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4.
PLoS One ; 17(1): e0263058, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35077500

RESUMEN

BACKGROUND: Multidisciplinary collaboration has generally been shown to have positive effects on healthcare but can be difficult to facilitate. This study assessed the effects of a multidisciplinary fibroid clinic on practice patterns and clinician perceptions to better understand drivers of interspecialty collaboration. MATERIALS AND METHODS: Annual rates of hysterectomies, myomectomies, and uterine fibroid embolizations (UFEs) performed in an urban healthcare system were collected from 2012-2019. Rates of each procedure were compared over time before and after launching a multidisciplinary fibroid clinic at the academic medical center. Referral rates were also compared. The gynecologists and interventional radiologists (IRs) involved in the clinic were interviewed 2 years prior to and after the clinic launch about their approaches to fibroids and perceptions of others who treat this condition. A phenomenological approach was used to identify and compare themes within the interviews by two researchers with excellent inter-rater agreement (κ = 0.80). RESULTS AND DISCUSSION: Annual rates of fibroid procedures increased over time (p<0.01) but the relative number of UFEs decreased (p = 0.01). UFE referrals by the clinic gynecologists significantly increased as did the number of combined fibroid procedures (p<0.01). However, the rates of one fibroid procedure relative to others were not different between the clinic and rest of the healthcare system (p = 0.55). Specialty-specific perceptions of fibroid treatments and inter-specialty dynamics did not change. Despite this, clinicians unanimously perceived the clinic and post-clinic practice patterns as positive and distinct from their previous work and relationships between gynecology and IR elsewhere. Limitations of this study included its single clinic design and potential confounder of differences in advertising pre- versus post-clinic. CONCLUSION: Creating the right practice environment may be more important for fostering inter-specialty collaboration and work satisfaction than shared mental models or procedural volumes in certain practice settings.


Asunto(s)
Embolización Terapéutica , Histerectomía , Leiomioma/cirugía , Pautas de la Práctica en Medicina , Miomectomía Uterina , Neoplasias Uterinas/cirugía , Adulto , Femenino , Humanos , Persona de Mediana Edad
6.
J Vasc Surg Venous Lymphat Disord ; 8(6): 939-944, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32414673

RESUMEN

OBJECTIVE: The objective of this study was to assess factors associated with symptom resolution after endovascular stenting for superior or inferior vena cava syndrome. METHODS: Eighty-six consecutive vena cava Z-configuration stent placements in 82 patients (53 ± 14 years old) at a single institution were reviewed for patient demographics, comorbidities, and durability of stent patency (also evaluated were persistent or recurrent symptoms, stent occlusion, and need for repeated stenting). Logistic regression was used to identify independent factors associated with stent patency, and Φ coefficients and analysis of variance were used to compare cases subdivided by lesion location (superior vena cava, inferior vena cava) and the presence or absence of malignant disease. RESULTS: Clinical follow-up was available in 77 of 86 (90%) cases. Technical success with clinical failure (persistent symptoms) occurred in 40% of these cases with a median follow-up of 67 (interquartile range, 14-570) days and mortality rate of 63% during this period. Malignant obstructions had a significantly higher clinical failure rate of 54% compared with 15% for nonmalignant obstructions (Φ = 0.34; P = .002). However, only metastatic disease was independently associated with clinical failure when controlling for demographics, other comorbidities, and differential follow-up (adjusted odds ratio, 8.27; 95% confidence interval, 2.79-24.50). CONCLUSIONS: Vena cava Z-stenting effectively resolves symptoms in 85% of nonmalignant obstructions compared with only 46% of malignant obstructions. Patients should be counseled accordingly, and those with malignant obstructions may require closer follow-up to evaluate the need for reintervention and goals of care.


