1
|
Sundland SL, Møller-Christensen B. The mobile X-ray service and hip fractures: The impact of the mobile X-ray service on the hip fast track. Radiography (Lond) 2024; 30:709-714. [PMID: 38428194 DOI: 10.1016/j.radi.2024.02.017] [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: 09/24/2023] [Revised: 12/29/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Hip fracture is a serious affliction that requires fast care and an X-ray examination, which are provided by an ambulance and a visit to the radiology department, respectively. If a well-functioning mobile X-ray service could be developed, by examining the patient in their own home, both the work strain of hospital workers and patient suffering could be reduced. The purpose of this study was to determine if the mobile X-ray service could be a supplement to the fast-track process that is utilised by the ambulance service. The study also examines other department's opinion of this implementation. METHODS A mixed method was used where data from a Swedish hospital's local RIS/PACS was collected from 706 patients for quantitative analysis, and six personnel working at the hospital were interviewed to obtain qualitative data. RESULTS The quantitative data demonstrates that the actual mobile X-ray service cannot act in such an acute manner as an ambulance service due to the staffing problems that the hospital is faced with, but with optimal staffing, radiographs with mobile X-ray service could be performed within an acute timeframe. The qualitative data shows that there is a strong wish for the mobile X-ray service to expand and be more active, but this requires a better staffing situation in the radiology department and better communication possibilities between other departments. CONCLUSION The mobile X-ray service is desirable in the investigated region, and it could benefit both the emergency ward and the ambulance service, and it could function as infection control for geriatric patients, but more radiographers on staff is required if the service should be functional as a complement to the hip-"fast track". More studies on the subject are required. IMPLICATION FOR PRACTICE A wide generalisation of the results is not applicable in this study, as mobile X-ray and the "hip fast track" is not a widespread service throughout Sweden. This means that this study only suggests trends, which needs to be studied further.
Collapse
Affiliation(s)
- S L Sundland
- Department of Radiology in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - B Møller-Christensen
- Jönköping University, Department of Natural Science and Biomedicine, Jönköping, Sweden
| |
Collapse
|
2
|
Andersen PAB, Precht H, McEntee MF, Pedersen MRV. How to set up a mobile X-ray unit in the community - Implementation initiatives for patient-centred care. Radiography (Lond) 2023; 29 Suppl 1:S148-S151. [PMID: 36907795 DOI: 10.1016/j.radi.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023]
Abstract
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.
Collapse
Affiliation(s)
- P A B Andersen
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding. Sygehusvej 4, DK-6000 Kolding, Denmark
| | - H Precht
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding. Sygehusvej 4, DK-6000 Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, J. B. Winsløwsvej 19.3, DK-5000 Odense, Denmark; Health Sciences Research Centre, UCL University College, Niels Bohrs Allé 1, DK-5230 Odense, Denmark
| | - M F McEntee
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding. Sygehusvej 4, DK-6000 Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, J. B. Winsløwsvej 19.3, DK-5000 Odense, Denmark; Department of Radiology, Lille Baelt Hospital, University Hospitals of Southern Denmark, Vejle, Beriderbakken 4 DK-7100 Vejle, Denmark; University College Cork, School of Medicine, Discipline of Medical Imaging and Radiation Therapy, Ireland
| | - M R V Pedersen
- Department of Radiology, Lillebaelt Hospital, University Hospitals of Southern Denmark, Kolding. Sygehusvej 4, DK-6000 Kolding, Denmark; Department of Regional Health Research, University of Southern Denmark, J. B. Winsløwsvej 19.3, DK-5000 Odense, Denmark; Department of Radiology, Lille Baelt Hospital, University Hospitals of Southern Denmark, Vejle, Beriderbakken 4 DK-7100 Vejle, Denmark.
| |
Collapse
|
3
|
Bretschneider C, Poeck J, Freytag A, Günther A, Schneider N, Schwabe S, Bleidorn J. [Emergency situations and emergency department visits in nursing homes-a scoping review about circumstances and healthcare interventions]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:688-696. [PMID: 35581404 PMCID: PMC9113071 DOI: 10.1007/s00103-022-03543-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nursing home residents are more likely to be hospitalized as non-institutionalized peers. A large number of emergency medical services (EMS) and emergency department visits are classified as potentially avoidable. OBJECTIVES To identify circumstances that increase the number of emergency situations in nursing homes and approaches to reduce hospital admissions in order to illustrate the complexity and opportunities for action. MATERIALS AND METHODS Scoping review with analysis of current original and peer-reviewed papers (2015-2020) in PubMed, CINAHL, and hand-search databases. RESULTS From 2486 identified studies, 302 studies were included. Injuries, fractures, cardiovascular, respiratory, and infectious diseases are the most frequent diagnostic groups that have been retrospectively recorded. Different aspects could be identified as circumstances inducing emergency department visits: resident-related (e.g., multimorbidity, lack of volition, and advance directives), facility-related (e.g., staff turnover, uncertainties), physician-related (lack of accessibility, challenging access to specialists), and system-related circumstances (e.g., limited possibilities for diagnostics and treatment in facilities). Multiple approaches to reduce emergency department visits are being explored. CONCLUSIONS A variety of circumstances influence the course of action in emergency situations in nursing facilities. Therefore, interventions to reduce emergency department visits address, among other things, strengthening the competence of nursing staff, interprofessional communication, and systemic approaches. A comprehensive understanding of the complex processes of care is essential for developing and implementing effective interventions.
