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Amin KS, Forman HP, Davis MA. Response to letter. Clin Imaging 2024; 111:110173. [PMID: 38735100 DOI: 10.1016/j.clinimag.2024.110173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Kanhai S Amin
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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Amin KS, Forman HP, Davis MA. Even with ChatGPT, race matters. Clin Imaging 2024; 109:110113. [PMID: 38552383 DOI: 10.1016/j.clinimag.2024.110113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/15/2024] [Accepted: 02/24/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Applications of large language models such as ChatGPT are increasingly being studied. Before these technologies become entrenched, it is crucial to analyze whether they perpetuate racial inequities. METHODS We asked Open AI's ChatGPT-3.5 and ChatGPT-4 to simplify 750 radiology reports with the prompt "I am a ___ patient. Simplify this radiology report:" while providing the context of the five major racial classifications on the U.S. census: White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander. To ensure an unbiased analysis, the readability scores of the outputs were calculated and compared. RESULTS Statistically significant differences were found in both models based on the racial context. For ChatGPT-3.5, output for White and Asian was at a significantly higher reading grade level than both Black or African American and American Indian or Alaska Native, among other differences. For ChatGPT-4, output for Asian was at a significantly higher reading grade level than American Indian or Alaska Native and Native Hawaiian or other Pacific Islander, among other differences. CONCLUSION Here, we tested an application where we would expect no differences in output based on racial classification. Hence, the differences found are alarming and demonstrate that the medical community must remain vigilant to ensure large language models do not provide biased or otherwise harmful outputs.
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Affiliation(s)
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Melissa A Davis
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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Affiliation(s)
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Yale School of Management, New Haven, CT, USA
| | - Joseph S Ross
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Forman HP. Large Language Models as an Inexpensive and Effective Extra Set of Eyes in Radiology Reporting. Radiology 2024; 311:e240844. [PMID: 38625009 DOI: 10.1148/radiol.240844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Affiliation(s)
- Howard P Forman
- From the Department of Radiology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn; Department of Economics, Yale College, New Haven, Conn; and Yale School of Public Health, New Haven, Conn
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Doshi R, Amin KS, Khosla P, Bajaj SS, Chheang S, Forman HP. Quantitative Evaluation of Large Language Models to Streamline Radiology Report Impressions: A Multimodal Retrospective Analysis. Radiology 2024; 310:e231593. [PMID: 38530171 DOI: 10.1148/radiol.231593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Background The complex medical terminology of radiology reports may cause confusion or anxiety for patients, especially given increased access to electronic health records. Large language models (LLMs) can potentially simplify radiology report readability. Purpose To compare the performance of four publicly available LLMs (ChatGPT-3.5 and ChatGPT-4, Bard [now known as Gemini], and Bing) in producing simplified radiology report impressions. Materials and Methods In this retrospective comparative analysis of the four LLMs (accessed July 23 to July 26, 2023), the Medical Information Mart for Intensive Care (MIMIC)-IV database was used to gather 750 anonymized radiology report impressions covering a range of imaging modalities (MRI, CT, US, radiography, mammography) and anatomic regions. Three distinct prompts were employed to assess the LLMs' ability to simplify report impressions. The first prompt (prompt 1) was "Simplify this radiology report." The second prompt (prompt 2) was "I am a patient. Simplify this radiology report." The last prompt (prompt 3) was "Simplify this radiology report at the 7th grade level." Each prompt was followed by the radiology report impression and was queried once. The primary outcome was simplification as assessed by readability score. Readability was assessed using the average of four established readability indexes. The nonparametric Wilcoxon signed-rank test was applied to compare reading grade levels across LLM output. Results All four LLMs simplified radiology report impressions across all prompts tested (P < .001). Within prompts, differences were found between LLMs. Providing the context of being a patient or requesting simplification at the seventh-grade level reduced the reading grade level of output for all models and prompts (except prompt 1 to prompt 2 for ChatGPT-4) (P < .001). Conclusion Although the success of each LLM varied depending on the specific prompt wording, all four models simplified radiology report impressions across all modalities and prompts tested. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Rahsepar in this issue.
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Affiliation(s)
- Rushabh Doshi
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Kanhai S Amin
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Pavan Khosla
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Simar S Bajaj
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Sophie Chheang
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Howard P Forman
- From the Yale School of Medicine (R.D., P.K.) and Department of Radiology and Biomedical Imaging (K.S.A., S.S.B., S.C., H.P.F.), Yale School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn (H.P.F.); and Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn (H.P.F.)
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Kerekes DM, Frey AE, Prsic EH, Tran TT, Clune JE, Sznol M, Kluger HM, Forman HP, Becher RD, Olino KL, Khan SA. Immunotherapy Initiation at the End of Life in Patients With Metastatic Cancer in the US. JAMA Oncol 2024; 10:342-351. [PMID: 38175659 PMCID: PMC10767643 DOI: 10.1001/jamaoncol.2023.6025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/08/2023] [Indexed: 01/05/2024]
Abstract
Importance While immunotherapy is being used in an expanding range of clinical scenarios, the incidence of immunotherapy initiation at the end of life (EOL) is unknown. Objective To describe patient characteristics, practice patterns, and risk factors concerning EOL-initiated (EOL-I) immunotherapy over time. Design, Setting, and Participants Retrospective cohort study using a US national clinical database of patients with metastatic melanoma, non-small cell lung cancer (NSCLC), or kidney cell carcinoma (KCC) diagnosed after US Food and Drug Administration approval of immune checkpoint inhibitors for the treatment of each disease through December 2019. Mean follow-up was 13.7 months. Data analysis was performed from December 2022 to May 2023. Exposures Age, sex, race and ethnicity, insurance, location, facility type, hospital volume, Charlson-Deyo Comorbidity Index, and location of metastases. Main Outcomes and Measures Main outcomes were EOL-I immunotherapy, defined as immunotherapy initiated within 1 month of death, and characteristics of the cohort receiving EOL-I immunotherapy and factors associated with its use. Results Overall, data for 242 371 patients were analyzed. The study included 20 415 patients with stage IV melanoma, 197 331 patients with stage IV NSCLC, and 24 625 patients with stage IV KCC. Mean (SD) age was 67.9 (11.4) years, 42.5% were older than 70 years, 56.0% were male, and 29.3% received immunotherapy. The percentage of patients who received EOL-I immunotherapy increased over time for all cancers. More than 1 in 14 immunotherapy treatments in 2019 were initiated within 1 month of death. Risk-adjusted patients with 3 or more organs involved in metastatic disease were 3.8-fold more likely (95% CI, 3.1-4.7; P < .001) to die within 1 month of immunotherapy initiation than those with lymph node involvement only. Treatment at an academic or high-volume center rather than a nonacademic or very low-volume center was associated with a 31% (odds ratio, 0.69; 95% CI, 0.65-0.74; P < .001) and 30% (odds ratio, 0.70; 95% CI, 0.65-0.76; P < .001) decrease in odds of death within a month of initiating immunotherapy, respectively. Conclusions and Relevance Findings of this cohort study show that the initiation of immunotherapy at the EOL is increasing over time. Patients with higher metastatic burden and who were treated at nonacademic or low-volume facilities had higher odds of receiving EOL-I immunotherapy. Tracking EOL-I immunotherapy can offer insights into national prescribing patterns and serve as a harbinger for shifts in the clinical approach to patients with advanced cancer.
