Evaluation of an independent, radiographer-led community diagnostic ultrasound service provided to general practitioners

Pallan, Miranda; Linnane, John; Ramaiah, Sam

doi:10.1093/pubmed/fdi006

Cited by 14 publications

(42 citation statements)

References 3 publications

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“…Twelve (21 %) of the 57 studies investigated quality management strategies including the Lean, Six Sigma and continuous quality improvement methodologies [96][97][98][99][100][101] and process/service re-design [102][103][104][105][106][107]. The type of study designs used include the controlled pre-and post-intervention [99], the post-intervention [104] and the remaining 10 studies adopted the uncontrolled pre-and post-intervention design. The PEWT were reported in seven studies [96, 98, 100-102, 104, 107], one study reported the RTAT [103] and two studies reported the TRWT [99,106].…”

Section: Quality Management Methodologiesmentioning

confidence: 99%

“…Most of these studies reported improved outcomes [96][97][98][99][100][101][102][103][104][105]107]. For example, the mean PEWTs were 56 (90 % CI 54, 57) and 36 (90 % CI 34, 38)min pre-and post- 17 (30) 37 (65) 6 (11) a Productivity-enhancing technologies reported included: speech recognition reporting (SRR), picture archival and communication system (PACS), radiology information system (RIS), computed radiographer (CR), computerised physician order entry (CPOE), digital radiography (DR).…”

Section: Quality Management Methodologiesmentioning

confidence: 99%

“…For example, many of the studies that reported positive findings did not test and/or report the statistical significance of their findings [93, 97, 98, 101, 102, 105, 121, 122, 126-128, 142, 146]. Only a few studies reported the confidence interval on their results [2,100,104]. Many of the studies did not define the timelines used in computing the outcome measures [92,94,97,105,115,116,120].…”

Section: Robustness/quality Of the Studiesmentioning

confidence: 99%

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The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

et al. 2014

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We reviewed the literature for the impact of service delivery initiatives (SDIs) on patients' waiting times within radiology departments. We searched MEDLINE, EMBASE, CINAHL, INSPEC and The Cochrane Library for relevant articles published between 1995 and February, 2013. The Cochrane EPOC risk of bias tool was used to assess the risk of bias on studies that met specified design criteria. Fifty-seven studies met the inclusion criteria. The types of SDI implemented included extended scope practice (ESP, three studies), quality management (12 studies), productivity-enhancing technologies (PETs, 29 studies), multiple interventions (11 studies), outsourcing and pay-for-performance (one study each). The uncontrolled pre-and post-intervention and the postintervention designs were used in 54 (95 %) of the studies. The reporting quality was poor: many of the studies did not test and/or report the statistical significance of their results. The studies were highly heterogeneous, therefore metaanalysis was inappropriate. The following type of SDIs showed promising results: extended scope practice; quality management methodologies including Six Sigma, Lean methodology, and continuous quality improvement; productivityenhancing technologies including speech recognition reporting, teleradiology and computerised physician order entry systems. We have suggested improved study design and the mapping of the definitions of patient waiting times in radiology to generic timelines as a starting point for moving towards a situation where it becomes less restrictive to compare and/or pool the results of future studies in a meta-analysis.

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Section: Quality Management Methodologiesmentioning

confidence: 99%

Section: Quality Management Methodologiesmentioning

confidence: 99%

Section: Robustness/quality Of the Studiesmentioning

confidence: 99%

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The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

et al. 2014

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“…Twenty 16,17,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] of the coded comparative studies were considered to relate to aspects of service delivery and organisation (Table 4) and 30 dealt with both service delivery and test performance/accuracy. The remaining coded comparative studies were mainly relevant to aspects of test accuracy in primary care or community settings.…”

Section: Comparative Studiesmentioning

confidence: 99%

“…A few studies covered particular diagnostic tests or technologies, for example genetic testing, 42 ultrasound 16 and endoscopy. 17 The studies were conducted in a range of different health-care systems, with only three performed in the UK.…”

Section: Comparative Studiesmentioning

confidence: 99%

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Chambers

Baxter

Johnson

et al. 2016

Health Serv Deliv Res

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BackgroundCurrent NHS policy favours the expansion of diagnostic testing services in community and primary care settings.ObjectivesOur objectives were to identify current models of community diagnostic services in the UK and internationally and to assess the evidence for quality, safety and clinical effectiveness of such services. We were also interested in whether or not there is any evidence to support a broader range of diagnostic tests being provided in the community.Review methodsWe performed an initial broad literature mapping exercise to assess the quantity and nature of the published research evidence. The results were used to inform selection of three areas for investigation in more detail. We chose to perform focused reviews on logistics of diagnostic modalities in primary care (because the relevant issues differ widely between different types of test); diagnostic ultrasound (a key diagnostic technology affected by developments in equipment); and a diagnostic pathway (assessment of breathlessness) typically delivered wholly or partly in primary care/community settings. Databases and other sources searched, and search dates, were decided individually for each review. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion.ResultsWe identified seven main models of service that are delivered in primary care/community settings and in most cases with the possible involvement of community/primary care staff. Not all of these models are relevant to all types of diagnostic test. Overall, the evidence base for community- and primary care-based diagnostic services was limited, with very few controlled studies comparing different models of service. We found evidence from different settings that these services can reduce referrals to secondary care and allow more patients to be managed in primary care, but the quality of the research was generally poor. Evidence on the quality (including diagnostic accuracy and appropriateness of test ordering) and safety of such services was mixed.ConclusionsIn the absence of clear evidence of superior clinical effectiveness and cost-effectiveness, the expansion of community-based services appears to be driven by other factors. These include policies to encourage moving services out of hospitals; the promise of reduced waiting times for diagnosis; the availability of a wider range of suitable tests and/or cheaper, more user-friendly equipment; and the ability of commercial providers to bid for NHS contracts. However, service development also faces a number of barriers, including issues related to staffing, training, governance and quality control.LimitationsWe have not attempted to cover all types of diagnostic technology in equal depth. Time and staff resources constrained our ability to carry out review processes in duplicate. Research in this field is limited by the difficulty of obtaining, from publicly available sources, up-to-date information about what models of service are commissioned, where and from which providers.Future workThere is a need for research to compare the outcomes of different service models using robust study designs. Comparisons of ‘true’ community-based services with secondary care-based open-access services and rapid access clinics would be particularly valuable. There are specific needs for economic evaluations and for studies that incorporate effects on the wider health system. There appears to be no easy way of identifying what services are being commissioned from whom and keeping up with local evaluations of new services, suggesting a need to improve the availability of information in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Limited options: a report on GP access to services

et al. 2007

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Evaluation of an independent, radiographer-led community diagnostic ultrasound service provided to general practitioners

Cited by 14 publications

References 3 publications

The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

The Effectiveness of Service Delivery Initiatives at Improving Patients’ Waiting Times in Clinical Radiology Departments: A Systematic Review

Evidence for models of diagnostic service provision in the community: literature mapping exercise and focused rapid reviews

Limited options: a report on GP access to services

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