Asunto(s)
Angioplastia de Balón/instrumentación , Neoplasias/complicaciones , Cuidados Paliativos , Stents , Síndrome de la Vena Cava Superior/terapia , Enfermedades Vasculares/terapia , Vena Cava Inferior , Vena Cava Superior , Adulto , Anciano , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/mortalidad , Constricción Patológica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/mortalidad , Síndrome de la Vena Cava Superior/fisiopatología , Factores de Tiempo , Insuficiencia del Tratamiento , Enfermedades Vasculares/etiología , Enfermedades Vasculares/mortalidad , Enfermedades Vasculares/fisiopatología , Grado de Desobstrucción Vascular , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/fisiopatología , Vena Cava Superior/diagnóstico por imagen , Vena Cava Superior/fisiopatología
7.
J Vasc Interv Radiol ; 30(10): 1549-1554, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31526576

RESUMEN

PURPOSE: To identify factors independently associated with disease recurrence after venoplasty and stent placement for May-Thurner syndrome (MTS). MATERIALS AND METHODS: Fifty-nine consecutive patients (age, 47 y ± 15; 93% female) were identified who had undergone endovascular stent placement for MTS. Patient charts were reviewed for demographic data, risk factors for venous thrombosis, comorbidities, and venous inflow or outflow at first follow-up (3 wk to 6 mo after treatment). Logistic regression was used to identify independent predictors of symptom recurrence or repeat intervention, and multivariate analysis of variance and receiver operator characteristic curve analysis were used to assess relationships between degrees of in-stent stenosis and other variables in the 73% of patients with available cross-sectional imaging. Median follow up was 20.7 months (interquartile range, 4.7-49.5 mo). RESULTS: All procedures were technically successful. Disease recurrence, defined as symptom recurrence following initial postprocedural resolution, was observed in 38% of patients. No preprocedural variable was found to be independently predictive of disease recurrence; however, poor venous inflow or outflow were both strongly associated with recurrent disease, with adjusted odds ratios and 95% confidence intervals of 38.02 (3.76-384.20; P = .002) and 7.00 (1.15-42.71; P = .04), respectively. Higher degrees of in-stent stenosis were also associated with symptom recurrence, with an area under the curve of 0.93 (P = .000002) and 39%-41% stenosis being 78%-83% sensitive and 88%-92% specific for symptom recurrence. CONCLUSIONS: These results suggest that cross-sectional imaging can help differentiate patients in whom closer follow-up may be warranted after venoplasty and stent placement for MTS and also guide counseling regarding prognosis.


Asunto(s)
Procedimientos Endovasculares/instrumentación , Vena Ilíaca , Síndrome de May-Thurner/terapia , Stents , Adulto , Chicago , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Vena Ilíaca/diagnóstico por imagen , Vena Ilíaca/fisiopatología , Masculino , Síndrome de May-Thurner/diagnóstico por imagen , Síndrome de May-Thurner/fisiopatología , Persona de Mediana Edad , Flebografía/métodos , Recurrencia , Retratamiento , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular
8.
Semin Intervent Radiol ; 36(2): 65-67, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31190692

RESUMEN

Complications are an uncommon but psychologically difficult aspect to any procedural specialty. Being able to deal with the personal aspect of complications and having the tools to learn from and grow from complications are vital aspects of the practice of radiology. This article discusses the psychodynamics of complications that occur in interventional radiology and proposes some coping mechanisms to deal with these adverse events.

9.
PLoS One ; 14(2): e0212014, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30759151

RESUMEN

BACKGROUND: Physician engagement has become a key metric for healthcare leadership and is associated with better healthcare outcomes. However, engagement tends to be low and difficult to measure and improve. This study sought to efficiently characterize the professional cultural dynamics between physicians and administrators at an academic hospital and how those dynamics affect physician engagement. MATERIALS AND METHODS: A qualitative mixed methods analysis was completed in 6 weeks, consisting of a preliminary analysis of the hospital system's history that was used to purposefully recruit 20 physicians across specialties and 20 healthcare administrators across management levels for semi-structured interviews and observation. Participation rates of 77% (20/26) and 83% (20/24) were achieved for physicians and administrators, respectively. Cohorts consisted of equal numbers of men and women with experience ranging from 1 to 35 years within the organization. Field notes and transcripts were systematically analyzed using an iterative inductive-deductive approach. Emergent themes were presented and discussed with approximately 400 physicians and administrators within the organization to assess validity and which results were most meaningful. RESULTS & DISCUSSION: This investigation indicated a professional cultural disconnect was undermining efforts to improve physician engagement. This disconnect was further complicated by a minority (10%) not believing an issue existed and conflicting connotations not readily perceived by participants who often offered similar solutions. Physicians and administrators felt these results accurately reflected their realities and used this information as a common language to plan targeted interventions to improve physician engagement. Limitations of the study included its cross-sectional nature with a modest sample size at a single institution. CONCLUSIONS: A qualitative mixed methods analysis efficiently identified professional cultural barriers within an academic hospital to serve as an institution-specific guide to improving physician engagement.