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Affiliation(s)
- Daniel M. Kerekes
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Alexander E. Frey
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth H. Prsic
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Thuy T. Tran
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - James E. Clune
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Mario Sznol
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Harriet M. Kluger
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Robert D. Becher
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Kelly L. Olino
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Sajid A. Khan
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
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Amin K, Doshi R, Forman HP. Large language models as a source of health information: Are they patient-centered? A longitudinal analysis. Healthc (Amst) 2024; 12:100731. [PMID: 38141269 DOI: 10.1016/j.hjdsi.2023.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/25/2023]
Affiliation(s)
| | | | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA; Yale School of Management, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Tu LH, Melnick E, Venkatesh AK, Sheth KN, Navaratnam D, Yaesoubi R, Forman HP, Mahajan A. Reply to "Considering Health Systems Worldwide: Point of View From a Middle-Income Country". AJR Am J Roentgenol 2024; 222:e2430900. [PMID: 38294162 DOI: 10.2214/ajr.24.30900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Affiliation(s)
- Long H Tu
- Yale School of Medicine New Haven, CT
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Tu LH, Melnick E, Venkatesh AK, Sheth KN, Navaratnam D, Yaesoubi R, Forman HP, Mahajan A. Cost-Effectiveness of CT, CTA, MRI, and Specialized MRI for Evaluation of Patients Presenting to the Emergency Department With Dizziness. AJR Am J Roentgenol 2024; 222:e2330060. [PMID: 37937837 DOI: 10.2214/ajr.23.30060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND. Underlying stroke is often misdiagnosed in patients presenting with dizziness. Although such patients are usually ineligible for acute stroke treatment, accurate diagnosis may still improve outcomes through selection of patients for secondary prevention measures. OBJECTIVE. The purpose of our study was to investigate the cost-effectiveness of differing neuroimaging approaches in the evaluation of patients presenting to the emergency department (ED) with dizziness who are not candidates for acute intervention. METHODS. A Markov decision-analytic model was constructed from a health care system perspective for the evaluation of a patient presenting to the ED with dizziness. Four diagnostic strategies were compared: noncontrast head CT, head and neck CTA, conventional brain MRI, and specialized brain MRI (including multiplanar high-resolution DWI). Differing long-term costs and outcomes related to stroke detection and secondary prevention measures were compared. Cost-effectiveness was calculated in terms of lifetime expenditures in 2022 U.S. dollars for each quality-adjusted life year (QALY); deterministic and probabilistic sensitivity analyses were performed. RESULTS. Specialized MRI resulted in the highest QALYs and was the most cost-effective strategy with US$13,477 greater cost and 0.48 greater QALYs compared with noncontrast head CT. Conventional MRI had the next-highest health benefit, although was dominated by extension with incremental cost of US$6757 and 0.25 QALY; CTA was also dominated by extension, with incremental cost of US$3952 for 0.13 QALY. Non-contrast CT alone had the lowest utility among the four imaging choices. In the deterministic sensitivity analyses, specialized MRI remained the most cost-effective strategy. Conventional MRI was more cost-effective than CTA across a wide range of model parameters, with incremental cost-effectiveness remaining less than US$30,000/QALY. Probabilistic sensitivity analysis yielded similar results as found in the base-case analysis, with specialized MRI being more cost-effective than conventional MRI, which in turn was more cost-effective than CTA. CONCLUSION. The use of MRI in patients presenting to the ED with dizziness improves stroke detection and selection for subsequent preventive measures. MRI-based evaluation leads to lower long-term costs and higher cumulative QALYs. CLINICAL IMPACT. MRI, incorporating specialized protocols when available, is the preferred approach for evaluation of patients presenting to the ED with dizziness, to establish a stroke diagnosis and to select patients for secondary prevention measures.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 20 York St, New Haven, CT 06510
| | - Edward Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | | | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 20 York St, New Haven, CT 06510
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 20 York St, New Haven, CT 06510
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10
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Forman HP, Bhalla S. Subsegmental Pulmonary Emboli and Chronic Pulmonary Emboli Should Not Be Ignored. Radiology 2024; 310:e232873. [PMID: 38411509 DOI: 10.1148/radiol.232873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Affiliation(s)
- Howard P Forman
- * Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, Tompkins East 2-204, New Haven, CT 06520
- Yale School of Public Health, New Haven, Conn
| | - Sanjeev Bhalla
- Department of Cardiothoracic Imaging, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St Louis, Mo
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Khunte M, Zhong A, Wu X, Payabvash S, Gandhi D, Forman HP, Malhotra A. Distribution and Disparities of Industry Payments to Radiologists (2016-2020). Acad Radiol 2023; 30:3056-3063. [PMID: 37210267 DOI: 10.1016/j.acra.2023.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND The frequency, magnitude, and distribution of industry payments to radiologists are not well understood. RATIONALE AND OBJECTIVES The aim of this study was to analyze the distribution of industry payments to physicians working in diagnostic radiology, interventional radiology, and radiation oncology, study the categories of payments and determine their correlation. MATERIALS AND METHODS The Open Payments Database from the Centers for Medicare & Medicaid Services was accessed and analyzed for the period from January 1, 2016 to December 31, 2020. Payments were grouped into six categories: consulting fees, education, gifts, research, speaker fees, and royalties/ownership. The total amount and types of industry payments going to the top 5% group were determined overall and for each category of payment. RESULTS From 2016 to 2020, a total of 513 020 payments, amounting to $370 782 608, were made to 28 739 radiologists suggesting that approximately 70% of the 41 000 radiologists in the US received at least one industry payment during the 5-year period. The median payment value was $27 (IQR: $15-$120) and the median number of payments per physician over the 5-year period was 4 (IQR: 1-13). Gifts were the most frequent payment type made (76.4%), but accounted for only 4.8% of payment value. The median total value of payments earned by members of the top 5% group over the 5-year period was $58 878 (IQR: $29 686-$162 425) ($11 776 per year) compared to $172 (IQR: $49-877) ($34 per year) in the bottom 95% group. Members of the top 5% group received a median of 67 (IQR: 26-147) individual payments (13 payments per year) while members of the bottom 95% group received a median of 3 (IQR: 1-11) (0.6 payments per year). CONCLUSION Between 2016 and 2020, industry payments to radiologists were highly concentrated both in terms of number/frequency and value of payments.
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Affiliation(s)
- Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.)
| | - Anthony Zhong
- Harvard Medical School, Boston, Massachusetts (A.Z.)
| | - Xiao Wu
- Department of Radiology, University of California at San Francisco, San Francisco, California (X.W.)
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.)
| | - Dheeraj Gandhi
- Department of Radiology, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland (D.G.)
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.)
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT 06520-8042 (M.K., S.P., H.P.F., A.M.).
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Tu LH, Navaratnam D, Melnick ER, Forman HP, Venkatesh AK, Malhotra A, Yaesoubi R, Sureshanand S, Sheth KN, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. AJR Am J Roentgenol 2023; 221:836-845. [PMID: 37404082 DOI: 10.2214/ajr.23.29617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND. CT with CTA is widely used to exclude stroke in patients with dizziness, although MRI has higher sensitivity. OBJECTIVE. The purpose of this article was to compare patients presenting to the emergency department (ED) with dizziness who undergo CT with CTA alone versus those who undergo MRI in terms of stroke-related management and outcomes. METHODS. This retrospective study included 1917 patients (mean age, 59.5 years; 776 men, 1141 women) presenting to the ED with dizziness from January 1, 2018, to December 31, 2021. A first propensity score matching analysis incorporated demographic characteristics, medical history, findings from the review of systems, physical examination findings, and symptoms to construct matched groups of patients discharged from the ED after undergoing head CT with head and neck CTA alone and patients who underwent brain MRI (with or without CT and CTA). Outcomes were compared. A second analysis compared matched patients discharged after CT with CTA alone and patients who underwent specialized abbreviated MRI using multiplanar high-resolution DWI for increased sensitivity for posterior circulation stroke. Sensitivity analyses were performed involving MRI examinations performed as the first or only neuroimaging examination and involving alternative matching and imputation techniques. RESULTS. In the first analysis (406 patients per group), patients who underwent MRI, compared with patients who underwent CT with CTA alone, showed greater frequency of critical neuroimaging results (10.1% vs 4.7%, p = .005), change in secondary stroke prevention medication (9.6% vs 3.2%, p = .001), and subsequent echocardiography evaluation (6.4% vs 1.0%, p < .001). In the second analysis (100 patients per group), patients who underwent specialized abbreviated MRI, compared with patients who underwent CT with CTA alone, showed greater frequency of critical neuroimaging results (10.0% vs 2.0%, p = .04), change in secondary stroke prevention medication (14.0% vs 1.0%, p = .001), and subsequent echocardiography evaluation (12.0% vs 2.0%, p = .01) and lower frequency of 90-day ED readmissions (12.0% vs 28.0%, p = .008). Sensitivity analyses showed qualitatively similar findings. CONCLUSION. A proportion of patients discharged after CT with CTA alone may have benefitted from alternative or additional evaluation by MRI (including MRI using a specialized abbreviated protocol). CLINICAL IMPACT. Use of MRI may motivate clinically impactful management changes in patients presenting with dizziness.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
| | | | - Edward R Melnick
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | | | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, Tompkin's East 2, New Haven, CT 06510
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Amin KS, Davis MA, Doshi R, Haims AH, Khosla P, Forman HP. Accuracy of ChatGPT, Google Bard, and Microsoft Bing for Simplifying Radiology Reports. Radiology 2023; 309:e232561. [PMID: 37987662 DOI: 10.1148/radiol.232561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Affiliation(s)
- Kanhai S Amin
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Melissa A Davis
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Rushabh Doshi
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Andrew H Haims
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Pavan Khosla
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
| | - Howard P Forman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520
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Abstract
Diagnostic imaging reports are generally written with a target audience of other providers. As a result, the reports are written with medical jargon and technical detail to ensure accurate communication. With implementation of the 21st Century Cures Act, patients have greater and quicker access to their imaging reports, but these reports are still written above the comprehension level of the average patient. Consequently, many patients have requested reports to be conveyed in language accessible to them. Numerous studies have shown that improving patient understanding of their condition results in better outcomes, so driving comprehension of imaging reports is essential. Summary statements, second reports, and the inclusion of the radiologist's phone number have been proposed, but these solutions have implications for radiologist workflow. Artificial intelligence (AI) has the potential to simplify imaging reports without significant disruptions. Many AI technologies have been applied to radiology reports in the past for various clinical and research purposes, but patient focused solutions have largely been ignored. New natural language processing technologies and large language models (LLMs) have the potential to improve patient understanding of their imaging reports. However, LLMs are a nascent technology and significant research is required before LLM-driven report simplification is used in patient care.
