Growth in Thoracentesis and Paracentesis Performed by Radiology and Advanced Practice Providers: Medicare Volume and Reimbursement Trends From 2012 to 2018

Tublin, Joshua M.; Lindquester, Will S.; Dhangana, Rajoo; Tublin, Mitchell

doi:10.1016/j.jacr.2022.02.031

Cited by 7 publications

(2 citation statements)

References 13 publications

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“…10 Alternative outpatient models of care have emerged for managing ascites such as paracenteses performed by interventional radiologists (IR). [11][12][13] Yet safety net institutions, defined by the Institute of Medicine as primarily serving patients with no insurance or Medicaid, may lack outpatient IR services due to staffing, space, and/or financial barriers. 14 For veterans, the alternative of an outpatient procedure clinic staffed by hospitalists has been described.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Care for Low-Income Patients with Cirrhosis: Implementing an Innovative Outpatient Clinic for Refractory Ascites in a Safety Net Hospital

Dowlatshahi,

Koh,

Vyas

et al. 2024

J GEN INTERN MED

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Background Disparities in life-saving interventions for low-income patients with cirrhosis necessitate innovative models of care. Aim To implement a novel generalist-led FLuid ASPiration (FLASP) clinic to reduce emergency department (ED) care for refractory ascites. Setting A large safety net hospital in Los Angeles. Participants MediCal patients with paracentesis in the ED from 6/1/2020 to 1/31/2021 or in FLASP clinic or the ED from 3/1/2021 to 4/30/2022. Program Description According to RE-AIM, adoption obtained administrative endorsement and oriented ED staff. Reach engaged ED staff and eligible patients with timely access to FLASP. Implementation trained FLASP clinicians in safer, guideline-based paracentesis, facilitated timely access, and offered patient education and support. Program Evaluation After FLASP clinic opened, significantly fewer ED visits were made by patients discharged after paracentesis [rate ratio (RR) of 0.33 (95% CI 0.28, 0.40, p < 0.0001)] but not if subsequently hospitalized (RR = 0.88, 95% CI 0.70, 1.11). Among 2685 paracenteses in 225 FLASP patients, complications were infrequent: 39 (1.5%) spontaneous bacterial peritonitis, 265 (9.9%) acute kidney injury, and 2 (< 0.001%) hypotension. FLASP patients rated satisfaction highly on a Likert-type question. Discussion Patients with refractory ascites in large safety net hospitals may benefit from an outpatient procedure clinic instead of ED care.

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Section: Introductionmentioning

confidence: 99%

Disparities in Care for Low-Income Patients with Cirrhosis: Implementing an Innovative Outpatient Clinic for Refractory Ascites in a Safety Net Hospital

Dowlatshahi,

Koh,

Vyas

et al. 2024

J GEN INTERN MED

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“…A systemic review reported a .62% occurrence rate of pneumothorax among 9231 patients undergoing thoracentesis (Fong et al, 2021). Thoracentesis-related pneumothorax is associated with significant morbidity and mortality (Martinez-Zayas et al, 2022;Tublin et al, 2022). Pneumothorax necessitates chest intubation in about half of the patients, which increases the length of hospital stay (Nishizawa et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Incidence of Pneumothorax After Ultrasound-Guided Thoracentesis

SARDAR,

SAFDAR,

TARAR

et al. 2023

Biol Clin Sci Res J

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The retrospective study was conducted in tertiary care hospitals between June 2021 and June 2022 to evaluate the risk factors and occurrence of pneumothorax after ultrasound-guided thoracentesis. The study included subjects with pleural effusion in whom pre-procedural thoracentesis under ultrasound guidance was performed. Outcomes were recorded, including chest tube insertion, rate of re-expansion of lungs, length of hospital stay, ICU admission, and mortality rate. Results showed that 500 65 (13%) patients developed pneumothorax. The most frequent etiologies of pleural were congestive heart failure (21%) and malignancy (55%). Multivariate analysis showed an independent association between the volume of pleural fluid drained and the occurrence of thoracentesis-associated pneumothorax (Odds ratio 1.002, 95% Confidence interval 1–1.002; P=.042). It was concluded that pre-procedural thoracentesis under US guidance is associated with a relatively high incidence of pneumothorax. Drainage of a larger volume of pleural fluid is a significant risk factor for developing pneumothorax.

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Percutaneous kidney biopsy trends in the Medicare population by specialty from 2011 to 2021: implications for nephrology training requirements and radiology referral patterns

Lindquester,

Chandra,

Dhangana

et al. 2023

Abdom Radiol

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Growth in Thoracentesis and Paracentesis Performed by Radiology and Advanced Practice Providers: Medicare Volume and Reimbursement Trends From 2012 to 2018

Cited by 7 publications

References 13 publications

Disparities in Care for Low-Income Patients with Cirrhosis: Implementing an Innovative Outpatient Clinic for Refractory Ascites in a Safety Net Hospital

Disparities in Care for Low-Income Patients with Cirrhosis: Implementing an Innovative Outpatient Clinic for Refractory Ascites in a Safety Net Hospital

Risk Factors and Incidence of Pneumothorax After Ultrasound-Guided Thoracentesis

Percutaneous kidney biopsy trends in the Medicare population by specialty from 2011 to 2021: implications for nephrology training requirements and radiology referral patterns

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