Curbing the Urge to Image

Litkowski, Patricia; Smetana, Gerald W.; Zeidel, Mark L.; Blanchard, Melvin

doi:10.1016/j.amjmed.2016.06.020

Cited by 50 publications

(33 citation statements)

References 30 publications

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“…Advanced imaging studies -MRIs and computed tomography (CT) scans -account for approximately 3 percent of health spending (Iglehart 2009). In the late 1990s and early 2000s, there was double-digit increase year on year in the rate that advanced imaging studies were being performed, in spite of evidence suggesting that nearly half of studies performed may have been unnecessary (Lee and Levy 2012;Litkowski 2016). In addition to increasing cost sharing and promoting price transparency, insurers have increasingly required that physicians obtain prior approval for advanced imaging studies before the payers will fund them for their beneficiaries.…”

Section: Appendix a Background On Cost Sharing Mri Scans And Agencymentioning

confidence: 99%

Are Health Care Services Shoppable? Evidence from the Consumption of Lower-Limb MRI Scans

Chernew

Cooper

Larsen-Hallock

et al. 2018

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We study how privately insured individuals choose lower-limb MRI scan providers. Despite significant out-of-pocket costs and little variation in quality, patients often received care in highpriced locations when lower priced options were available. The choice of provider is such that, on average, patients bypassed 6 lower-priced providers between their homes and treatment locations. We show that referring physicians heavily influence where patients receive care. The influence of referring physicians is dramatically greater than the influence of patient cost-sharing or patients' home zip code fixed effects. Patients with vertically integrated referring physicians are also more likely to receive costlier hospital-based scans.

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Section: Appendix a Background On Cost Sharing Mri Scans And Agencymentioning

confidence: 99%

Are Health Care Services Shoppable? Evidence from the Consumption of Lower-Limb MRI Scans

Chernew

Cooper

Larsen-Hallock

et al. 2018

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“…Interventions aimed at decreasing unnecessary CT utilization can be grouped into three broad categories: pre-ordering, at the time of ordering, and post-imaging feedback [8][9][10]. Assessing these strategies and their effectiveness at reducing imaging is a popular topic in the literature with several systematic reviews having been published.…”

Section: Description Of the Existing Intervention Datamentioning

confidence: 99%

A Systematic Review Protocol to Determine the Most Effective Strategies to Reduce Computed Tomography Usage in the Emergency Department

Elzinga¹,

Dunne²,

Vorobeichik³

et al. 2020

Cureus

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This study describes the protocol for a systematic review and meta-analysis. The primary objective of the review is to identify experimental studies assessing the effectiveness of interventions that aim to reduce the proportion of computed tomography (CT) in emergency departments (EDs). Data permitting, our secondary objectives will be to assess the impact of reduction in CT utilization on the length of stay, admission to hospital, and uptake/satisfaction with the intervention. When available, balancing measures such as readmission to hospital or ED revisit rates will be included. Pre-defined subgroup analyses include patient populations (adult or pediatric), type of ED, and the nature of the intervention. Through this review, the research team aims to inform knowledge translation initiatives aimed at lowering CT usage in the ED by identifying the most effective interventions to safely improve CT resource stewardship.

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“…Medical imaging has particularly taken a major leap forward in terms of sophisticated technological advances in recent years [11][12][13]. The utilization of medical imaging has increased as a whole especially for the cross-sectional imaging modalities (computed tomography and magnetic resonance imaging) with a corresponding increase in the cost of services [12,14,15]. Computed tomography (CT) in particularly has recorded an exponential increase in utilization in recent years [12].…”

Section: Introductionmentioning

confidence: 99%

“…Computed tomography (CT) in particularly has recorded an exponential increase in utilization in recent years [12]. CT utilization however faces a dual challenge; the increasing cost for advanced procedures and the high exposure to ionizing radiation [14,16].…”

Section: Introductionmentioning

confidence: 99%

Assessing and coping with the financial burden of Computed Tomography utilization in Limbe, Cameroon: a sequential explanatory mixed-methods study.

Tambe

Mbuagbaw

Ongolo‐Zogo

et al. 2020

Preprint

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Background: Out-of-pocket (OOP) payments for healthcare services leads to unequal access to care with many not able to seek care or suffer catastrophic health expenditure and impoverishment. The cost of healthcare is on the rise and technological innovations in medical imaging are partly responsible. In this study we assess the risk of financial hardship after Computed Tomography (CT) utilization in a health facility in Cameroon and elaborate on how users adapt and cope.Methods: We carried out a sequential explanatory mixed methods study with a quantitative hospital-based survey of CT users followed by an in-depth interview of some purposively selected participants who reported risk of financial hardship after CT utilization. Data was summarized using frequencies, percentages and 95% confidence intervals. Logistic regression was used in multivariable analysis to determine predictors of risk of financial hardship. Identified themes from in-depth interviews were categorized. Quantitative and qualitative data were integrated.Results: A total of 372 participants were surveyed with a male to female sex ratio of 1:1.2. The mean age (standard deviation) was 52(17) years. CT scans of the head and facial bones accounted for 63% (95%CI: 59%, 68%) and the top three indications were suspected stroke (27% [95%CI: 22%, 32%]), trauma (14% [95%CI: 10%, 18%]) and persistent headaches with blurred vision (14% [95%CI: 10%, 18%]). Seventy-two percent (95%CI: 67%, 76%) of respondents declared being at risk of financial hardship after CT utilization and predictors in the multivariable analysis were low socioeconomic status (aOR: 0.19 [95%CI: 0.10, 0.38]; p<0.001) and not having any form of financial risk protection (aOR: 3.59 [95%CI: 1.31, 9.85]; p=0.013). Coping strategies included relying on family members and friends for financial assistance, lobbying hospital administration, social services and healthcare staff for a reduction of the direct cost, and borrowing of money.Conclusion: Lack of financial risk protection and a low socioeconomic status are associated with risk of financial hardship after CT utilization and diverse coping strategies are engaged to minimize the financial burden. Reducing OOP payments for CT scans and/or the direct cost will reduce this hardship and improve access to CT.

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Curbing the Urge to Image

Cited by 50 publications

References 30 publications

Are Health Care Services Shoppable? Evidence from the Consumption of Lower-Limb MRI Scans

Are Health Care Services Shoppable? Evidence from the Consumption of Lower-Limb MRI Scans

A Systematic Review Protocol to Determine the Most Effective Strategies to Reduce Computed Tomography Usage in the Emergency Department

Assessing and coping with the financial burden of Computed Tomography utilization in Limbe, Cameroon: a sequential explanatory mixed-methods study.

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