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Affiliation(s)
| | | | | | - Sophie Chheang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Yale School of Management, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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15
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Malhotra A, Bajaj S, Garg T, Khunte M, Pahwa B, Wu X, Payabvash S, Mukherjee S, Gandhi D, Forman HP. American College of Radiology Appropriateness Criteria®: a bibliometric analysis of panel members. Insights Imaging 2023; 14:113. [PMID: 37395838 PMCID: PMC10317907 DOI: 10.1186/s13244-023-01456-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/12/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE To assess the features of panel members involved in the writing of the ACR-AC and identify alignment with research output and topic-specific research publications. METHODS A cross-sectional analysis was performed on the research output of panel members of 34 ACR-AC documents published in 2021. For each author, we searched Medline to record total number of papers (P), total number of ACR-AC papers (C) and total number of previously published papers that are relevant to the ACR-AC topic (R). RESULTS Three hundred eighty-three different panel members constituted 602 panel positions for creating 34 ACR-AC in 2021 with a median panel size of 17 members. Sixty-eight (17.5%) of experts had been part of ≥10 previously published ACR-AC papers and 154 (40%) were members in ≥ 5 published ACR-AC papers. The median number of previously published papers relevant to the ACR-AC topic was 1 (IQR: 0-5). 44% of the panel members had no previously published paper relevant to the ACR-AC topic. The proportion of ACR-AC papers (C/P) was higher for authors with ≥ 5 ACR-AC papers (0.21) than authors with < 5 ACR-AC papers (0.11, p < 0.0001); however, proportion of relevant papers per topic (R/P) was higher for authors with < 5 ACR-AC papers (0.10) than authors with ≥ 5 ACR-AC papers (0.07). CONCLUSION The composition of the ACR Appropriateness Criteria panels reflects many members with little or no previously published literature on the topic of consideration. Similar pool of experts exists on multiple expert panels formulating imaging appropriateness guidelines. KEY POINTS There were 68 (17.5%) panel experts on ≥ 10 ACR-AC panels. Nearly 45% of the panel experts had zero median number of relevant papers. Fifteen panels (44%) had > 50% of members having zero relevant papers.
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Affiliation(s)
- Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA.
| | - Suryansh Bajaj
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Mihir Khunte
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Bhavya Pahwa
- University College of Medical Sciences, Delhi, India
| | - Xiao Wu
- Department of Radiology, University of California at San Francisco, San Francisco, USA
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
| | - Suresh Mukherjee
- Radiology and Radiation Oncology, University of Illinois, Peoria, IL and Robert Wood Johnson Medical School, Newark, NJ, USA
| | - Dheeraj Gandhi
- Interventional Neuroradiology, Nuclear Medicine, Neurology and Neurosurgery, University of Maryland School of Medicine, Maryland, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Tompkins East 2, 333 Cedar St, Box 208042, New Haven, CT, 06520-8042, USA
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Laditi F, Sun W, Forman HP. Characterization of the Landscape of Joint MD/MBA Programs in the US, 2002 to 2022. JAMA Netw Open 2023; 6:e2321268. [PMID: 37389880 PMCID: PMC10314300 DOI: 10.1001/jamanetworkopen.2023.21268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
This cross-sectional study characterizes the landscape of joint MD/MBA programs in the US from 2002 to 2022.
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Affiliation(s)
- Folawiyo Laditi
- Yale University School of Medicine, New Haven Connecticut
- Yale School of Management, New Haven, Connecticut
| | - Wilton Sun
- Yale University School of Medicine, New Haven Connecticut
| | - Howard P. Forman
- Yale University School of Medicine, New Haven Connecticut
- Yale School of Management, New Haven, Connecticut
- Department of Radiology, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
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17
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Mahoney SE, Taylor SN, Forman HP. No such thing as a free lunch: The direct marginal costs of breastfeeding. J Perinatol 2023; 43:678-682. [PMID: 36949157 DOI: 10.1038/s41372-023-01646-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/19/2023] [Accepted: 03/08/2023] [Indexed: 03/24/2023]
Abstract
Understanding costs associated with breastfeeding is critical to developing maximally effective policy to support breastfeeding by addressing financial barriers. Breastfeeding is not without cost; direct costs include those of equipment, modified nutritional intake, and time (opportunity cost). Breastfeeding need not require more equipment than formula feeding, though maternal equipment use varies by maternal preference. Meeting increased nutritional demands requires increased spending on food and potentially dietary supplementation, the marginal cost of which depends on a mother's baseline diet. The opportunity cost of the three to four hours per day breastfeeding demands may be prohibitively high, particularly to low-income workers. These costs are relatively highest for low-income individuals, a group disproportionately comprising racial and ethnic minorities, and who demonstrate lower rates of breastfeeding than their white and higher-income peers. Acknowledging and addressing these costs and their regressive nature represents a critical component of effective breastfeeding policy and promotion.
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Affiliation(s)
- Sarah E Mahoney
- Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Sarah N Taylor
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT, USA.
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT, USA
- Yale School of Management, Yale University, New Haven, CT, USA
- Yale School of Public Health, Yale University, New Haven, CT, USA
- Department of Economics, Yale University, New Haven, CT, USA
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18
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Potnis KC, Di M, Isufi I, Gowda L, Seropian SE, Foss FM, Forman HP, Huntington SF. Cost-effectiveness of chimeric antigen receptor T-cell therapy in adults with relapsed or refractory follicular lymphoma. Blood Adv 2023; 7:801-810. [PMID: 36342852 PMCID: PMC10011202 DOI: 10.1182/bloodadvances.2022008097] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
Abstract
Follicular lymphoma (FL) is traditionally considered treatable but incurable. In March 2021, the US Food and Drug Administration approved the use of chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed or refractory (R/R) FL after ≥2 lines of therapy. Priced at $373 000, CAR T-cell therapy is potentially curative, and its cost-effectiveness compared with other modern R/R FL treatment strategies is unknown. We developed a Markov model to assess the cost-effectiveness of third-line CAR T-cell vs standard of care (SOC) therapies in adults with R/R FL. We estimated progression rates for patients receiving CAR T-cell and SOC therapies from the ZUMA-5 trial and the LEO CReWE study, respectively. We calculated costs, discounted life years, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) of CAR T-cell vs SOC therapies with a willingness-to-pay threshold of $150 000 per QALY. Our analysis was conducted from a US payer's perspective over a lifetime horizon. In our base-case model, the cost of the CAR T-cell strategy was $731 682 compared with $458 490 for SOC therapies. However, CAR T-cell therapy was associated with incremental clinical benefit of 1.50 QALYs, resulting in an ICER of $182 127 per QALY. Our model was most sensitive to the utilities associated with CAR T-cell therapy remission and third-line SOC therapies and to the total upfront CAR T-cell therapy cost. Under current pricing, CAR T-cell therapy is unlikely to be cost-effective in unselected patients with FL in the third-line setting. Both randomized clinical trials and longer term clinical follow-up can help clarify the benefits of CAR T-cell therapy and optimal sequencing in patients with FL.
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Affiliation(s)
| | - Mengyang Di
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Iris Isufi
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Lohith Gowda
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Stuart E. Seropian
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
| | - Francine M. Foss
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
- Department of Dermatology, Yale School of Medicine, Yale University, New Haven, CT
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT
- Yale School of Management, Yale University, New Haven, CT
| | - Scott F. Huntington
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, CT
- Correspondence: Scott Huntington, Division of Hematology, Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, PO Box 208028, New Haven, CT 06520;
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19
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Affiliation(s)
- John Xuefeng Jiang
- From the Department of Accounting and Information Systems, Broad College of Business, Michigan State University, East Lansing, Mich (J.X.J., S.G.); Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (H.P.F.); Johns Hopkins Carey Business School, Baltimore, Md (G.B.); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 100 International Drive, Baltimore, MD 21202 (G.B.)
| | - Howard P Forman
- From the Department of Accounting and Information Systems, Broad College of Business, Michigan State University, East Lansing, Mich (J.X.J., S.G.); Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (H.P.F.); Johns Hopkins Carey Business School, Baltimore, Md (G.B.); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 100 International Drive, Baltimore, MD 21202 (G.B.)
| | - Sanjay Gupta
- From the Department of Accounting and Information Systems, Broad College of Business, Michigan State University, East Lansing, Mich (J.X.J., S.G.); Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (H.P.F.); Johns Hopkins Carey Business School, Baltimore, Md (G.B.); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 100 International Drive, Baltimore, MD 21202 (G.B.)
| | - Ge Bai
- From the Department of Accounting and Information Systems, Broad College of Business, Michigan State University, East Lansing, Mich (J.X.J., S.G.); Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Conn (H.P.F.); Johns Hopkins Carey Business School, Baltimore, Md (G.B.); and Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 100 International Drive, Baltimore, MD 21202 (G.B.)
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20
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Forman HP, Davis MA. Even in Radiology, Race Matters. Radiology 2023; 307:e223330. [PMID: 36809221 DOI: 10.1148/radiol.223330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Howard P Forman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, Tompkins East 2-204, New Haven, CT 06520 (H.P.F., M.A.D.); Yale School of Management, New Haven, Conn (H.P.F.); Yale School of Public Health, New Haven, Conn (H.P.F.); and Economics Department, Yale University, New Haven, Conn (H.P.F.)
| | - Melissa A Davis
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, Tompkins East 2-204, New Haven, CT 06520 (H.P.F., M.A.D.); Yale School of Management, New Haven, Conn (H.P.F.); Yale School of Public Health, New Haven, Conn (H.P.F.); and Economics Department, Yale University, New Haven, Conn (H.P.F.)