Asunto(s)
Centros Médicos Académicos , Administradores de Instituciones de Salud/psicología , Relaciones Interprofesionales , Estrés Laboral/etiología , Médicos/psicología , Compromiso Laboral , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/estadística & datos numéricos , Adulto , Actitud del Personal de Salud , Estudios Transversales , Femenino , Administradores de Instituciones de Salud/estadística & datos numéricos , Humanos , Comunicación Interdisciplinaria , Liderazgo , Masculino , Persona de Mediana Edad , Relaciones Médico-Paciente , Médicos/estadística & datos numéricos , Investigación Cualitativa
11.
J Vasc Interv Radiol ; 29(11): 1571-1577, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30293732

RESUMEN

PURPOSE: To retrospectively review the effectiveness and safety of radiofrequency (RF) wire recanalization of refractory central venous occlusions (CVOs) and compare recurrent and nonrecurrent CVOs in terms of patient and occlusion characteristics. MATERIALS AND METHODS: Twenty CVOs were treated in 18 patients (age 40 y ± 13; 9 women) with 11 superior vena cava (SVC) or brachiocephalic vein occlusions (ie, supradiaphragmatic) and 9 inferior vena cava or iliac vein occlusions (ie, infradiaphragmatic). Indications included pain, edema, ulceration, and/or dialysis arteriovenous fistula dysfunction peripheral to the CVO(s). All patients had multiple venous thrombotic risk factors, including mechanical venous compression, endothelial injury, and/or coagulopathies. CVO traversal was first attempted with standard and advanced techniques before RF wire recanalization and followed up with computed tomographic venography and clinic visits approximately 1, 3, 6, and 12 months after treatment. RESULTS: Sixteen CVOs (80%) were successfully transversed and associated with symptom relief. One major complication occurred involving SVC perforation into the pericardial space. Primary CVO patency rate was 56% at a median follow-up of 14.1 months (interquartile range [IQR], 9.2-20.0 mo). Recurrent CVOs tended to be infradiaphragmatic (71% vs 12% for supradiaphragmatic; P = .02), longer (12.9 cm ± 10.0 vs 2.3 cm ± 1.3; P < .01), and associated with implanted venous stents, filters, or cardiac pacer/defibrillator leads (86% vs 22%; P = .01). Median time to restenosis/occlusion was 1.5 months (IQR, 1.1-6.1 mo). CONCLUSIONS: RF wire recanalization is a relatively effective and safe option for refractory CVOs. Patients with longer, infradiaphragmatic CVOs associated with indwelling devices may require closer follow-up for CVO recurrence.


Asunto(s)
Ablación por Catéter/instrumentación , Dispositivos de Acceso Vascular , Enfermedades Vasculares/cirugía , Venas/cirugía , Adulto , Ablación por Catéter/efectos adversos , Chicago , Angiografía por Tomografía Computarizada , Constricción Patológica , Diseño de Equipo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flebografía/métodos , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Enfermedades Vasculares/diagnóstico por imagen , Enfermedades Vasculares/fisiopatología , Grado de Desobstrucción Vascular , Venas/diagnóstico por imagen , Venas/fisiopatología , Adulto Joven
12.
Semin Intervent Radiol ; 35(1): 41-47, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29628615

RESUMEN

Postpartum hemorrhage (PPH) is the leading cause of maternal perinatal morbidity and mortality worldwide. Defined as greater than 500 mL blood loss after vaginal delivery, and greater than 1,000 mL blood loss after cesarean delivery, PPH has many causes, including uterine atony, lower genital tract lacerations, coagulopathy, and placental anomalies. Correction of coagulopathy and identification of the cause of bleeding are mainstays of treatment. Medical therapies such as uterotonics, balloon tamponade, pelvic artery embolization, and uterine-sparing surgical options are available. Hysterectomy is performed when conservative therapies fail. Pelvic artery embolization is safe and effective, and is the first-line therapy for medically refractory PPH. A thorough knowledge of pelvic arterial anatomy is critical. Recognition of variant anatomy can prevent therapeutic failure. Pelvic embolization is minimally invasive, has a low complication rate, spares the uterus, and preserves fertility.

