Background/Aims In considering whether the new role of nurse angiographer could be developed nationally, radiation exposure was focused on as a performance indicator to demonstrate if patients were positively or negatively impacted when compared to national benchmarks. Measuring this clinical performance indicator in the first 104 training cases would provide evidence to either adapt training to ensure improved clinical performance, or allow the role to be adopted in other hospitals. Methods A quasi-experimental, retrospective, comparative audit was statistically analysed to compare a training nurse angiographer’s dose area product and screening time against the national X-ray diagnostic reference levels, to identify whether they could consistently perform coronary angiography safely within these parameters. Results This audit provided reasonably robust evidence that appropriately experienced nurses can be trained in coronary angiography safely within the national diagnostic reference levels. This provides assurance that this new role does not negatively impact patients’ procedural outcomes and that existing measures in place provide satisfactory governance. This also indicates that robust background knowledge and pre-learnt motor skills are beneficial to any operator. Conclusions Although this study contributes to research within this area, further research is needed to demonstrate the scope and benefits of this nursing role to a wider healthcare population.
Background
The Medical Services Advisory Committee (MSAC) is responsible for the assessment of medical imaging tests proposed for public funding. A number of factors related to the clinical or cost effectiveness of an imaging service may impact on the funding decision.
Objective
To determine what evidentiary and economic factors impact most on MSAC recommendations for the funding of imaging tests.
Methods
Information was extracted on health technology assessments (HTAs) of medical imaging tests published on the MSAC website, with a funding decision between 2006 to July 2021. Imaging tests with diagnostic, staging or screening indications were eligible. Data were extracted in test‐indication pairs and included data on evidence quality, quantity, consistency of findings, cost‐effectiveness and financial impact. Multivariate logistic regression analysis was performed with adjustments for clustered data.
Results
Overall, 42 imaging test applications to MSAC were included, representing 91 clinical indications. Most were diagnostic tests. The most common evidentiary concerns reported by MSAC were limited evidence (36%), low quality evidence (26%), and applicability of the data (22%). The reference standard for diagnostic accuracy was imperfect or not appropriate in 25% of the indications. In regression analyses, uncertainty about cost‐effectiveness of an imaging service predicted most negative funding decisions.
Conclusions
The single biggest contributor to a negative funding decision by MSAC was uncertainty about the cost‐effectiveness of the imaging service. This was likely driven by uncertainty regarding the impact on patient health. HTAs that are able to demonstrate the clinical utility of a new imaging service are more likely to publicly funded.
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