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21
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Cavallo JJ, de Oliveira Santo I, Mezrich JL, Forman HP. Clinical Implementation of a Combined Artificial Intelligence and Natural Language Processing Quality Assurance Program for Pulmonary Nodule Detection in the Emergency Department Setting. J Am Coll Radiol 2023; 20:438-445. [PMID: 36736547 DOI: 10.1016/j.jacr.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/18/2022] [Accepted: 12/08/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This quality assurance study assessed the implementation of a combined artificial intelligence (AI) and natural language processing (NLP) program for pulmonary nodule detection in the emergency department setting. The program was designed to function outside of normal reading workflows to minimize radiologist interruption. MATERIALS AND METHODS In all, 19,246 CT examinations including at least some portion of the lung anatomy performed in the emergent setting from October 1, 2021, to June 1, 2022, were processed by the combined AI-NLP program. The program used an AI algorithm trained on 6-mm to 30-mm pulmonary nodules to analyze CT images and an NLP to analyze radiological reports. Cases flagged as negative for pulmonary nodules by the NLP but positive by the AI algorithm were classified as suspected discrepancies. Discrepancies result in secondary review of examinations for possible addenda. RESULTS Out of 19,246 CT examinations, 50 examinations (0.26%) resulted in secondary review, and 34 of 50 (68%) reviews resulted in addenda. Of the 34 addenda, 20 patients received instruction for new follow-up imaging. Median time to addendum was 11 hours. The majority of reviews and addenda resulted from missed pulmonary nodules on CT examinations of the abdomen and pelvis. CONCLUSION A background quality assurance process using AI and NLP helped improve the detection of pulmonary nodules and resulted in increased numbers of patients receiving appropriate follow-up imaging recommendations. This was achieved without disrupting in-shift radiologist workflow or causing significant delays in patient follow for the diagnosed pulmonary nodule.
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Affiliation(s)
- Joseph J Cavallo
- Assistant Director of Informatics and Assistant Medical Director of Clinical Affairs, Yale Radiology, Yale Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut; Yale Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut.
| | - Irene de Oliveira Santo
- Yale Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut. https://twitter.com/DixeIrene
| | - Jonathan L Mezrich
- Assistant Director of Informatics and Assistant Medical Director of Clinical Affairs, Yale Radiology, Yale Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut; Yale Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, Connecticut; Director, MD/MBA Program, Yale School of Management, Yale University, New Haven, Connecticut; and Director, Health Care Management Program, Yale School of Public Health, Yale University, New Haven, Connecticut. https://twitter.com/thehowie
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22
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Tu LH, Malhotra A, Venkatesh AK, Taylor RA, Sheth KN, Yaesoubi R, Forman HP, Sureshanand S, Navaratnam D. Clinical criteria to exclude acute vascular pathology on CT angiogram in patients with dizziness. PLoS One 2023; 18:e0280752. [PMID: 36893103 PMCID: PMC9997874 DOI: 10.1371/journal.pone.0280752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Patients presenting to the emergency department (ED) with dizziness may be imaged via CTA head and neck to detect acute vascular pathology including large vessel occlusion. We identify commonly documented clinical variables which could delineate dizzy patients with near zero risk of acute vascular abnormality on CTA. METHODS We performed a cross-sectional analysis of adult ED encounters with chief complaint of dizziness and CTA head and neck imaging at three EDs between 1/1/2014-12/31/2017. A decision rule was derived to exclude acute vascular pathology tested on a separate validation cohort; sensitivity analysis was performed using dizzy "stroke code" presentations. RESULTS Testing, validation, and sensitivity analysis cohorts were composed of 1072, 357, and 81 cases with 41, 6, and 12 instances of acute vascular pathology respectively. The decision rule had the following features: no past medical history of stroke, arterial dissection, or transient ischemic attack (including unexplained aphasia, incoordination, or ataxia); no history of coronary artery disease, diabetes, migraines, current/long-term smoker, and current/long-term anti-coagulation or anti-platelet medication use. In the derivation phase, the rule had a sensitivity of 100% (95% CI: 0.91-1.00), specificity of 59% (95% CI: 0.56-0.62), and negative predictive value of 100% (95% CI: 0.99-1.00). In the validation phase, the rule had a sensitivity of 100% (95% CI: 0.61-1.00), specificity of 53% (95% CI: 0.48-0.58), and negative predictive value of 100% (95% CI: 0.98-1.00). The rule performed similarly on dizzy stroke codes and was more sensitive/predictive than all NIHSS cut-offs. CTAs for dizziness might be avoidable in 52% (95% CI: 0.47-0.57) of cases. CONCLUSIONS A collection of clinical factors may be able to "exclude" acute vascular pathology in up to half of patients imaged by CTA for dizziness. These findings require further development and prospective validation, though could improve the evaluation of dizzy patients in the ED.
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Affiliation(s)
- Long H. Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
- * E-mail:
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Arjun K. Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Richard A. Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
| | - Reza Yaesoubi
- Health Policy and Management, Yale School of Public Health, New Haven, CT, United States of America
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United States of America
| | - Soundari Sureshanand
- Yale Center for Clinical Investigation, Yale School of Medicine, New Haven, CT, United States of America
| | - Dhasakumar Navaratnam
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
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Affiliation(s)
- Long H Tu
- From the Yale School of Medicine (L.H.T., J.E.M., H.P.F.), the Yale School of Public Health (H.P.F.), and the Yale School of Management (H.P.F.) - all in New Haven, CT
| | - Jennifer E Miller
- From the Yale School of Medicine (L.H.T., J.E.M., H.P.F.), the Yale School of Public Health (H.P.F.), and the Yale School of Management (H.P.F.) - all in New Haven, CT
| | - Howard P Forman
- From the Yale School of Medicine (L.H.T., J.E.M., H.P.F.), the Yale School of Public Health (H.P.F.), and the Yale School of Management (H.P.F.) - all in New Haven, CT
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Tu LH, Malhotra A, Sheth KN, Yaesoubi R, Forman HP, Venkatesh AK. Yield of Head Computed Tomography Examinations for Common Psychiatric Presentations and Implications for Medical Clearance From a 6-Year Analysis of Acute Hospital Visits. JAMA Intern Med 2022; 182:879-881. [PMID: 35727595 PMCID: PMC9214629 DOI: 10.1001/jamainternmed.2022.2198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional study uses single health system data on acute hospital visits over 6 years to determine the yield of head computed tomography examinations for actionable pathology in common psychiatric presentations and to characterize low-risk scenarios in which imaging may be avoidable.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Reza Yaesoubi
- Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Liao JM, Bai G, Forman HP, White AA, Lee CI. JACR Health Policy Expert Panel: Hospital Price Transparency. J Am Coll Radiol 2022; 19:792-794. [PMID: 35460605 DOI: 10.1016/j.jacr.2022.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Joshua M Liao
- Director of the Value and Systems Science Lab and Associate Chair for Health Systems, Department of Medicine at the University of Washington, and the Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Gei Bai
- Johns Hopkins Carey Business School, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Howard P Forman
- Department of Diagnostic Radiology, Yale University School of Medicine; Yale School of Management; Department of Economics, Yale College; and Yale School of Public Health, New Haven, Connecticut, and is Director of Clinical Leadership Development for Yale New Haven Health System and Faculty Director for Finance, Department of Radiology
| | - Andrew A White
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington, and is Director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington and Deputy Editor of JACR
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Caraballo C, Mahajan S, Valero-Elizondo J, Massey D, Lu Y, Roy B, Riley C, Annapureddy AR, Murugiah K, Elumn J, Nasir K, Nunez-Smith M, Forman HP, Jackson CL, Herrin J, Krumholz HM. Evaluation of Temporal Trends in Racial and Ethnic Disparities in Sleep Duration Among US Adults, 2004-2018. JAMA Netw Open 2022; 5:e226385. [PMID: 35389500 PMCID: PMC8990329 DOI: 10.1001/jamanetworkopen.2022.6385] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
IMPORTANCE Historically marginalized racial and ethnic groups are generally more likely to experience sleep deficiencies. It is unclear how these sleep duration disparities have changed during recent years. OBJECTIVE To evaluate 15-year trends in racial and ethnic differences in self-reported sleep duration among adults in the US. DESIGN, SETTING, AND PARTICIPANTS This serial cross-sectional study used US population-based National Health Interview Survey data collected from 2004 to 2018. A total of 429 195 noninstitutionalized adults were included in the analysis, which was performed from July 26, 2021, to February 10, 2022. EXPOSURES Self-reported race, ethnicity, household income, and sex. MAIN OUTCOMES AND MEASURES Temporal trends and racial and ethnic differences in short (<7 hours in 24 hours) and long (>9 hours in 24 hours) sleep duration and racial and ethnic differences in the association between sleep duration and age. RESULTS The study sample consisted of 429 195 individuals (median [IQR] age, 46 [31-60] years; 51.7% women), of whom 5.1% identified as Asian, 11.8% identified as Black, 14.7% identified as Hispanic or Latino, and 68.5% identified as White. In 2004, the adjusted estimated prevalence of short and long sleep duration were 31.4% and 2.5%, respectively, among Asian individuals; 35.3% and 6.4%, respectively, among Black individuals; 27.0% and 4.6%, respectively, among Hispanic or Latino individuals; and 27.8% and 3.5%, respectively, among White individuals. During the study period, there was a significant increase in short sleep prevalence among Black (6.39 [95% CI, 3.32-9.46] percentage points), Hispanic or Latino (6.61 [95% CI, 4.03-9.20] percentage points), and White (3.22 [95% CI, 2.06-4.38] percentage points) individuals (P < .001 for each), whereas prevalence of long sleep changed significantly only among Hispanic or Latino individuals (-1.42 [95% CI, -2.52 to -0.32] percentage points; P = .01). In 2018, compared with White individuals, short sleep prevalence among Black and Hispanic or Latino individuals was higher by 10.68 (95% CI, 8.12-13.24; P < .001) and 2.44 (95% CI, 0.23-4.65; P = .03) percentage points, respectively, and long sleep prevalence was higher only among Black individuals (1.44 [95% CI, 0.39-2.48] percentage points; P = .007). The short sleep disparities were greatest among women and among those with middle or high household income. In addition, across age groups, Black individuals had a higher short and long sleep duration prevalence compared with White individuals of the same age. CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that from 2004 to 2018, the prevalence of short and long sleep duration was persistently higher among Black individuals in the US. The disparities in short sleep duration appear to be highest among women, individuals who had middle or high income, and young or middle-aged adults, which may be associated with health disparities.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Amarnath R. Annapureddy
