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CT, MRI Use in Emergency Departments Soaring

Roxanna Guilford-Blake for HealthLeaders Media, October 8, 2010

"We need to continually examine our practices to determine how best we can continue to provide high-quality patient care in a cost-effective manner," lead author Frederick Kofi Korley, MD, of the department of emergency medicine at Johns Hopkins University in Baltimore, said in an interview with HealthLeaders.

A. Mark Fendrick, co-director of the University of Michigan's Center for Value-Based Insurance Design in Ann Arbor, agreed, saying that such an examination will require coming to terms with an acceptable miss rate.

"What seems to be absent is a transparent discussion examining the tradeoffs between the clinical and cost implications of increased use and an unwillingness to miss a potentially treatable condition," he said. "We do not have the resources to be sure in every instance that the patient does not have a treatable condition."

The JAMA findings align with findings of research Fendrick and his colleagues published last year in which they concluded that CT scans in dizziness presentations should "be a target for efforts to optimize the effectiveness and efficiency of care."

The message is the same for the JAMA study: "What we try to do in VBID is to be as clinically nuanced as possible," Fendrick explains. A severe concussion is different from an ankle injury. "The value of a clinical service depends on the indication and the patient receiving it."

That approach appears to be gaining traction. "I am very optimistic that the multi-billion dollar investment in comparative-effectiveness research and, more importantly, health information technology, will allow for the development of real-time clinical decision support tools that will allow increased use of these services when they are truly beneficial, and a decreased use when they are less so."

See also:

The Technology to Order the Right Imaging Test the First Time

Doctors Need Decision Support in Ordering Imaging Diagnostics

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2 comments on "CT, MRI Use in Emergency Departments Soaring"


cgutbezahl (10/8/2010 at 10:03 AM)
An alternative interpretation of the results is not concern that greater use hasn't improved diagnostic rates, but that increased use has not degraded the value of the test. Often when a new technology gains widespread use, the original benefits are lost as the technology is spread to a less well defined patient population. In this case, wider use was associated with a slightly improved yield rate. Another interesting finding is that comparing this data with reports that claim that the cost of defensive medicine is low. There could be many reasons for the discrepancy but most significantly is that the data showing increased usage in EDs is objective claims based, while the report that claims that defensive medicine costs are low relies on subjective interpretation rather than quantifiable data.

Donald (10/8/2010 at 9:57 AM)
Most doctors I know would say an acceptable "miss rate" is 0%. So when is a miss acceptable? When it isn't you being missed. That's the problem with evidenced-based research - it sounds good, but oddly enough, those who advocate for it are also more likely to believe health care is a right - that's some pretty strong cognitive dissonance. Just can't have it both ways. If health care is a right, then no room exists for a miss rate.