Point-of-Care Echocardiography in the Accountable Care Organization Era

Platz, Elke; Solomon, Scott D.

doi:10.1161/circimaging.112.973578

Cited by 12 publications

(13 citation statements)

References 43 publications

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“…This is because, arguably, the same diagnosis could be made with less diagnostic information. However, emergency ultrasound results are available early on in the diagnostic process and provides timely clues when dealing with acute diagnostic challenges [6].…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of Emergency Ultrasound by Emergency Physicians after Implementation in a Hospital in the Netherlands

2014

Emergency Medicine

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Although commonly performed in modern medicine, emergency ultrasound utilization by emergency physicians themselves is not common practise in The Netherlands, although the characteristics of critical care patients are the same worldwide. This article describes the impact of implementation of ultrasound on treatment of acutely ill patients. All ultrasound exams performed by the author during the first year after implementation are analysed and categorised according to the level of attribution to the diagnostic and therapeutic process.On a total of 122 ultrasound exams on critical care patients, 27% of cases directly influenced the medical process and guided medical treatment. 91% of positive results were correct after comparison with final diagnosis at discharge or cause of death. In conclusion, emergency ultrasound by qualified emergency physicians is safe and effective in critical care.

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Section: Discussionmentioning

confidence: 99%

Clinical Impact of Emergency Ultrasound by Emergency Physicians after Implementation in a Hospital in the Netherlands

2014

Emergency Medicine

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“…[84]. This designation of "most useful test" would also apply to more than 90% of all remaining conditions associated • Focused Screening: Triage and classification of CV risk [66,67] • High quality pathophysiologic exam [29,79,80] • Low cost focused exam [29,65,[81][82][83] • System Biology Screening [8,47] • Accessibility: AHA "the single most useful diagnostic test in the evaluation of patients with heart failure…." [84] • Most peer reviewed literature (TABLE) • Essentialism: focused echocardiogram [58] • Anatomy correlated with function [85] • Quantification of risk: system biology [8,47] • Mature multi-feature biomarker [86,87] • Causality (cause and effect test) [4,6] • Network remodeling [29,54,[88][89][90][91] • Computer-assisted, centralized interpretation [56,82] • Remote access to expertise [92] [34] with sudden death in athletes Table4.…”

Section: Echo/doppler Screening Testmentioning

confidence: 99%

Part I - Sudden Cardiac Death in Athletes Pathophysiologic Screening: A Transformative Solution to a Social Imperative

Paterick¹

2015

JESO

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“…Open access and computer-assisted decision-making allow the user to prioritize referral and alleviate unnecessary expenses [29,51,52] . [42,43,47] is defined as an echocardiographic exam performed outside of a medical facility, which translates into a significant cost savings [42] by reducing the cost of services [28].…”

Section: Open Access Echocardiographymentioning

confidence: 99%

“…This directive is based on the premise that for a wide range of general prediction problems, easy-to-implement computer-based software is as reliable as and typically more reliable than, human expert interpretation [48][49][50]54]. Immediate on-site test interpretation [6,42,49,53] and automated quality assurance assist appropriate triage [16,34,35,47]. Elective use of web-based physician assistance enhances accuracy and reduces cost [47].…”

Section: Computer Assisted Data Interpretation and Decisionmakingmentioning

confidence: 99%

“…Testing a low risk population mandates the use of fewer resources [28,40];focus on prognostication, and not diagnosis [6]; ECG and traditional echo cardiographic models are deemed ineffective [28]; nonessential data are excluded [1,2,18,27,29,41]; use of lower cost point-of-care ultrasound devices [42,43]; aggressively reduce acquisition time (≈10 minutes) [43,44]; emphasize causality [2,5,9,13,28,34,43,45]; and prioritize the confirmation of normal and there-by rule out the rare abnormal [7]. …”

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confidence: 99%

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Part 3 - Cardiac Death in Athletes Implementation of a High Quality, Low Cost, Pathophysiologic Screening Exam

Paterick¹

2015

JESO

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Open Access Review Articlebecause of the low prevalence of diseased athletes and the large number of false-positive and false negative tests [1,[23][24][25][26][27][28][29]. Both cost and price of a complete echocardiogram is prohibitively high (e.g., $427 Medicare to >$2,275) [30].The cost of a limited echocardiogram is much lower (e.g.,$10 to $75) [24,31,32], but it does not focus upon the essential features pertinent to athletic screening to determine risk [29,32,33]. Small hand held devices have a certain degree of cost effectiveness, [24] but have a high price because this technology currently is incapable of obtaining or quantifying emergent physiologic data.A logical solution to this dilemma is an essential, focused echocardiogram designed to obtain small numbers of related pathophysiologic data [28] and maximize cost-effectiveness [19]. Practice expenses are further reduced by selection of point-ofcare ultrasound, remote exam rooms, limited documentation, cloud storage and reduction of costly services [28]. The cost of a focused echo cannot mirror the cost of a limited echo, CPT (93308), because the components and services used are substantially different. The essential, focused screening emphasizes the essentials of simplicity [15,[34][35][36]:assurance of normal and rule-out of abnormal. [2,5,9,13,28,34,43,45]; and prioritize the confirmation of normal and there-by rule out the rare abnormal [7]. Additional novel efficiencies include open-access ordering High QualityEssential criteria for quality include: eliminate false positives and false negatives [5,7]; prioritize pathophysiology [5,9], causality [10][11][12], simplicity [13][14][15], inductive reasoning [16], and "essentialism" [17,18].

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Point-of-Care Echocardiography in the Accountable Care Organization Era

Cited by 12 publications

References 43 publications

Clinical Impact of Emergency Ultrasound by Emergency Physicians after Implementation in a Hospital in the Netherlands

Clinical Impact of Emergency Ultrasound by Emergency Physicians after Implementation in a Hospital in the Netherlands

Part I - Sudden Cardiac Death in Athletes Pathophysiologic Screening: A Transformative Solution to a Social Imperative

Part 3 - Cardiac Death in Athletes Implementation of a High Quality, Low Cost, Pathophysiologic Screening Exam

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