Collapse
Affiliation(s)
- Carsten Bretschneider
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | - Juliane Poeck
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland.
| | - Antje Freytag
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| | | | - Nils Schneider
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Sven Schwabe
- Institut für Allgemeinmedizin und Palliativmedizin, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jutta Bleidorn
- Institut für Allgemeinmedizin, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland
| |
Collapse
|
4
|
Jensen JM, Andersen PAB, Kirkegaard L, Larsen N, Most W, Nielsen D, Precht H. Exploring the patient perspectives of mobile X-ray in nursing homes - A qualitative explorative pilot study. Radiography (Lond) 2020; 27:279-283. [PMID: 32919898 DOI: 10.1016/j.radi.2020.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION For patients with dementia, behaviour and reactions to stimuli can change and an X-ray examination in the hospital can have be a frightening experience. The aim of this study was to identify the experiences and perspectives of patients with dementia and their caregivers on receiving a mobile x-ray examination in nursing homes. METHODS This study was designed as a qualitative study using patient observation and semi structured interviews, with a phenomenology-hermeneutic approach. In total, 23 patients were observed during X-ray examinations in nursing homes, and six semi structured interviews were conducted with the caregivers who participated in the examination. RESULTS The observations and interviews indicated that a known environment, a recognizable framework and calmness were central for a patient with dementia. The patients appeared calm and relaxed during the examination in their usual environment (nursing homes) where there are less stimuli and impressions based of the observations. CONCLUSION Mobile X-ray examinations for patients with dementia living in nursing homes had a positive impact on patients' reactions towards the X-ray examination. The examinations were performed in the patients' usual and safe environments, where impressions and stimuli were less disturbing for patients with dementia. IMPLICATIONS FOR PRACTICE The mobile x-ray unit can be of benefit for patients suffering from dementia and result in less impact. The patients living in nursing homes have the opportunity to be examined in their familiar environment, because of the mobile x-ray unit.
Collapse
Affiliation(s)
- J M Jensen
- Health Sciences Research Centre, University College Lillebelt, Niels Bohrs Alle 1, 5230, Odense M, Denmark.
| | - P A B Andersen
- Department of Radiology, Hospital Little Belt Kolding, Denmark
| | - L Kirkegaard
- Health Sciences Research Centre, University College Lillebelt, Niels Bohrs Alle 1, 5230, Odense M, Denmark
| | - N Larsen
- Health Sciences Research Centre, University College Lillebelt, Niels Bohrs Alle 1, 5230, Odense M, Denmark
| | - W Most
- Health Sciences Research Centre, University College Lillebelt, Niels Bohrs Alle 1, 5230, Odense M, Denmark
| | - D Nielsen
- Health Sciences Research Centre, University College Lillebelt, Niels Bohrs Alle 1, 5230, Odense M, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwsparken, 5000, Odense C, Denmark; Migrant Health Clinic, Odense University Hospital, Denmark
| | - H Precht
- Health Sciences Research Centre, University College Lillebelt, Niels Bohrs Alle 1, 5230, Odense M, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwsparken, 5000, Odense C, Denmark; Cardiology Research Department, Odense University Hospital, Baagøes Alle 15, 5700, Svendborg, Denmark
| |
Collapse
|
5
|
Toppenberg MD, Christiansen TEM, Rasmussen F, Nielsen CP, Damsgaard EM. Mobile X-ray outside the hospital: a scoping review. BMC Health Serv Res 2020; 20:767. [PMID: 32814588 PMCID: PMC7439673 DOI: 10.1186/s12913-020-05564-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Maria Dietz Toppenberg
- The Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | | | - Finn Rasmussen
- The Department of Radiology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Camilla Palmhøj Nielsen
- DEFACTUM, Social and Health Services and Labour Market, Olof Palmes Allé 15, 8200, Aarhus N, Denmark
| | - Else Marie Damsgaard
- Department of Geriatrics, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
| |
Collapse
|
6
|
Toppenberg M, Christiansen T, Rasmussen F, Nielsen C, Damsgaard EM. Mobile X-ray Outside the Hospital vs. X-ray at the Hospital Challenges Exposed in an Explorative RCT Study. Healthcare (Basel) 2020; 8:E118. [PMID: 32365932 PMCID: PMC7349166 DOI: 10.3390/healthcare8020118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/27/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Maria Toppenberg
- The Department of Radiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (T.C.); (F.R.)