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Johanna Elumn
- SEICHE Center for Health and Justice, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Xu X, Soulos PR, Herrin J, Wang SY, Pollack CE, Killelea BK, Forman HP, Gross CP. Perioperative magnetic resonance imaging in breast cancer care: Distinct adoption trajectories among physician patient-sharing networks. PLoS One 2022; 17:e0265188. [PMID: 35290417 PMCID: PMC8923453 DOI: 10.1371/journal.pone.0265188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite no proven benefit in clinical outcomes, perioperative magnetic resonance imaging (MRI) was rapidly adopted into breast cancer care in the 2000's, offering a prime opportunity for assessing factors influencing overutilization of unproven technology. OBJECTIVES To examine variation among physician patient-sharing networks in their trajectory of adopting perioperative MRI for breast cancer surgery and compare the characteristics of patients, providers, and mastectomy use in physician networks that had different adoption trajectories. METHODS AND FINDINGS Using the Surveillance, Epidemiology, and End Results-Medicare database in 2004-2009, we identified 147 physician patient-sharing networks (caring for 26,886 patients with stage I-III breast cancer). After adjusting for patient clinical risk factors, we calculated risk-adjusted rate of perioperative MRI use for each physician network in 2004-2005, 2006-2007, and 2008-2009, respectively. Based on the risk-adjusted rate, we identified three distinct trajectories of adopting perioperative MRI among physician networks: 1) low adoption (risk-adjusted rate of perioperative MRI increased from 2.8% in 2004-2005 to 14.8% in 2008-2009), 2) medium adoption (8.8% to 45.1%), and 3) high adoption (33.0% to 71.7%). Physician networks in the higher adoption trajectory tended to have a larger proportion of cancer specialists, more patients with high income, and fewer patients who were Black. After adjusting for patients' clinical risk factors, the proportion of patients undergoing mastectomy decreased from 41.1% in 2004-2005 to 38.5% in 2008-2009 among those in physician networks with low MRI adoption, but increased from 27.0% to 31.4% among those in physician networks with high MRI adoption (p = 0.03 for the interaction term between trajectory group and time). CONCLUSIONS Physician patient-sharing networks varied in their trajectory of adopting perioperative MRI. These distinct trajectories were associated with the composition of patients and providers in the networks, and had important implications for patterns of mastectomy use.
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Affiliation(s)
- Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, United States of America
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Pamela R. Soulos
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Jeph Herrin
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Shi-Yi Wang
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Craig Evan Pollack
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Brigid K. Killelea
- Hartford HealthCare Medical Group, Bridgeport, Connecticut, United States of America
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Cary P. Gross
- Cancer Outcomes, Public Policy and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
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Affiliation(s)
- Howard P Forman
- From the Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510; Yale School of Management, New Haven, Conn; Department of Economics, Yale College, New Haven, Conn; and Yale School of Public Health, New Haven, Conn
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Tu LH, Venkatesh AK, Malhotra A, Taylor RA, Sheth KN, Forman HP, Yaesoubi R. Scenarios to improve CT head utilization in the emergency department delineated by critical results reporting. Emerg Radiol 2021; 29:81-88. [PMID: 34617133 DOI: 10.1007/s10140-021-01947-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Increasing use of advanced imaging in the emergency department (ED) has resulted in higher cost without better outcomes. Our goal was to evaluate the yield of CT head exams by scenario to guide efforts at improving patient selection. METHODS We performed a retrospective study at an academic medical center over 4 years (1/1/2014-12/31/2017). The chief complaint, imaging order, and exam result text were obtained for all adult ED encounters. For the 50 most common chief complaints leading to CT head exams, the ratio of exams to total encounters and ratio of critical results to imaging studies were calculated. Significant difference in "yield" was assessed via binomial test. RESULTS Over 708,145 adult ED encounters, 58,783 CT head exams were ordered, with an overall critical result yield of 8.0%. The three most common chief complaints had higher yield (p < 0.05): altered mental status (9.8%), fall (9.7%), and new headache (10.1%). Lower yield (p < 0.05) was found for 19 chief complaints: dizziness (6.2%), falls in patients > 65 years old (7.1%), syncope (5.3%), seizure with known epilepsy (4.8%), chest pain (3.7%), head injury (4.9%), headache re-evaluation (7.0%), alcohol intoxication (2.5%), fatigue (6.5%), headache-recurrent or in the setting of known migraines (5.2%), hypertension (4.4%), lethargy (5.8%), loss of consciousness (5.3%), migraine (3.2%), psychiatric evaluation (2.9%), near syncope (4.6%), drug problem (3.1%), symptomatically decreased blood sugar (3.2%), and suicidal (1.7%). CONCLUSION Our study provides a priority list of low yield scenarios of CT head use for improvement of patient selection.
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Affiliation(s)
- Long H Tu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Richard A Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Reza Yaesoubi
- Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR, Roy B, Riley C, Murugiah K, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018. JAMA 2021; 326:637-648. [PMID: 34402830 PMCID: PMC8371573 DOI: 10.1001/jama.2021.9907] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
IMPORTANCE The elimination of racial and ethnic differences in health status and health care access is a US goal, but it is unclear whether the country has made progress over the last 2 decades. OBJECTIVE To determine 20-year trends in the racial and ethnic differences in self-reported measures of health status and health care access and affordability among adults in the US. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional study of National Health Interview Survey data, 1999-2018, that included 596 355 adults. EXPOSURES Self-reported race, ethnicity, and income level. MAIN OUTCOMES AND MEASURES Rates and racial and ethnic differences in self-reported health status and health care access and affordability. RESULTS The study included 596 355 adults (mean [SE] age, 46.2 [0.07] years, 51.8% [SE, 0.10] women), of whom 4.7% were Asian, 11.8% were Black, 13.8% were Latino/Hispanic, and 69.7% were White. The estimated percentages of people with low income were 28.2%, 46.1%, 51.5%, and 23.9% among Asian, Black, Latino/Hispanic, and White individuals, respectively. Black individuals with low income had the highest estimated prevalence of poor or fair health status (29.1% [95% CI, 26.5%-31.7%] in 1999 and 24.9% [95% CI, 21.8%-28.3%] in 2018), while White individuals with middle and high income had the lowest (6.4% [95% CI, 5.9%-6.8%] in 1999 and 6.3% [95% CI, 5.8%-6.7%] in 2018). Black individuals had a significantly higher estimated prevalence of poor or fair health status than White individuals in 1999, regardless of income strata (P < .001 for the overall and low-income groups; P = .03 for middle and high-income group). From 1999 to 2018, racial and ethnic gaps in poor or fair health status did not change significantly, with or without income stratification, except for a significant decrease in the difference between White and Black individuals with low income (-6.7 percentage points [95% CI, -11.3 to -2.0]; P = .005); the difference in 2018 was no longer statistically significant (P = .13). Black and White individuals had the highest levels of self-reported functional limitations, which increased significantly among all groups over time. There were significant reductions in the racial and ethnic differences in some self-reported measures of health care access, but not affordability, with and without income stratification. CONCLUSIONS AND RELEVANCE In a serial cross-sectional survey study of US adults from 1999 to 2018, racial and ethnic differences in self-reported health status, access, and affordability improved in some subgroups, but largely persisted.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Daisy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Oyere Onuma
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Abstract
OBJECTIVES To create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital. DESIGN Methodological study. SETTING Multicentre study. PARTICIPANTS All hospitals and health systems reporting the required financial metrics in the USA in 2017 were included for a total of 1075 participants. INTERVENTIONS We examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used principal coordinate analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody's Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS). PRIMARY OUTCOME MEASURES Ability to reproduce both financial trends from a 'gold-standard' metric and known associations with non-fiscal data. RESULTS The validity of the YHFS was evaluated by: (1) cross-validating it with previously excluded data; (2) comparing it to existing models and (3) replicating known associations with non-fiscal data. Ten per cent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody's and Standard and Poor's bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores. CONCLUSIONS We created a reliable and publicly available composite score of hospital financial stability.
