topic mobile X-ray needs more research.

Mobile X-ray Outside the Hospital vs. X-ray at the Hospital Challenges Exposed in an Explorative RCT Study

BACKGROUND

For frail patients, it may sometimes be preferable to carry out X-ray examinations at the patients' own home. The general state of such patients may worsen due to transport and change of environment when transported for examination at the hospital.

OBJECTIVE

The aim of the randomized controlled trial (RCT) was to investigate if mobile X-ray improves healthcare for fragile patients. The primary outcome was the number of hospitalizations.

DATA SOURCES

We collected all data using questionnaires and data from the Electronic Patient Record (ER).

PARTICIPANTS

Patients referred to a mobile X-ray examination living in nursing homes and homes for the elderly in the Aarhus Municipality (Denmark).

INTERVENTION

mobile X-ray examinations compared to those at the hospital. Study appraisal: Data were collected and stored using the computer programme Redcap. Stata was used for statistical calculations. One hundred and thirty-six patients were included in the RCT. We did not find significant differences between mobile X-ray (intervention) and X-ray at the hospital (control) concerning hospitalizations and number of hospital days. Challenges: We met several challenges when carrying out RCT in the planned study population. Doctors often withdraw the referral when they found out that their patient should go to the hospital instead of mobile X-ray. The nursing home staff often considered the patient too frail to allow the test person to ask questions post X-ray. We also met challenges in the randomization method resulting in bias in the first data collection, so we had to adjust the randomization method.

CONCLUSIONS

For the fragile patients in the present explorative study, mobile X-ray did not significantly reduce the number of hospitalizations compared to X-ray at the hospital. Yet, mobile X-ray may be a new important diagnostic tool for more precise treatment to the frailest patients for whom transportation to the hospital is too exhausting. We need studies with focus on this aspect. We also recommend future RCT studies in a population for which mobile X-ray has not yet been a possibility.

Impact of mobile radiography services in nursing homes on the utilisation of diagnostic imaging procedures

Background

In the last decade, mobile radiography services have been introduced in nursing homes in several countries. Earlier research found an underutilisation of diagnostic imaging among nursing home residents. However, the effects of introducing mobile radiography services on the use of diagnostic imaging are unknown. The purpose of this study was to determine the utilisation of diagnostic imaging among nursing home residents and if there are any differences between hospitals with and without a mobile radiography service.

Methods

Data for 2015 were collected from the radiological information systems of 11 hospitals. The data included information on the anatomical region/organ/organ system, modality, and information on where the examination took place. Using nursing home beds as a proxy for nursing home residents’ differences in the use of diagnostic imaging in areas with hospitals with and without mobile radiography services were analysed. The chi-squared test was used to compare the areas.

Results

From 11,066 examinations of nursing home residents, 87% were plain radiographs, 8% were CT scans, and 4% were ultrasound examinations. In areas with mobile radiography services, there was a significantly higher proportion of diagnostic imaging used per nursing home bed, 50% per bed compared to 36% per bed in areas without; p = < 0.001. Furthermore, in areas with mobile radiography services, there was a significantly lower proportion of CT and ultrasound used per nursing home bed, 2.5 and 1.4% respectively per bed compared to 4.7 and 2.2% respectively per bed in areas without; p = < 0.001.

Conclusions

This study demonstrate a lower use of radiology by nursing home residents compared to the general population, and indicates that mobile radiography services increase the level closer to the user rate in the general population. The proportions of plain radiographs are significantly higher in areas with a mobile radiography service, while the proportion of more advanced imaging techniques such as CT and ultrasound are lower. The higher use of diagnostic imaging is most likely appropriate because of higher morbidity and lower use of diagnostic imaging among nursing home residents, compared to the general population. Further research is necessary on how to improve diagnostic imaging services for nursing home residents.