13.
J Vasc Interv Radiol ; 29(3): 367-372.e1, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29395900

RESUMEN

PURPOSE: To inductively characterize perceptions of quality in interventional oncology (IO) based on values and experiences of patients and referring providers. MATERIALS AND METHODS: Brief ethnographic interviews were completed with referring providers and patients before and after a variety of liver-directed procedures about their experiences, concerns, and perceptions of IO services at a single institution. Constructivist grounded theory was used to systematically analyze interview transcripts for themes until thematic saturation was achieved. All transcripts were analyzed by a reviewer with 3-years of experience performing such analyses, and 50% were randomly selected to be coded by 2 additional blinded reviewers. Interreviewer agreement was assessed via Cohen κ. RESULTS: Interviews with 22 patients (mean age, 65 y ± 13; 9 women) and 12 providers (mean age, 54 y ± 9; 6 women) were required to reach and confirm thematic saturation. Interreviewer agreement for interview themes was excellent (κ = 0.78; P < .001). Perceptions of high-quality IO care relied on interventional radiologists being responsive, friendly, and open; engaging in multidisciplinary collaboration; having thoughtful, dedicated support staff; and facilitating well-coordinated care after procedures and follow-up more than technical expertise and periprocedural comfort. Patient and provider perceptions of quality differed, but disjointed care after procedures was the most common critique among both groups. CONCLUSIONS: An inductive qualitative approach effectively characterized specific aspects of perceptions of high-quality IO care among patients and referring providers.


Asunto(s)
Oncología Médica , Pacientes/psicología , Médicos/psicología , Calidad de la Atención de Salud , Radiografía Intervencional , Anciano , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Derivación y Consulta
14.
J Vasc Interv Radiol ; 29(3): 389-394, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29455879

RESUMEN

This case series illustrates a radial access complication seen in 7 of 9 consecutive patients (age range, 44-53 y) undergoing uterine artery embolization in May and June 2017. Demonstrative images and videos identify a transient and clinically consequential skin ischemia caused by intraprocedural saline solution infusion through the occlusive radial artery sheath. All complications documented were classified as mild adverse events (class A) according to Society of Interventional Radiology criteria. Complication severity ranged from transient blanching to ischemic necrosis of the skin. Operator cognizance of this phenomenon with appropriate adjustment of saline solution infusion rates will prevent tissue ischemia and necrosis in radial access cases.


Asunto(s)
Cateterismo Periférico/efectos adversos , Isquemia/etiología , Leiomioma/terapia , Arteria Radial/cirugía , Cloruro de Sodio/administración & dosificación , Embolización de la Arteria Uterina , Neoplasias Uterinas/terapia , Adulto , Femenino , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Ultrasonografía Intervencional
16.
J Vasc Interv Radiol ; 28(6): 850-856, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28292636

RESUMEN

PURPOSE: To characterize the unique experiences, values, and perspectives of interventional radiology (IR) fellows. MATERIALS AND METHODS: Sixteen fellows from 4 US vascular and IR programs were interviewed within 2 months of beginning and 2-3 months following their 2015-2016 fellowships about patient interactions, training experiences, and views of IR and other specialties. Interviews were systematically analyzed for dominant themes by using constructivist grounded theory. Four interviews with 2015-2016 interventional cardiology fellows, 16 interviews with IR attending physicians, and online descriptions of IR were also analyzed for context. Themes were compared qualitatively and quantitatively. RESULTS: Interobserver agreement was good for interview themes (κ = 0.70; P < .0001). IR fellows' professional identity emerged primarily from radiologic and surgical interests, with distinct emphasis on being "innovators," "thinking differently," and "needing to adapt and advertise abilities to survive." Fellows' descriptions of patient care were more clinically focused than past interviews with attending physicians (P = .05), but clinical interests common in medical specialties were limited, and descriptions of "nonprocedural patient care" were primarily periprocedural (81%). Descriptions of the future of the field conveyed competing pressures, loose role definition, and disconnect between academic and private-practice IR. CONCLUSIONS: IR fellows share professional interests, views of their field and others, and descriptions of patient care, but there is uncertainty regarding future roles of the specialty and a need for more specific and unified definitions of nonprocedural patient care in IR.