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Affiliation(s)
- Radoslav Zinoviev
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Rick Antle
- Yale School of Management, New Haven, Connecticut, USA
| | - Howard P Forman
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Management, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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Sutton R, Silvestri DM, Sodagari F, Krishnamurthy R, Forman HP. Pediatric Emergency Imaging Studies in Academic Radiology Departments: A Nationwide Survey of Staffing Practices. J Am Coll Radiol 2021; 18:1351-1358. [PMID: 33989533 DOI: 10.1016/j.jacr.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Particularly for pediatric patients presenting with acute conditions or challenging diagnoses, identifying variation in emergency radiology staffing models is essential in establishing a standard of care. We conducted a cross-sectional survey among radiology departments at academic pediatric hospitals to evaluate staffing models for providing imaging interpretation for emergency department imaging requests. METHODS We conducted an anonymous telephone survey of academic pediatric hospitals affiliated with an accredited radiology residency program across the United States. We queried the timing, location, and experience of reporting radiologists for initial and final interpretations of emergency department imaging studies, during weekday, overnight, and weekend hours. We compared weekday with overnight, and weekday with weekend, using Fisher's exact test and an α of 0.05. RESULTS Surveying 42 of 47 freestanding academic pediatric hospitals (89%), we found statistically significant differences for initial reporting radiologist, final reporting radiologist, and final report timing between weekday and overnight. We found statistically significant differences for initial reporting radiologist and final report timing between weekday and weekend. Attending radiologist involvement in initial reports was 100% during daytime, but only 33.3% and 69.0% during overnight and weekends. For initial interpretation during overnight and weekend, 38.1% and 28.6% use resident radiologists without attending radiologists, and 28.6% and 2.4% use teleradiology. All finalized reports as soon as possible during weekdays, but only 52.4% and 78.6% during overnight and weekend. DISCUSSION A minority of hospitals use 24-hour in-house radiology attending radiologist coverage. During overnight periods, the majority of academic pediatric emergency departments rely on resident radiologists without attending radiologist supervision or outside teleradiology services to provide initial reports. During weekend periods, over a quarter rely on resident radiologists without attending radiologist supervision for initial reporting. This demonstrates significant variation in staffing practices at academic pediatric hospitals. Future studies should look to determine whether this variation has any impact on standard of care.
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Affiliation(s)
- Robert Sutton
- University Hospital Llandough, Llandough, Penarth, UK.
| | - David M Silvestri
- Office of Quality & Safety, NYC Health + Hospitals, New York, New York
| | - Faezeh Sodagari
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Rajesh Krishnamurthy
- Department of Diagnostic Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
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Mezrich JL, Jin G, Lye C, Yousman L, Forman HP. Patient Electronic Access to Final Radiology Reports: What Is the Current Standard of Practice, and Is an Embargo Period Appropriate? Radiology 2021; 300:187-189. [PMID: 33944630 DOI: 10.1148/radiol.2021204382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients have a right to their medical records, and it has become commonplace for institutions to set up online portals through which patients can access their electronic health information, including radiology reports. However, institutional approaches vary on how and when such access is provided. Many institutions have advocated built-in "embargo" periods, during which radiology reports are not immediately released to patients, to give ordering clinicians the opportunity to first receive, review, and discuss the radiology report with their patients. To understand current practices, a telephone survey was conducted of 83 hospitals identified in the 2019-2020 U.S. News & World Report Best Hospitals Rankings. Of 70 respondents, 91% (64 of 70) offered online portal access. Forty-two percent of those with online access (27 of 64 respondents) reported a delay of 4 days or longer, and 52% (33 of 64 respondents) indicated that they first send reports for review by the referring clinician before releasing to the patient. This demonstrates a lack of standardized practice in prompt patient access to health records, which may soon be mandated under the final rule of the 21st Century Cures Act. This article discusses considerations and potential benefits of early access for patients, radiologists, and primary care physicians in communicating health information and providing patient-centered care. © RSNA, 2021.
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Affiliation(s)
- Jonathan L Mezrich
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Grace Jin
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Carolyn Lye
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Laurie Yousman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
| | - Howard P Forman
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, TE2, New Haven, CT 06520 (J.L.M., C.L., H.P.F.); Yale University, New Haven, Conn (G.J., L.Y.); and Yale Law School, New Haven, Conn (C.L.)
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Wu X, Wira CR, Matouk CC, Forman HP, Gandhi D, Sanelli P, Schindler J, Malhotra A. Drip-and-ship versus mothership for endovascular treatment of acute stroke: A comparative effectiveness analysis. Int J Stroke 2021; 17:315-322. [PMID: 33759645 DOI: 10.1177/17474930211008701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Triage for suspected acute stroke has two main options: (1) transport to the closest primary stroke center (PSC) and then to the nearest comprehensive stroke center (CSC) (Drip-and-Ship) or (2) transport the patient to the nearest CSC, bypassing a closer PSC (mothership). The purpose was to evaluate the effectiveness of drip-and-ship versus mothership models for acute stroke patients. METHODS A Markov decision-analytic model was constructed. All model parameters were derived from recent medical literature. Our target population was adult patient with sudden onset of acute stroke within 8 h of onset over a one-year horizon. The primary outcome was quantified in terms of quality-adjusted-life-years (QALYs). RESULTS The base case scenario show that the drip-and-ship strategy has a slightly higher expected health benefit, 0.591 QALY, as compared to 0.586 QALY in the mothership strategy when the time to PSC is 30 min and to CSC is 65 min, although the difference in health benefit becomes minimal as the time to PSC increases towards 60 min. Multiple sensitivity analyses show that when both PSC and CSC are far from place of onset (>1.5 h away), drip-and-ship becomes the better strategy. Mothership strategy is favored by smaller difference between distances to PSC and CSC, shorter transfer time from PSC to CSC, and longer delay in reperfusion in CSC for transferred patients. Drip-and-ship is favored by the reverse. CONCLUSION Drip-and-ship has a slightly higher utility than mothership. This study assesses the complex issue of prehospital triage of acute stroke patients and can provide a framework for real-world data input.
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Affiliation(s)
- Xiao Wu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Charles R Wira
- Department of Emergency Medicine, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Charles C Matouk
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Dheeraj Gandhi
- Radiology, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pina Sanelli
- Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joseph Schindler
- Department of Neurology, 12228Yale School of Medicine, New Haven, CT, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
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Tiako MJN, Forman HP, Nuñez-Smith M. Racial Health Disparities, COVID-19, and a Way Forward for US Health Systems. J Hosp Med 2021; 16:50-52. [PMID: 33357329 DOI: 10.12788/jhm.3545] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/10/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Max Jordan Nguemeni Tiako
- Yale School of Medicine, New Haven, Connecticut
- Center for Emergency Care and Policy Research, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut
| | - Howard P Forman
- Yale School of Medicine, New Haven, Connecticut
- Yale School of Management, New Haven, Connecticut
| | - Marcella Nuñez-Smith
- Yale School of Medicine, New Haven, Connecticut
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, Connecticut
- Yale School of Management, New Haven, Connecticut
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Dym RJ, Forman HP, Scheinfeld MH. Night and Day: Confounding Factors Complicate Comparison and Generalizability of Radiology Error Rates. Radiology 2020; 298:E115-E116. [PMID: 33320068 DOI: 10.1148/radiol.2020203577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- R Joshua Dym
- Department of Radiology, Section of Emergency Radiology, University Hospital, Rutgers New Jersey Medical School, Newark, NJ
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Conn
| | - Meir H Scheinfeld
- Department of Radiology, Division of Emergency Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467
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Affiliation(s)
- Saad B Omer
- Yale Institute for Global Health, New Haven, Connecticut
- Departments of Internal Medicine and Epidemiology of Microbial Diseases, Yale Schools of Medicine and Public Health, New Haven, Connecticut
| | - Inci Yildirim
- Yale Institute for Global Health, New Haven, Connecticut
- Section of Infectious Diseases and Global Health, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Howard P Forman
- Yale School of Public Health, New Haven, Connecticut
- Yale School of Management, New Haven, Connecticut
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Caraballo C, Massey D, Mahajan S, Lu Y, Annapureddy AR, Roy B, Riley C, Murugiah K, Valero-Elizondo J, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018. medRxiv 2020:2020.10.30.20223420. [PMID: 33173905 PMCID: PMC7654899 DOI: 10.1101/2020.10.30.20223420] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. OBJECTIVES To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in the US in the last two decades. DESIGN Cross-sectional. SETTING Data from the National Health Interview Survey, 1999-2018. PARTICIPANTS Individuals >18 years old. EXPOSURE Race and ethnicity: non-Hispanic Black, non-Hispanic Asian, non-Hispanic White, Hispanic. MAIN OUTCOME AND MEASURES Rates of lack of insurance coverage, lack of a usual source of care, and foregone/delayed medical care due to cost. We also estimated the gap between non-Hispanic White and the other subgroups for these outcomes. RESULTS We included 596,355 adults, of which 69.7% identified as White, 11.8% as Black, 4.7% as Asian, and 13.8% as Hispanic. The proportion uninsured and the rates of lacking a usual source of care remained stable across all 4 race/ethnicity subgroups up to 2009, while rates of foregone/delayed medical care due to cost increased. Between 2010 and 2015, the percentage of uninsured diminished for all, with the steepest reduction among Hispanics (-2.1% per year). In the same period, rates of no usual source of care declined only among Hispanics (-1.2% per year) while rates of foregone/delayed medical care due to cost decreased for all. No substantial changes were observed from 2016-2018 in any outcome across subgroups. Compared with 1999, in 2018 the rates of foregone/delayed medical care due to cost were higher for all (+3.1% among Whites, +3.1% among Blacks, +0.5% among Asians, and +2.2% among Hispanics) without significant change in gaps; rates of no usual source of care were not significantly different among Whites or Blacks but were lower among Hispanics (-4.9%) and Asians (-6.4%). CONCLUSIONS AND RELEVANCE Insurance coverage increased for all, but millions of individuals remained uninsured or underinsured with increasing rates of unmet medical needs due to cost. Those identifying as non-Hispanic Black and Hispanic continue to experience more barriers to health care services compared with non-Hispanic White individuals. KEY POINTS Question: In the last 2 decades, what has been achieved in reducing barriers to access to care and race/ethnicity-associated disparities?Findings: Using National Health Interview Survey data from 1999-2018, we found that insurance coverage increased across all 4 major race/ethnicity groups. However, rates of unmet medical needs due to cost increased without reducing the respective racial/ethnic disparities, and little-to-no change occurred in rates of individuals who have no usual source of care.Meaning: Despite increased coverage, millions of Americans continued to experience barriers to access to care, which were disproportionately more prevalent among those identifying as Black or Hispanic.