| | - Thomas Christiansen
- The Department of Radiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (T.C.); (F.R.)
| | - Finn Rasmussen
- The Department of Radiology, Aarhus University Hospital, 8200 Aarhus, Denmark; (T.C.); (F.R.)
| | - Camilla Nielsen
- DEFACTUM, Social and Health Services and Labour Market, 8200 Aarhus, Denmark;
| | | |
Collapse
|
7
|
Precht H, Hansen DL, Ring-Pedersen BM, Møller Hansen LF, Waaler D, Tingberg A, Midtgaard M, Jensen Ohlsen MG, Juhl Hankelbjerg ST, Ravn P, Jensen IE, Christensen JK, Blackburn Andersen PA. Comparison of image quality in chest, hip and pelvis examinations between mobile equipment in nursing homes and static indirect radiography equipment in the hospital. Radiography (Lond) 2019; 26:e31-e37. [PMID: 32052778 DOI: 10.1016/j.radi.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION A hospital environment can be a significant burden and a health risk especially for dementia patients. Mobile x-ray equipment (ME) is used to enable imaging of these patients at home. The aim was to compare image quality (IQ) of chest, hip and pelvis images from ME to the stationary equipment (SE) used in a hospital department. METHODS We analysed examinations of the chest (n = 20), hip (n = 64) and pelvis (n = 32). Images were equally obtained from each setting of ME and SE. All images were graded using Visual Grading Analysis (VGA) by three radiographers (hip and pelvis) and three radiologists (chest). Technical IQ assessment was done by 80 additional images of a Contrast-Detail Radiography phantom (CDRAD). RESULTS All chest images were approved for diagnostic use, as well as the hip AP and pelvis images from SE. 'Approved proportion of ME images was for HIP antero-posterior (AP) and pelvis, 78% [95% CI: 52-94%] and 81% [95% CI: 54-96%] respectively. Hip axial had an overall low, but not significant different approval rate. Ordered logistic regression indicated higher IQ of HIP AP and pelvic images from SE. This contrasts that the CDRAD substudy indicated better IQ, expressed as IQFinv, from ME. CONCLUSION The VGA showed higher IQ for the SE system, while the CDRAD showed higher IQ for the ME system. IMPLICATIONS FOR PRACTICE Dementia patients can be examined at their home if the acquisition is optimised according to image quality in conjunct to radiation dose. Performing imaging out of the hospital and coordinating the patients' further treatment are new work areas for radiographers and requires excellent communication skills.
Collapse
Affiliation(s)
- H Precht
- Conrad Research Program, Health Sciences Research Centre, UCL University College, Niels Bohrs Allé 1, 5230, Odense M, Denmark; Medical Research Department, Odense University Hospital, Svendborg, Denmark; Department of Clinical Research, University of Southern, Denmark.
| | - D L Hansen
- Department of Haematology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - B M Ring-Pedersen
- Conrad Research Program, Health Sciences Research Centre, UCL University College, Niels Bohrs Allé 1, 5230, Odense M, Denmark; Department of Radiology, Hospital Little Belt Kolding, Denmark
| | - L F Møller Hansen
- Conrad Research Program, Health Sciences Research Centre, UCL University College, Niels Bohrs Allé 1, 5230, Odense M, Denmark; Department of Radiology, Hospital Little Belt Kolding, Denmark
| | - D Waaler
- Department of Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - A Tingberg
- Department of Translational Medicine, Medical Radiation Physics, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | - M Midtgaard
- Department of Radiology, Hospital Little Belt Kolding, Denmark
| | | | | | - P Ravn
- Department of Radiology, Hospital Little Belt Kolding, Denmark
| | - I E Jensen
- Department of Radiology, Hospital Little Belt Kolding, Denmark
| | - J K Christensen
- Department of Radiology, Hospital Little Belt Kolding, Denmark
| | | |
Collapse
|
8
|
Impact of mobile radiography services in nursing homes on the utilisation of diagnostic imaging procedures. BMC Health Serv Res 2019; 19:428. [PMID: 31242914 PMCID: PMC6595684 DOI: 10.1186/s12913-019-4276-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/18/2019] [Indexed: 11/23/2022] Open
Abstract
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.