Asunto(s)
Actitud del Personal de Salud , Becas , Rol Profesional , Radiólogos/psicología , Radiología Intervencionista , Adulto , Femenino , Humanos , Entrevistas como Asunto , Masculino , Estados Unidos
17.
PLoS One ; 12(2): e0172865, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28235088

RESUMEN

PURPOSE: In response to limited physician adoption of various healthcare initiatives, we sought to propose and assess a novel approach to policy development where one first characterizes diverse physician groups' common interests, using a medical student and constructivist grounded theory. METHODS: In 6 months, a medical student completed 36 semi-structured interviews with interventional radiologists, gynecologists, and vascular surgeons that were systematically analyzed according to constructivist grounded theory to identifying common themes. Common drivers of clinical decision making and professional values across 3 distinct specialty groups were derived from physicians' descriptions of their clinical decision making, stories, and concerns. RESULTS: Common drivers of clinical decision making included patient preference/benefit, experience, reimbursement, busyness/volume, and referral networks. Common values included honesty, trustworthiness, loyalty, humble service, compassion and perseverance, and practical wisdom. Although personal gains were perceived as important interests, such values were easily sacrificed for the good of patients or other non-financial interests. This balance was largely dependent on the incentives and security provided by physicians' environments. CONCLUSIONS: Using a medical student interviewer and constructivist grounded theory is a feasible means of collecting rich qualitative data to guide policy development. Healthcare administrators and medical educators should consider incorporating this methodology early in policy development to anticipate how value differences between physician groups will influence their acceptance of policies and other broad healthcare initiatives.


Asunto(s)
Toma de Decisiones , Atención a la Salud/legislación & jurisprudencia , Política de Salud , Comunicación Interdisciplinaria , Prioridad del Paciente , Actitud del Personal de Salud , Sistemas de Apoyo a Decisiones Clínicas , Educación de Postgrado en Medicina , Empatía , Femenino , Teoría Fundamentada , Humanos , Masculino , Médicos , Proyectos Piloto , Confianza , Recursos Humanos
18.
J Vasc Interv Radiol ; 28(3): 420-428, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28082073

RESUMEN

PURPOSE: To better understand why interventional radiologists and gynecologists differ in their approaches to symptomatic uterine fibroids. METHODS: Conversational interviews were conducted with 26 interventional radiologists and gynecologists about their professional roles, clinical reasoning, and practice variation within and outside their specialty. Interview transcripts were systematically analyzed using NVivo 10 software (QSR International, Burlington, Massachusetts) according to grounded theory and content analysis to identify key themes and compare themes across specialties and practice environments. Data were supplemented with retrospective analysis of 7,659 patients with symptomatic uterine fibroids treated at a large academic center over 11 years. RESULTS: Interventional radiologists' shares of symptomatic uterine fibroid treatment and endovascular stent treatments have remained constant (P > .05) for 11 y at a large medical center, whereas minimally invasive gynecologic fibroid treatments and the percentage of interventional radiology (IR) procedures reimbursed by Medicaid/Medicare have increased significantly (r > .90, P < .001 and r = .93, P < .001). Interventional radiologists and gynecologists shared a commitment to do "the right thing" for patients, but each group possessed distinct professional values affecting how they viewed medical evidence, outcomes, and their colleagues. When differences were apparent and concerning, physicians tended to suspect ulterior motives not in patients' best interests. CONCLUSIONS: Interventional radiologists and gynecologists demonstrated wide-ranging perspectives regarding their role in caring for patients with symptomatic uterine fibroids. To promote genuine collaboration and adoption of shared goals, stakeholders should seek and promote a deeper understanding of specialty-specific values and culture.


Asunto(s)
Ginecología , Leiomioma/terapia , Pautas de la Práctica en Medicina , Radiólogos , Radiología Intervencionista , Especialización , Cirujanos , Neoplasias Uterinas/terapia , Centros Médicos Académicos , Actitud del Personal de Salud , Conducta Cooperativa , Femenino , Ginecología/tendencias , Conocimientos, Actitudes y Práctica en Salud , Humanos , Histerectomía , Comunicación Interdisciplinaria , Entrevistas como Asunto , Laparoscopía , Leiomioma/diagnóstico por imagen , Masculino , Grupo de Atención al Paciente , Pautas de la Práctica en Medicina/tendencias , Radiólogos/psicología , Radiólogos/tendencias , Radiología Intervencionista/tendencias , Estudios Retrospectivos , Especialización/tendencias , Cirujanos/psicología , Cirujanos/tendencias , Factores de Tiempo , Resultado del Tratamiento , Embolización de la Arteria Uterina , Miomectomía Uterina , Neoplasias Uterinas/diagnóstico por imagen
19.
Cardiovasc Intervent Radiol ; 40(6): 814-821, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28062898

