Cardiovascular Magnetic Resonance Imaging-Incremental Value in a Series of 361 Patients Demonstrating Cost Savings and Clinical Benefits: An Outcome-Based Study.
Cardiac-Gated Imaging Techniques; Cardiovascular Diseases – Diagnosis; Clinical Effectiveness; clinical impact; Cost Benefit Analysis; Cost Savings; Descriptive Statistics; Health Care Costs – Evaluation; Human; Magnetic resonance imaging; Magnetic Resonance Imaging – Evaluation; Outcome Assessment; Patients; Quality of Health Care; Retrospective Design
BACKGROUND: This study was designed to assess the clinical impact and cost-benefit of cardiovascular magnetic resonance imaging (CMR). In the face of current health care cost concerns, cardiac imaging modalities have come under focused review. Data related to CMR clinical impact and cost-benefit are lacking. METHODS AND RESULTS: Retrospective review of 361 consecutive patients (pts) who underwent CMR exams was conducted. Indications for CMR were tabulated for appropriateness criteria. Components of the CMR exam were identified along with evidence of clinical impact. The cost of each CMR exam was ascertained along with cost savings attributable to the CMR exam for calculation of an incremental cost-effectiveness ratio. A total of 354 of 361 pts (98%) had diagnostic quality studies. Of the 361 pts, 350 (97%) had at least 1 published Appropriateness Criterion for CMR. A significant clinical impact attributable to CMR exam results was observed in 256 of 361 pts (71%). The CMR exam resulted in a new diagnosis in 69 of 361 (27%) pts. Cardiovascular magnetic resonance imaging results avoided invasive procedures in 38 (11%) pts and prevented additional diagnostic testing in 26 (7%) pts. Comparison of health care savings using CMR as opposed to current standards of care showed a net cost savings of $833 037, ie, per patient cost savings of $2308. CONCLUSIONS: Cardiovascular magnetic resonance imaging provides diagnostic image quality in \textgreater98% of cases. Cardiovascular magnetic resonance imaging findings have documentable clinical impact on patient management in 71% of pts undergoing the exam, in a cost beneficial manner.
Hegde Vinayak A; Biederman Robert Ww; Mikolich J Ronald
Clinical Medicine Insights. Cardiology
2017
1905-7
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1177/1179546817710026" target="_blank" rel="noreferrer noopener">10.1177/1179546817710026</a>
Relevance of routine admission electrocardiograms for psychiatric patients.
Adult; Aged; Arrhythmias; Cardiac/diagnosis/*epidemiology/etiology; Comorbidity; Cost Savings; Diagnosis; Diagnostic Tests; Dual (Psychiatry); Electrocardiography/economics/*statistics & numerical data; Female; Humans; Male; Mental Disorders/diagnosis/*epidemiology/rehabilitation; Middle Aged; Myocardial Ischemia/diagnosis/*epidemiology/etiology; Patient Admission/economics/*statistics & numerical data; Routine/economics/*statistics & numerical data; Sensitivity and Specificity; Treatment Outcome
OBJECTIVE: To make clinically relevant recommendations for electrocardiogram (ECG) testing among psychiatric patients, the study examined the practice of ordering ECGs for this population. METHODS: The records of 4,045 patients consecutively admitted for psychiatric care to seven community teaching hospitals over one year were examined. The frequency of ECG orders was documented, and abnormal ECG results were grouped into two categories: relevant to psychiatric treatment (ischemia or conduction defects) and incidental to treatment (minor abnormalities and screening abnormalities). For those with abnormalities, additional cardiac follow-up data were recorded. Associations between ECG results and patients' characteristics were analyzed. RESULTS: ECGs were performed for 2,857 (71 percent) of first admissions, of which 2,225 (78 percent) showed neither relevant nor screening abnormalities. Eighteen percent of those tested had relevant abnormalities, most commonly a first-degree atrioventricular block or some evidence of a myocardial infarction. ECG screening abnormalities were found for another 4 percent, primarily left ventricular hypertrophy (3 percent), but no follow-up occurred for 46 percent of these patients. Among patients under 40 years of age, 8 percent had relevant abnormalities, and 3 percent had screening abnormalities. Among patients without apparent cardiac risk, 10 percent had relevant and 3 percent had screening abnormalities. More than half the patients who had a second or third admission during the year had a repeat ECG, even when previous ECGs were normal. CONCLUSIONS: Routine ECG is not an effective treatment or screening tool in this population, and substantial cost savings could result from more selective testing, particularly among young patients, those at low risk, and those with repeat admissions.
Heiselman D E; Bredle D L; Kessler E; Rutecki G W; Hines R M; Whittier F C; Bunn P D; Ognibene A J
Psychiatric services (Washington, D.C.)
1997
1997-10
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1176/ps.48.10.1323" target="_blank" rel="noreferrer noopener">10.1176/ps.48.10.1323</a>
Radiographically guided shave margins may reduce lumpectomy re-excision rates.
breast conservation; Breast Neoplasms – Surgery; Computer-Assisted; cost reduction; Cost Savings; Data Analysis; Data Analysis Software; Descriptive Statistics; Human; Intraoperative Period; Lumpectomy – Methods; re-excision; Reoperation – Trends; Statistical; Surgery; Ultrasonography; ultrasound
Minimizing margin re-excision optimizes patient care by providing appropriate oncologic resection and reducing costs. This study aims to assess margin positivity rate in two groups: shave margin based on gross specimen (control group, CG) vs shave margin based on intraoperative imaging (radiographic group, RG). A total of 182 patients who underwent lumpectomy for stage O-III breast cancer at a single institution from January 2013 to January 2014 were evaluated. There was statistically significant decrease in margin re-excision rate with intraoperative mammography but not with ultrasound. Surgeons are ideally equipped to use intraoperative imaging to guide margin excision, thus, improving care and reducing costs.
Larson Kelsey E; Jadeja Priya; Marko Alison; Jadeja Veeraj; Pratt Debra
The breast journal
2018
2018-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/tbj.13050" target="_blank" rel="noreferrer noopener">10.1111/tbj.13050</a>
The electronic medical record in dermatology.
Computerized/organization & administration; Cost Savings; Dermatology/*organization & administration; Electronic Health Records/*organization & administration; Female; Health Care Costs; Humans; Male; Medicaid/*economics; Medical Records Systems; Medicare/*economics; Program Development; Program Evaluation; United States
Governmental incentives to stimulate the "meaningful use" of electronic medical records and future disincentives for Medicaid and Medicare provide an impetus for dermatologists to consider adding this technology to their clinical practice. Dermatologists should carefully weigh the pros and cons of establishing an electronic medical record system before incorporating this expensive technology. This article reviews available scientific and economic data required for dermatologists to help make an informed choice.
Grosshandler Joshua A; Tulbert Brittain; Kaufmann Mark D; Bhatia Ashish; Brodell Robert T
Archives of dermatology
2010
2010-09
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1001/archdermatol.2010.229" target="_blank" rel="noreferrer noopener">10.1001/archdermatol.2010.229</a>