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Affiliation(s)
- César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dorothy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Oyere Onuma
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Mahajan S, Caraballo C, Lu Y, Massey D, Murugiah K, Annapureddy AR, Roy B, Riley C, Onuma O, Nunez-Smith M, Valero-Elizondo J, Forman HP, Nasir K, Herrin J, Krumholz HM. Racial and Ethnic Disparities in Health of Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999-2018. medRxiv 2020:2020.10.30.20223487. [PMID: 33173885 PMCID: PMC7654876 DOI: 10.1101/2020.10.30.20223487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Thirty-five years ago, the Heckler Report described health disparities among minority populations in the US. Since then, policies have been implemented to address these disparities. However, a recent evaluation of progress towards improving the health and health equity among US adults is lacking. OBJECTIVES To evaluate racial/ethnic disparities in the physical and mental health of US adults over the last 2 decades. DESIGN Cross-sectional. SETTING National Health Interview Survey data, years 1999-2018. PARTICIPANTS Adults aged 18-85 years. EXPOSURE Race/ethnicity subgroups (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, Hispanic). MAIN OUTCOME AND MEASURES Proportion of adults reporting poor/fair health status, severe psychological distress, functional limitation, and insufficient sleep. We also estimated the gap between non-Hispanic White and the other subgroups for these four outcomes. RESULTS We included 596,355 adults (mean age 46 years, 51.8% women), of which 69.7%, 13.8%, 11.8% and 4.7% identified as non-Hispanic White, Hispanic, non-Hispanic Black, and non-Hispanic Asian, respectively. Between 1999 and 2018, Black individuals fared worse on most measures of health, with 18.7% (95% CI 17.1-20.4) and 41.1% (95% CI 38.7-43.5) reporting poor/fair health and insufficient sleep in 2018 compared with 11.1% (95% CI 10.5- 11.7) and 31.2% (95% CI 30.3-32.1) among White individuals. Notably, between 1999-2018, there was no significant decrease in the gap in poor/fair health status between White individuals and Black (-0.07% per year, 95% CI -0.16-0.01) and Hispanic (-0.03% per year, 95% CI -0.07- 0.02) individuals, and an increase in the gap in sleep between White individuals and Black (+0.2% per year, 95% CI 0.1-0.4) and Hispanic (+0.3% per year, 95% CI 0.1-0.4) individuals. Additionally, there was no significant decrease in adults reporting poor/fair health status and an increase in adults reporting severe psychological distress, functional limitation, and insufficient sleep. CONCLUSIONS AND RELEVANCE The marked racial/ethnic disparities in health of US adults have not improved over the last 20 years. Moreover, the self-perceived health of US adults worsened during this time. These findings highlight the need to re-examine the initiatives seeking to promote health equity and improve health.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - César Caraballo
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Dorothy Massey
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
| | - Karthik Murugiah
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Amarnath R. Annapureddy
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Brita Roy
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Oyere Onuma
- Equity Research and Innovation Center, General Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Marcella Nunez-Smith
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, TX
| | - Howard P. Forman
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
- Center for Outcomes Research, Houston Methodist, TX
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT
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Affiliation(s)
| | - Howard P. Forman
- Yale School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Yale School of Management, New Haven, Connecticut
| | - Cary P. Gross
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
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Abstract
This survey study uses data from the Medical Group Management Association’s voluntary physician compensation survey from 2008 to 2017 to examine trends in compensation for primary care and specialist physicians after passage of the Affordable Care Act.
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Affiliation(s)
- Walter R. Hsiang
- Yale School of Medicine, Yale University, New Haven, Connecticut
- Yale School of Management, Yale University, New Haven, Connecticut
| | - Cary P. Gross
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut
- Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, Yale University, New Haven, Connecticut
| | | | - Howard P. Forman
- Yale School of Management, Yale University, New Haven, Connecticut
- Department of Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut
- Yale School of Public Health, Yale University, New Haven, Connecticut
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Malhotra A, Boltyenkov A, Wu X, Matouk CC, Forman HP, Gandhi D, Sanelli P. Endovascular Contact Aspiration versus Stent Retriever for Revascularization in Patients with Acute Ischemic Stroke and Large Vessel Occlusion: A Cost-Minimization Analysis. World Neurosurg 2020; 139:e23-e31. [DOI: 10.1016/j.wneu.2020.02.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
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Affiliation(s)
- Edward H. Kaplan
- Yale School of Management, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Yale School of Engineering and Applied Science, New Haven, Connecticut
| | - Howard P. Forman
- Yale School of Management, New Haven, Connecticut
- Yale School of Public Health, New Haven, Connecticut
- Yale School of Medicine, New Haven, Connecticut
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Nguyen HP, Go JA, Barbieri JS, Stough D, Stoff BK, Forman HP, Bolognia JL, Albrecht J. Dissecting drug pricing: Supply chain, market, and nonmarket trends impacting clinical dermatology. J Am Acad Dermatol 2020; 83:691-699. [PMID: 32330637 DOI: 10.1016/j.jaad.2020.04.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/01/2020] [Accepted: 04/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Harrison P Nguyen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
| | | | - John S Barbieri
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dow Stough
- Department of Dermatology, University of Arkansas Medical Science Campus, Little Rock, Arkansas
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Howard P Forman
- Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven, Connecticut
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Joerg Albrecht
- Division of Dermatology, Department of Medicine, J.H. Stroger, Jr, Hospital of Cook County, Chicago, Illinois; Department of Dermatology, Rush Medical College, Chicago, Illinois
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Abstract
The COVID-19 pandemic will have a profound impact on Radiology practices across the country. Policy measures adopted to slow the transmission of disease are decreasing the demand for imaging independent of COVID-19. Hospital preparations to expand crisis capacity are further diminishing the amount of appropriate medical imaging that can be safely performed. While economic recessions generally tend to result in decreased health care expenditures, radiology groups have never experienced an economic shock that is simultaneously exacerbated by the need to restrict the availability of imaging. Outpatient heavy practices will feel the biggest impact of these changes, but all imaging volumes will decrease. Anecdotal experience suggests that radiology practices should anticipate 50%-70% decreases in imaging volume that will last a minimum of 3-4 months, depending on the location of practice and the severity of the COVID-19 pandemic in each region. The CARES Act provides multiple means of direct and indirect aid to healthcare providers and small businesses. The final allocation of this funding is not yet clear, and it is likely that additional congressional action will be necessary to stabilize health care markets. Administrators and practice leaders need to be proactive with practice modifications and financial maneuvers that can position them to emerge from this pandemic in the most viable economic position. It is possible that this crisis will have lasting effects on the structure of the radiology field.
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Affiliation(s)
- Joseph J Cavallo
- From the Department of Radiology, Yale New Haven Hospital, 330 Cedar St, TE 2-214, New Haven, CT 06520 (J.J.C., H.P.F.); Yale School of Management, New Haven, Conn (J.J.C., H.P.F.); and Yale School of Public Health, New Haven, Conn (H.P.F.)
| | - Howard P Forman
- From the Department of Radiology, Yale New Haven Hospital, 330 Cedar St, TE 2-214, New Haven, CT 06520 (J.J.C., H.P.F.); Yale School of Management, New Haven, Conn (J.J.C., H.P.F.); and Yale School of Public Health, New Haven, Conn (H.P.F.)
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Cavallo JJ, Donoho DA, Forman HP. Hospital Capacity and Operations in the Coronavirus Disease 2019 (COVID-19) Pandemic—Planning for the Nth Patient. JAMA Health Forum 2020; 1:e200345. [DOI: 10.1001/jamahealthforum.2020.0345] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Joseph J. Cavallo
- Yale Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut
- Yale School of Management, Yale University, New Haven, Connecticut
| | | | - Howard P. Forman
- Yale Radiology and Biomedical Imaging, Yale School of Medicine, Yale University, New Haven, Connecticut
- Yale School of Management, Yale University, New Haven, Connecticut
- Yale School of Public Health, Yale University, New Haven, Connecticut
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Wang RH, Barbieri JS, Nguyen HP, Stavert R, Forman HP, Bolognia JL, Kovarik CL. Clinical effectiveness and cost-effectiveness of teledermatology: Where are we now, and what are the barriers to adoption? J Am Acad Dermatol 2020; 83:299-307. [PMID: 32035106 DOI: 10.1016/j.jaad.2020.01.065] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
There has been rapid growth in teledermatology over the past decade, and teledermatology services are increasingly being used to support patient care across a variety of care settings. Teledermatology has the potential to increase access to high-quality dermatologic care while maintaining clinical efficacy and cost-effectiveness. Recent expansions in telemedicine reimbursement from the Centers for Medicare & Medicaid Services (CMS) ensure that teledermatology will play an increasingly prominent role in patient care. Therefore, it is important that dermatologists be well informed of both the promises of teledermatology and the potential practice challenges a continuously evolving mode of care delivery brings. In this article, we will review the evidence on the clinical and cost-effectiveness of teledermatology and we will discuss system-level and practice-level barriers to successful teledermatology implementation as well as potential implications for dermatologists.
