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Background The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined. Published under a CC BY 4.0 license.
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Atenção à Saúde/normas , Radiologia/normas , Aquisição Baseada em Valor , Consenso , Controle de Custos , Atenção à Saúde/economia , Humanos , Internacionalidade , Radiologia/economia , Sociedades MédicasRESUMO
BACKGROUND: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. METHODS, FINDINGS AND INTERPRETATION: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
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Atenção à Saúde/economia , Custos de Cuidados de Saúde , Radiologia/economia , Radiologia/métodos , Austrália , Canadá , Europa (Continente) , Humanos , Nova Zelândia , Sociedades Médicas , Estados UnidosRESUMO
Musculoskeletal imaging is mainly based on the subjective and qualitative analysis of imaging examinations. However, integration of quantitative assessment of imaging data could increase the value of imaging in both research and clinical practice. Some imaging modalities, such as perfusion magnetic resonance imaging (MRI), diffusion MRI, or T2 mapping, are intrinsically quantitative. But conventional morphological imaging can also be analyzed through the quantification of various parameters. The quantitative data retrieved from imaging examinations can serve as biomarkers and be used to support diagnosis, determine patient prognosis, or monitor therapy.We focus on the value, or clinical utility, of quantitative imaging in the musculoskeletal field. There is currently a trend to move from volume- to value-based payments. This review contains definitions and examines the role that quantitative imaging may play in the implementation of value-based health care. The influence of artificial intelligence on the value of quantitative musculoskeletal imaging is also discussed.
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Doenças Musculoesqueléticas/diagnóstico por imagem , Aquisição Baseada em Valor , Humanos , Aumento da Imagem/métodos , Interpretação de Imagem Assistida por Computador/métodosRESUMO
PURPOSE: To evaluate differences in diagnostic yield of intra-uterine foetal (iuMR) and post-mortem MRI (PMMR) for complex brain malformations, using autopsy as the reference standard. METHODS: In this retrospective, multicentre study spanning 2 years, we reviewed 13 terminated singleton pregnancies with a prenatal ultrasound finding of complex foetal cerebral abnormalities, referred for both iuMR and PMMR. The iuMR and PMMR studies of the brain were reported independently by two groups of radiologists, blinded to each other's reports. Descriptive statistics were used to compare differences in intracranial abnormalities with autopsy (and genetic testing, where present) as reference standard. RESULTS: The median gestational age at termination was 24.6 weeks (IQR 22-29) with median time between delivery and PMMR of 133 h (IQR 101-165). There was full concordance between iuMR and PMMR findings and autopsy in 2/13 (15.3%) cases. Partial concordance between both imaging modalities was present in 6/13 (46.2%) and total discordance in the remainder (5/13, 38.5%). When compared to autopsy, PMMR missed important key findings specifically for neuronal migration and cerebellar anomalies, whereas iuMR appeared to overcall CSF space abnormalities which were less crucial to reaching the final overall diagnosis. CONCLUSIONS: iuMR should be performed to improve foetal phenotyping where there is a prenatal ultrasound for complex foetal brain abnormalities. Reliance on PMMR alone is likely to result in misdiagnosis in a majority of cases.
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Encéfalo/anormalidades , Encéfalo/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Imageamento por Ressonância Magnética , Diagnóstico Pré-Natal , Aborto Induzido , Autopsia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: The aims of this study were to measure: (i) the growth in after-hours emergency department--referred CT (ED-CT) performed in accredited training departments between 2011 and 2013; (ii) the growth in ED CT relative to growth in ED presentations at the same hospitals; and (iii) trainee workload resulting from after-hours ED CT. METHODS: Ethics approval was obtained for all participating sites. Accredited training facilities in Australia and New Zealand with three or more trainees and serving one or more EDs were invited to participate (N = 32). Four nights were surveyed between August and December 2013. For data collection, the number of ED patients having one or more CT scans; ED CT scan total images; non-contrast head CTs; and ED patients (total and categories 1 and 2) attending the ED in the preceding 24 h and first half of calendar year were collected for 2013 and corresponding days in 2012 and 2011. Trainee staffing levels were measured. RESULTS: Eleven of 32 sites provided data for all four nights and 14 of 32 for one or more nights. A 15.7% increase in number of ED CTs between 1700 and 2200 h and 16.8% increase between 2201 and 0730 h occurred in the 2 years between 2011 and 2013 compared with a 6.9% increase in overall ED and 26% increase in categories 1 and 2 presentations over the same period. The number of CT images, however, increased 23%. CONCLUSION: Growth in demand by EDs for after-hours CT services has implications for service provision and trainee workloads in Royal Australian and New Zealand College of Radiologists-accredited training departments.
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Acreditação/normas , Plantão Médico/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Plantão Médico/normas , Austrália/epidemiologia , Serviço Hospitalar de Emergência/normas , Hospitais de Ensino/normas , Auditoria Médica , Nova Zelândia/epidemiologia , Tomografia Computadorizada por Raios X/normas , Revisão da Utilização de Recursos de Saúde , Carga de Trabalho/estatística & dados numéricosAssuntos
Diagnóstico por Imagem/estatística & dados numéricos , Avaliação de Desempenho Profissional/estatística & dados numéricos , Planejamento em Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Escalas de Valor Relativo , Carga de Trabalho/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Nova Zelândia , Fluxo de TrabalhoRESUMO
BACKGROUND: The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001-2002. METHODS: A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. The number and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspected PE during an eight month period prior to the clinical trial (January 2002-August 2002) were compared with the number and type of diagnostic tests in 745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were used as unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. RESULTS: The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. CONCLUSION: Extrapolating the observed cost-savings of $59.30 per patient to the whole of Australia could potentially result in annual savings between $3.1 million to $3.7 million.
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OBJECTIVES: The aims of this study were to measure the: (i) effects of implementation of a new risk assessment strategy for patients with suspected pulmonary embolism (PE) on the use of imaging and D-dimer assay; (ii) negative predictive value for PE of a combination of low risk and negative D-dimer assay; and (iii) compliance of ED clinicians with the strategy. METHODS: A non-randomized clinical trial was conducted in the ED of a 720-bed teaching hospital between November 2002 and August 2003. Study subjects with suspected PE were compared with 191 randomly selected historical controls. The risk assessment strategy of Kline et al. was disseminated and implemented. RESULTS: The negative predictive value for PE was 99% (95% confidence interval [CI] = 97-100%) in 114 patients with low risk and negative D-dimer. There was a 21% absolute reduction in the rate of imaging following the implementation of the risk assessment strategy (56% vs 77%, P < 0.001). CONCLUSION: Low risk combined with a negative D-dimer result may allow exclusion of PE without imaging.