RESUMEN

PURPOSE: To understand how cultural differences between vascular surgeons (VSs) and interventional radiologists (IRs) affect their clinical decision making and inter-specialty relationships. METHODS: Twenty-four conversational interviews were conducted with IRs and VSs about their approaches to patient care, views of their specialty and others, and solutions to any expressed concerns. Interview transcripts were systematically analyzed to identify and compare key themes according to the constructivist grounded theory and content analysis using NVivo 10 software. These data were supplemented with a retrospective analysis of 3658 endovascular stent placements performed at a large medical academic center over 11 years. Aggregate counts were divided by provider specialty, and trends were assessed via correlation coefficients. RESULTS: Endovascular stent placements were relatively equally divided between IR and VS over 11 years with some variability from placements by cardiology. IRs tend to lay claim to treatments as masters of procedures, whereas VSs base their claims on being masters of the treated diseases, leading to collaboration in some practices and bitter competition in others. The level of perceived competition was most associated with specialists' awareness of and appreciation for specialty-specific values rather than differences in practice structure/reimbursement. CONCLUSIONS: Understanding cultural differences between IRs and VSs is imperative for fostering better collaboration to grow shared territory rather than competing for the same slice of the pie.


Asunto(s)
Conducta Competitiva , Procedimientos Endovasculares , Comunicación Interdisciplinaria , Colaboración Intersectorial , Radiología Intervencionista , Stents , Procedimientos Quirúrgicos Vasculares , Centros Médicos Académicos , Adulto , Competencia Clínica , Femenino , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Filosofía Médica , Estudios Retrospectivos , Estados Unidos
20.
J Cardiovasc Magn Reson ; 18(1): 52, 2016 08 26.
Artículo en Inglés | MEDLINE | ID: mdl-27566058

RESUMEN

BACKGROUND: Quality improvement efforts in cardiovascular imaging have been challenged by limited adoption of initiatives and policies. In order to better understand this limitation and inform future efforts, the range clinical values related to cardiovascular imaging at a large academic hospital was characterized. MATERIALS AND METHODS: 15 Northwestern Medicine physicians from internal medicine, cardiology, emergency medicine, cardiac/vascular surgery, and radiology were interviewed about their use of cardiovascular imaging and imaging guidelines. Interview transcripts were systemically analyzed according to constructivist grounded theory and combined with 56 previous interviews with interventional radiologists, interventional cardiologists, gynecologists, and vascular surgeons to develop a model describing specialty-specific values. This model was applied to the 15 pilot interviews focused on cardiovascular imaging, highlighting specialty specific differences in values and practice patterns. Transcripts were also reviewed independently by a cardiologist and 2 radiologists followed by a group discussion to assess reproducibility and achieve a consensus regarding the results. RESULTS: Differences in perceived value of cardiovascular imaging and use of guidelines among physicians were well explained by three value-associated identity categories (managers, diagnosticians, and fixers) that were further differentiated along three axes (broad v. focused-thinkers, complex v. definitive-answer-seekers, and public visibility). CONCLUSIONS: Quality improvement in cardiovascular imaging may be limited by a lack of understanding and incorporation of the complexity of medical culture into ongoing initiatives. Both individually and during policy development, it is important to first understand the complexity of stakeholders' diverse perceptions of "value," "quality," and "appropriateness."


Asunto(s)
Técnicas de Imagen Cardíaca/normas , Pautas de la Práctica en Medicina/normas , Especialización/normas , Centros Médicos Académicos/normas , Actitud del Personal de Salud , Toma de Decisiones Clínicas , Femenino , Adhesión a Directriz , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevistas como Asunto , Masculino , Selección de Paciente , Percepción , Formulación de Políticas , Guías de Práctica Clínica como Asunto , Valor Predictivo de las Pruebas , Indicadores de Calidad de la Atención de Salud/normas
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