Inpatient Imaging Utilization: Trends of the Past Decade

Shinagare, Atul B.; Ip, Ivan K.; Abbett, Sarah K.; Hanson, Richard W.; Seltzer, Steven E.; Khorasani, Ramin

doi:10.2214/ajr.13.10986

Cited by 21 publications

(12 citation statements)

References 30 publications

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“…A number of subsequent publications further increased the evidence and the controversy surrounding this assertion(7,8,21). Although it is possible that concern about ionizing radiation exposure contributed to the decline in use of CT it is unlikely to fully explain the decline, as the use of CT for inpatients at our institution continued to rise till 2009 and, in the current study, the use of non-ionizing MRI also declined after 2008(22). Another potential reason for the decline is the significant recent publicity about the cost of CT and MRI imaging, which may have also contributed to the decrease seen for both of these modalities(23).…”

Section: Discussionmentioning

confidence: 59%

“…We limited our study to imaging performed in the ED; some of the decrease might have been due to a deferral of imaging on admitted patients to the inpatient services. However, a study of inpatient imaging use at our institution found a similar decline, making this unlikely (22). In addition, our results are from a single center with over eight years of experience using health IT interventions with CDS targeting inappropriate use of imaging in the ED; it is possible that the implementation of CDS at a new institution might result in less robust initial results.…”

Section: Discussionmentioning

confidence: 88%

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Radiology Utilization in the Emergency Department: Trends of the Past 2 Decades

Raja

Sodickson

et al. 2014

American Journal of Roentgenology

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Objective To assess radiology utilization trends for emergency department (ED) patients from 1993 through 2012. Methods In this institutional review board-approved, retrospective study at a 793-bed tertiary care academic medical center, we reviewed radiology utilization from January 1, 1993 through December 31, 2012, during which time the number of ED patient visits increased from 48,000 to 61,000, and determined the number of imaging studies by modality (x-ray, sonography, CT, MRI, other) and associated relative value units (RVUs). We used linear regression to assess for trends in the number of imaging RVUs and imaging accession numbers, our primary and secondary outcomes, respectively. Results The total RVUs attributable to ED imaging per thousand ED visits increased 208% from 1993–2007 (p<0.0001) and then decreased 24.7% by 2012 (p<0.0019). The total number of imaging accession numbers per thousand ED visits increased 47.8%from 1993 until 2005(p=0.0003), then decreased 26.9% by 2012 (p<0.0001). CT RVUs per thousand ED visits increased 493% until 2007 (p<0.0001) and then decreased 33% (p<0.0001), MRI RVUs increased 2,475% until 2008 (p<0.0001) and then decreased 20.7% (p<0.032). Ultrasound RVUs increased 75.7% over the study period (p<0.0001) while x-ray RVUs decreased 28.1% (p=0.0009). Conclusions Following a period of substantial increase from 1993–2007, volume-adjusted ED imaging RVUs declined from 2007–2012, largely due to decreasing use of CT and MRI. Further studies are needed to determine the causes of this decline, which may include quality improvement activities, advocacy for appropriateness by leadership, concerns regarding radiation exposure and cost, and health IT interventions.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 88%

Radiology Utilization in the Emergency Department: Trends of the Past 2 Decades

Raja

Sodickson

et al. 2014

American Journal of Roentgenology

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“…Imaging CDS and CDS-enabled interventions have been associated with reductions in use of imaging and improved appropriateness (8)(9)(10)(11)(12)(13). Although condition-specific imaging CDS interventions for outpatients (9) and in the emergency department (ED) (10) have been reported, reports on inpatient interventions are lacking.…”

