Health Insurers and Medical-Imaging Policy — A Work in Progress

Iglehart, John K.

doi:10.1056/nejmhpr0808703

Cited by 285 publications

(178 citation statements)

References 17 publications

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“…The lack of a clear demonstration of an effect on outcomes has led to calls for regulation aimed at controlling spending and improving quality 46, 47. Little comparative effectiveness research has been published on differing initial noninvasive diagnostic strategies that are currently available to clinicians.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

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BackgroundThe optimal initial noninvasive diagnostic testing strategy for stable coronary artery disease (CAD) is unknown. Although American guidelines recommend an exercise stress test as the first‐line test, European guidelines suggest that stress imaging (myocardial perfusion imaging or stress echocardiography) or coronary computed tomography angiography may be preferable. Understanding the relationship between the initial strategy and downstream yield of obstructive CAD and major adverse cardiac events may provide insight as to the optimal strategy.Methods and ResultsWe conducted a population‐based retrospective cohort study of adults in Ontario, Canada, using health administrative and clinical data. The relationship between the initial testing strategy and obstructive CAD on invasive angiography was examined. Patients were then followed from their angiogram onward to determine whether they developed a composite end point of major adverse cardiac events. After adjusting for covariates, patients with initial myocardial perfusion imaging (odds ratio: 0.92; 95% confidence interval, 0.85, 1.00), coronary computed tomography angiography (odds ratio: 1.51; 95% confidence interval, 0.91, 2.49), or stress echo (odds ratio: 0.95; 95% confidence interval, 0.84, 1.08) did not a have significantly different yield of obstructive CAD compared with those with an initial exercise stress test. Furthermore, there was no significant difference in downstream major adverse cardiac events after invasive angiography among the 4 initial testing strategies after adjusting for clinically relevant covariates.ConclusionsOur study found no evidence to suggest significant differences in either yield of obstructive CAD or downstream major adverse cardiac events in patients undergoing an initial noninvasive testing strategy with stress or anatomical imaging compared with those undergoing an initial exercise stress test.

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Section: Discussionmentioning

confidence: 99%

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Roifman

Wijeysundera

Austin

et al. 2017

JAHA

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“…Perhaps the most obvious of these limitations is the fact that a large percentage of medical imaging studies are exempt from these quality standards, including general radiography which still accounts for the majority of medical imaging exams [1,2]. In addition, these exempt imaging exams are often performed in facilities supervised by non-radiologists, which in theory heightens concerns over image quality and patient safety [3].…”

Section: Limitations and Deficienciesmentioning

confidence: 99%

Creating Accountability in Image Quality Analysis. Part 2: Medical Imaging Accreditation

Reiner

2013

J Digit Imaging

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“…44 Advances in imaging techniques generally increase, rather than reduce, healthcare expenditures. 49 In this era of increasing healthcare expenses, physicians are bound to take the costs of each imaging modality into account. The more so, when the results of previous scans may include the purpose of any additional scan.…”

Section: Pre-operative Assessment Of the Level Of The Dominant Performentioning

confidence: 99%

30 Internal Mammary Artery Perforator Flap

Hanasono¹,

Robb²,

Skoracki³

et al. 2016

Reconstructive Plastic Surgery of the Head and Neck: Current Techniques and Flap Atlas

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Health Insurers and Medical-Imaging Policy — A Work in Progress

Cited by 285 publications

References 17 publications

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Comparison of Anatomic and Clinical Outcomes in Patients Undergoing Alternative Initial Noninvasive Testing Strategies for the Diagnosis of Stable Coronary Artery Disease

Creating Accountability in Image Quality Analysis. Part 2: Medical Imaging Accreditation

30 Internal Mammary Artery Perforator Flap

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