Reducing Unnecessary Shoulder MRI Examinations Within a Capitated Health Care System: A Potential Role for Shoulder Ultrasound

Sheehan, Scott E.; Coburn, John A.; Singh, Hardeep; Vanness, David J.; Sittig, Dean F.; Moberg, D. Paul; Safdar, Nasia; Lee, Kenneth S.; Brunner, Michael C.

doi:10.1016/j.jacr.2016.03.015

Cited by 22 publications

(25 citation statements)

References 45 publications

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“…Sheehan et al (2016) reported that 45% (106 cases) out of 237 prescribed MRIs for shoulder in a department of veterans affairs tertiary care hospital were inappropriate (18). In a recent research in Ontario, the inappropriate rate of hip MRI is estimated at 32.1% (19).…”

Section: Discussionmentioning

confidence: 99%

“…We found that having previous treatment and also other diagnostic tests are related to appropriateness of brain MRI. Manta (2019) showed that having no previous radiographic examination was the most predictor of inappropriate prescription of hip MRI in Ontario (19) Also Sheehan et al (2016) showed that ultrasound could be a cost saving substitution for 66 percentage of shoulder MRIs (18).…”

Section: Discussionmentioning

confidence: 99%

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Inappropriateness of brain MRI prescriptions and its financial burden

Kavosi

Sadeghi

Lotfi

et al. 2020

Preprint

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Background Diffusion of diagnostic tests such as (Magnetic Resonance Imaging) MRI is one of the main reasons for increasing growth of health care expenditure. So the current study aimed at estimation of the rate of brain MRI inappropriate prescriptions and their financial burden in Iran. Methods In this cross-sectional study 385 patients were selected by systematic stratified sampling in three public teaching hospitals in Shiraz, Iran. The selected participant's information was collected through data collection form which consisted of patients' demographic information, questions related to prescription and brain MRI prescription indications checklist. The completed indications checklist was compared to the appropriateness status table of indications and scenarios to detect the percent of appropriateness of prescriptions. Results About 21 percent of total brain MRI prescriptions are inappropriate. Previous treatment, number of refers to physician, having other diagnostic tests and the applicant of MRI (P<0.01) had significant relationships with prescriptions appropriateness. The estimated financial burden of inappropriate brain MRIs in Shiraz teaching hospitals was 99988 US dollar in 2017. Conclusions More than one fifth of brains MRIs were inappropriate. It caused about one hundred thousand United States Dollar (USD) financial burden which is 17 times of Iran's Gross Domestic Product (GDP) per capita. In order to better allocation of health system resources for provision of MRI services rationing policies for controlling consumer moral hazard and reducing provider induced demand can be helpful.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Inappropriateness of brain MRI prescriptions and its financial burden

Kavosi

Sadeghi

Lotfi

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous literature on the appropriateness of shoulder MRI among the general population reports high number of inappropriately ordered MRI. In a study of 237 consecutive patients at a tertiary hospital in 2013, it was found that 45% of the tests were inappropriately requested, mostly due to the lack of a preceding radiograph [29]. Furthermore, in 66% of the patients for whom an MRI was requested, it was determined that ultrasound would have been appropriate [29].…”

Section: Discussionmentioning

confidence: 99%

“…In a study of 237 consecutive patients at a tertiary hospital in 2013, it was found that 45% of the tests were inappropriately requested, mostly due to the lack of a preceding radiograph [29]. Furthermore, in 66% of the patients for whom an MRI was requested, it was determined that ultrasound would have been appropriate [29]. In another study looking at 100 consecutive MRI shoulder scan requests in the UK, 56% of the requests were deemed inappropriate [30].…”

Section: Discussionmentioning

confidence: 99%

Value of Shoulder MRI in Cancer Patients Presenting with Shoulder Related Symptoms

Mujtaba¹,

Nassar²,

Taher³

et al. 2019

JHS

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Nonspecific shoulder pain is common presentation among elderly patients and patients with a history of cancer. The major concern of shoulder pain in cancer patients is the development of metastases. MRI of the shoulder is the most commonly used imaging modality for assessment of suspected soft tissue pathologies associated with the shoulder pain. In this study, we try to examine the role of shoulder MRI in elderly patients with a history of cancer presenting with nonspecific shoulder complaints for assessment of metastases.

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“…Although adherence to AUC appears to decrease the cost of health care, 35 effectiveness studies suggest that imaging modalities that have a lower appropriateness rating, such as ultrasound for evaluation of shoulder pathology, may have an equivalent impact on health outcomes compared with MRI, but at a lower cost. 45,46 This issue of addressing or excluding costs (and similarly, relative radiation doses) highlights one additional factor that can affect whether the intended audience will accept and use AUC and CDS or not: transparency of the organizations that construct the criteria. Organizations such as the ACR and other qualified provider-led entities must be deliberate in their full disclosure of their methodology and assumptions to earn and retain the trust and confidence of referring providers, payers, and health care organizations.…”

Section: Limitations Of Appropriate Use Criteriamentioning

confidence: 99%

Appropriate Use Criteria in Musculoskeletal Imaging

Demertzis

Rubin

2017

Semin Musculoskelet Radiol

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In the United States, health care costs are spiraling upward at an unsustainable rate. Concurrently, medical specialties, legislatures, and the population each recognize the need to prove that current medical practices are effective, measured by outcomes. These forces necessitate a change in radiology's role, from emphasizing interpretation and reporting to maintaining and demonstrating quality and value. An important part of this task involves establishing the appropriateness of imaging tests by application of objective data and expert opinion in an effort to optimize resource utilization and modality selection. We explore the justifications for establishing appropriateness use criteria, various paradigms that have been applied to their creation, inherent limitations of appropriateness rules based on imperfect data, and challenges associated with their widespread implementation and utilization. An appendix of key terms that may be unfamiliar to radiologists is included for future reference.

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Reducing Unnecessary Shoulder MRI Examinations Within a Capitated Health Care System: A Potential Role for Shoulder Ultrasound

Cited by 22 publications

References 45 publications

Inappropriateness of brain MRI prescriptions and its financial burden

Inappropriateness of brain MRI prescriptions and its financial burden

Value of Shoulder MRI in Cancer Patients Presenting with Shoulder Related Symptoms

Appropriate Use Criteria in Musculoskeletal Imaging

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