Section: Discussionmentioning

confidence: 99%

Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

Dunne¹,

Ip²,

Abbett³

et al. 2015

Radiology

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MPH Purpose:To determine the effect of clinical decision support (CDS) on the use and yield of inpatient computed tomographic (CT) pulmonary angiography for acute pulmonary embolism (PE). Materials and Methods:This HIPAA-compliant, institutional review board-approved study with waiver of informed consent included all adults admitted to a 793-bed teaching hospital from April 1, 2007, to June 30, 2012. The CDS intervention, implemented after a baseline observation period, informed providers who placed an order for CT pulmonary angiographic imaging about the pretest probability of the study based on a validated decision rule. Use of CT pulmonary angiographic and admission data from administrative databases was obtained for this study. By using a validated natural language processing algorithm on radiology reports, each CT pulmonary angiographic examination was classified as positive or negative for acute PE. Primary outcome measure was monthly use of CT pulmonary angiography per 1000 admissions. Secondary outcome was CT pulmonary angiography yield (percentage of CT pulmonary angiographic examinations that were positive for acute PE). Linear trend analysis was used to assess for effect and trend differences in use and yield of CT pulmonary angiographic imaging before and after CDS. Results:In 272 374 admissions over the study period, 5287 patients underwent 5892 CT pulmonary angiographic examinations. A 12.3% decrease in monthly use of CT pulmonary angiography (26.0 to 22.8 CT pulmonary angiographic examinations per 1000 admissions before and after CDS, respectively; P = .008) observed 1 month after CDS implementation was sustained over the ensuing 32-month period. There was a nonsignificant 16.3% increase in monthly yield of CT pulmonary angiography or percentage of CT pulmonary angiographic examinations positive for acute PE after CDS (P = .65). Conclusion:Implementation of evidence-based CDS for inpatients was associated with a 12.3% immediate and sustained decrease in use of CT pulmonary angiographic examinations in the evaluation of inpatients for acute PE.q RSNA, 2015

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“…1,2 Additionally, the paradigm shift from imaging modalities using high radiation doses to those using minimal or no radiation has also promoted the use of MRI. 3 The increased use of MRI in health care delivery has brought to the fore some major challenges one of which is an increase in the cost of healthcare which includes the cost of purchase and the need to employ skilled personnel like radiographers and radiologists to use the equipment. 4,5 In Ghana, most people pay for this service out of pocket, forcing some clinicians to do a cost-benefit analysis before requesting MRI for their patients.…”

Section: Introductionmentioning

confidence: 99%

Magnetic Resonance Imaging (MRI) Utilization in a Ghanaian Teaching Hospital: Trend and Policy Implications

Mensah

Mensah²,

Gbadamosi

et al. 2020

gmj

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Background: The use of Magnetic Resonance Imaging (MRI) is new in Ghana compared with some Western countries.A number of studies have observed increased MRI utilization due to increased sensitivity to diagnosis, and the paradigm shift to modalities that do not use radiation. Challenges with MRI use include high cost of the examination and inappropriate requests by referring clinicians. Objective: To determine the MRI utilisation trend in Korle Bu Teaching Hospital (KBTH), Ghana and its policy implications. Materials and Methods: A retrospective study undertaken in the Radiology Department, KBTH, from February to March, 2017. Eight hundred and forty request forms for MRI studies between January, 2013 and December 2016 were reviewed. Information on patient’s age and sex, number of MRI studies done, body parts and clinical conditions evaluated, appropriateness of clinical requests and existing policies on MRI in Ghana was gathered. Measures of central tendency and spread were obtained. Chi square, Pearson’s correlation and linear regression analysis were also used in the analysis. Results: The top three body parts requested were Spine (55 %), Brain (19%) and Joints (6 %); degenerative disease was the most common clinical condition evaluated.Significant association and correlation were obtained between of the number of body parts evaluated and examination year as well as the variety of clinical conditions requested and examination year. Conclusion: A progressive increase was noted in MRI utilisation both in number and diversity but no policy guiding MRI use in Ghana exists.

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Inpatient Imaging Utilization: Trends of the Past Decade

Cited by 21 publications

References 30 publications

Radiology Utilization in the Emergency Department: Trends of the Past 2 Decades

Radiology Utilization in the Emergency Department: Trends of the Past 2 Decades

Effect of Evidence-based Clinical Decision Support on the Use and Yield of CT Pulmonary Angiographic Imaging in Hospitalized Patients

Magnetic Resonance Imaging (MRI) Utilization in a Ghanaian Teaching Hospital: Trend and Policy Implications

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