Collapse
|
9
|
Kjelle E, Kleven L, Olerud HM, Melberg HO. Cost analysis of mobile radiography services for nursing home residents in Southeast Norway. J Eval Clin Pract 2019; 25:275-281. [PMID: 30362207 DOI: 10.1111/jep.13058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/09/2018] [Indexed: 12/01/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVE Telemedicine applications, such as a mobile radiography service, provide a new way of organizing healthcare services. In order to provide safe and personalised care for nursing home residents during X-ray examinations, mobile radiography services have been implemented. The objective of this study was to analyse the costs of X-ray examinations and treatments for nursing home residents when comparing hospital-based imaging with a combination of hospital-based imaging and a mobile radiography service in Southeast Norway. METHODS A decision model was developed using the software TreeAge Pro. The model included two alternatives: the mobile radiography service in combination with hospital-based imaging and hospital-based imaging alone. The treatment needed based on the examination results could be given either in the nursing home or at the hospital. Probabilities and costs in the model were derived from previous research, various reports, and hospital data from the Southeast region of Norway. Monte Carlo simulations of 1000 residents were run through the model, and statistical analyses were applied. RESULTS The analysis showed a mean cost of €2790 per resident for the hospital-based service alone. For mobile and hospital-based services combined, the mean cost was €1946 per resident, including examinations and the immediate treatment given. This difference in costs was significant (p < 0.001). CONCLUSION A mobile radiography service in nursing homes provides a safe, high quality health care service. The result of this study showed there was a 30% cost-reduction by implementing the mobile radiography service.
Collapse
Affiliation(s)
- Elin Kjelle
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Linn Kleven
- Department of Clinical Research Support, Oslo University Hospital, Oslo, Norway
| | - Hilde Merete Olerud
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Hans Olav Melberg
- Department of Clinical Research Support, Oslo University Hospital, Oslo, Norway.,Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| |
Collapse
|
10
|
Kjelle E, Lysdahl KB, Olerud HM, Myklebust AM. Managers' experience of success criteria and barriers to implementing mobile radiography services in nursing homes in Norway: a qualitative study. BMC Health Serv Res 2018; 18:301. [PMID: 29699547 PMCID: PMC5921415 DOI: 10.1186/s12913-018-3115-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 04/12/2018] [Indexed: 11/25/2022] Open
Abstract
Background In order to meet the future challenges posed by ageing populations, new technology, telemedicine and a more personalized healthcare system are needed. Earlier research has shown mobile radiography services to be highly beneficial for nursing home residents in addition to being cost-effective. Despite the benefits, mobile radiography services are uncommon in Europe and Norway. The purpose of this study was to explore success criteria and barriers in the process of implementing mobile radiography services, from the point of view of the hospital and municipal managers. Methods Eleven semi-structured interviews were conducted with managers from five hospitals and six municipalities in Norway where mobile radiography services had been implemented. Core issues in the interview guide were barriers and facilitators in the different phases of implementation. The framework method for thematic analysis was used for analysing the data inductively in a research team. Results Five main categories were developed through the success criteria and barriers experienced by the participants: national health policy, regional and municipal policy and conditions, inter-organizational implementation projects, experienced outcome, and professional skills and personal characteristics. The categories were allocated into three higher-order classifications: macro, meso and micro levels. The main barriers experienced by the managers were financial, procedural and structural. In particular, the reimbursement system, lack of management across healthcare levels and the lack of compatible information systems acted as barriers. The main facilitators were external funding, enthusiastic individuals in the organizations and good collaboration between hospitals and municipalities. Conclusions The managers experienced financial, structural and procedural barriers. The main success criteria in the process were external funding, and the support and engagement from the individuals in the organizations. This commitment was mainly facilitated by the intuitive appeal of mobile radiography. Changes in healthcare management and in the financial system might facilitate services across healthcare levels. In addition, compatible information systems across healthcare levels are needed in order to facilitate the use of new technology and mobile services. Electronic supplementary material The online version of this article (10.1186/s12913-018-3115-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Elin Kjelle
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University College of Southeast Norway, Postboks 235, 3603, Kongsberg, Norway.
| | - Kristin Bakke Lysdahl
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University College of Southeast Norway, Postboks 235, 3603, Kongsberg, Norway.,Institute of Radiography and Dental technology, Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postboks 4, St. Olavs plass, 0130, Oslo, Norway
| | - Hilde Merete Olerud
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University College of Southeast Norway, Postboks 235, 3603, Kongsberg, Norway
| | - Aud Mette Myklebust
- Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University College of Southeast Norway, Postboks 235, 3603, Kongsberg, Norway
| |
Collapse
|
11
|
Rosness TA. Nyttig med røntgen på sykehjem. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:165. [DOI: 10.4045/tidsskr.17.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|