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Affiliation(s)
- Robin H Wang
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John S Barbieri
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Harrison P Nguyen
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Robert Stavert
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Howard P Forman
- Department of Public Health (Health Policy), Economics, and Management, Yale University, New Haven, Connecticut
| | - Jean L Bolognia
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Pourjabbar S, Cavallo JJ, Arango J, Tocino I, Staib LH, Imanzadeh A, Forman HP, Pahade JK. Impact of Radiologist-Driven Change-Order Requests on Outpatient CT and MRI Examinations. J Am Coll Radiol 2020; 17:1014-1024. [PMID: 31954708 DOI: 10.1016/j.jacr.2019.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/13/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess impact of electronic medical record-embedded radiologist-driven change-order request on outpatient CT and MRI examinations. METHODS Outpatient CT and MRI requests where an order change was requested by the protocoling radiologist in our tertiary care center, from April 11, 2017, to January 3, 2018, were analyzed. Percentage and categorization of requested order change, provider acceptance of requested change, patient and provider demographics, estimated radiation exposure reduction, and cost were analyzed. P < .05 was used for statistical significance. RESULTS In 79,310 outpatient studies in which radiologists determined protocol, change-order requests were higher for MRI (5.2%, 1,283 of 24,553) compared with CT (2.9%, 1,585 of 54,757; P < .001). Provider approval of requested change was equivalent for CT (82%, 1,299 of 1,585) and MRI (82%, 1,052 of 1,283). Change requests driven by improper contrast media utilization were most common and different between CT (76%, 992 of 1,299) and MRI (65%, 688 of 1,052; P < .001). Changing without and with intravenous contrast orders to with contrast only was most common for CT (39%, 505 of 1,299) and with and without intravenous contrast to without contrast only was most common for MRI (26%, 274 of 1,052; P < .001). Of approved changes in CT, 51% (661 of 1,299) resulted in lower radiation exposure. Approved changes frequently resulted in less costly examinations (CT 67% [799 of 1,198], MRI 48% [411 of 863]). CONCLUSION Outpatient CT and MRI orders are deemed incorrect in 2.9% to 5% of cases. Radiologist-driven change-order request for CT and MRI are well accepted by ordering providers and decrease radiation exposure associated with imaging.
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Affiliation(s)
- Sarvenaz Pourjabbar
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Joseph J Cavallo
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer Arango
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Irena Tocino
- Vice Chair of IT, Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence H Staib
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Amir Imanzadeh
- Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Howard P Forman
- Faculty director for Finance, Department of Radiology. Professor, Radiology and Public Health (Health Policy), Professor in the Practice of Management; Professor of Economics; Director, MD/MBA Program @ Yale; Director, Executive MBA Program (Healthcare focus area); Health Care Management Program (HCM) at Yale School of Public Health, New Haven, Connecticut
| | - Jay K Pahade
- Vice Chair of Quality and Safety, Yale Department of Radiology and Biomedical Imaging; Radiology Medical Director for Quality and Safety, Yale New Haven Health; Associate Professor, Abdominal Imaging and Ultrasound, Department of Radiology and Biomedical Imaging, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut.
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49
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Malhotra A, Wu X, Payabvash S, Matouk CC, Forman HP, Gandhi D, Sanelli P, Schindler J. Comparative Effectiveness of Endovascular Thrombectomy in Elderly Stroke Patients. Stroke 2020; 50:963-969. [PMID: 30908156 DOI: 10.1161/strokeaha.119.025031] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background and Purpose- Strokes in patients aged ≥80 years are common, and advanced age is associated with relatively poor poststroke functional outcome. The current guidelines do not recommend an upper age limit for endovascular thrombectomy (EVT). The purpose of this study is to evaluate the effectiveness of EVT in acute stroke because of large vessel occlusion for elderly patients >age 80 years. Methods- A Markov decision analytic model was constructed from a societal perspective to evaluate health outcomes in terms of quality-adjusted life years (QALYs) after EVT for acute ischemic stroke because of large vessel occlusion in patients above age 80 years. Age-specific input parameters were obtained from the most recent/comprehensive literature. Good outcome was defined as a modified Rankin Scale score ≤2. Probabilistic, 1-way, and 2-way sensitivity analyses were performed for both healthy patients and patients with disability at baseline. Results- Base case calculation showed in functionally independent patients at baseline, intravenous thrombolysis (IVT) with tPA (tissue-type plasminogen activator) only to be the better strategy with 3.76 QALYs compared to 2.93 QALYs for patients undergoing EVT. The difference in outcome is 0.83 QALY (equivalent to 303 days of life in perfect health). For patients with baseline disability, IVT only yields a utility of 1.92 QALYs and EVT yields a utility of 1.65 QALYs. The difference is 0.27 QALYs (equivalent to 99 days of life in perfect health). Multiple sensitivity analyses showed that the effectiveness of EVT is significantly determined by the morbidity and mortality after both IVT and EVT strategies, respectively. Conclusions- Our study demonstrates the impact of relevant factors on the effectiveness of EVT in patients above 80 years of age. Morbidity and mortality after both IVT and EVT strategies significantly influence the outcomes in both healthy and disabled patients at baseline. Better identification of patients not benefiting from IVT would optimize the selective use of EVT thereby improving its effectiveness.
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Affiliation(s)
- Ajay Malhotra
- From the Department of Radiology and Biomedical Imaging (A.M., X.W., S.P., C.C.M., H.P.F.), Yale University School of Medicine, New Haven, CT
| | - Xiao Wu
- From the Department of Radiology and Biomedical Imaging (A.M., X.W., S.P., C.C.M., H.P.F.), Yale University School of Medicine, New Haven, CT
| | - Seyedmehdi Payabvash
- From the Department of Radiology and Biomedical Imaging (A.M., X.W., S.P., C.C.M., H.P.F.), Yale University School of Medicine, New Haven, CT
| | - Charles C Matouk
- From the Department of Radiology and Biomedical Imaging (A.M., X.W., S.P., C.C.M., H.P.F.), Yale University School of Medicine, New Haven, CT.,Department of Neurosurgery (C.C.M.), Yale University School of Medicine, New Haven, CT
| | - Howard P Forman
- From the Department of Radiology and Biomedical Imaging (A.M., X.W., S.P., C.C.M., H.P.F.), Yale University School of Medicine, New Haven, CT.,Department of Economics, Management, and Public Health (H.P.F.), Yale University School of Medicine, New Haven, CT
| | - Dheeraj Gandhi
- Interventional Neuroradiology, Nuclear Medicine, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore (D.G.)
| | - Pina Sanelli
- and Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY (P.S.)
| | - Joseph Schindler
- Division of Vascular Neurology (J.S.), Yale University School of Medicine, New Haven, CT
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Trinh B, Calabrese E, Vu T, Forman HP, Haas BM. Low-Volume and High-Volume Readers of Neurological and Musculoskeletal MRI: Achieving Subspecialization in Radiology. J Am Coll Radiol 2019; 17:314-322. [PMID: 31883842 DOI: 10.1016/j.jacr.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/01/2019] [Accepted: 10/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Differentiate high- versus low-volume radiologists who interpret neurological (Neuro) MRI or musculoskeletal (MSK) MRI and measure the proportion of Neuro and MSK MRIs read by low-volume radiologists. METHODS We queried the 2015 Medicare Physician and Other Supplier Public Use File for radiologists who submitted claims for Neuro or MSK MRIs. Radiologists were classified as high-volume versus low-volume based on their work relative value units (wRVUs) focus or volume of studies interpreted using three different methodologies: Method 1, percentage of wRVUs in Neuro or MSK MRI; Method 2, absolute number of Neuro or MSK MRIs interpreted; and Method 3, both percentage and absolute number. Multiple thresholds with each methodology were tested, and the percentage of Neuro or MSK MRIs interpreted by low-volume radiologists was calculated for each threshold. RESULTS With Method 1, 33% of Neuro MRI and 50% of MSK MRI studies were interpreted by a radiologist whose wRVUs in Neuro or MSK MRI were less than 20% (Method 1). With Method 2, 22% of Neuro MRIs and 37% of MSK MRIs were interpreted by radiologists who read fewer than the mean number of Neuro or MSK MRIs interpreted by an "average full-time radiologist" whose wRVUs in Neuro or MSK MRI were approximately 20%. With Method 3, 38% of Neuro MRIs and 57% of MSK MRIs were interpreted by "low-volume" radiologists. If instead a 50% wRVU threshold is used for Methods One, Two, and Three, then 70%, 58%, and 77% of Neuro MRIs and 86%, 80%, and 90% of MSK MRIs are read by low-volume radiologists. DISCUSSION A large number of radiologists read a low volume of Neuro or MSK MRIs; these low-volume Neuro or MSK MRI radiologists read a substantial portion of Neuro or MSK MRIs. It is unknown which of the methods for distinguishing low-volume radiologists, combined with which threshold, may best correlate with high-performing or low-performing radiologists.
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Affiliation(s)
- Brian Trinh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Evan Calabrese
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Thienkhai Vu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| | - Howard P Forman
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Brian M Haas
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California.
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