Physical diagnosis versus modern technology. A review.
(17/28)
The role of physical diagnosis in an age of modern diagnostic technology has been evaluated by investigators assessing specific techniques in a number of areas, though there has been no systematic comprehensive study of the sensitivity, specificity, cost-benefit ratio, and reliability of physical diagnosis relative to technologic diagnostic tools. In a review of published studies comparing physical with nonphysical diagnostic techniques, the startling accuracy of physical diagnosticians in some areas contrasts sharply with the extremely poor correlation of physical findings with autopsy or imaging studies in others. In a time of constricting financial resources, physicians-and those who teach or judge physicians' skills-must begin to compare physical and nonphysical diagnostic techniques rigorously so that the best, safest, and least expensive diagnostic test is chosen in each clinical situation. (+info)
A technology solution for the high-tech diagnostic imaging conundrum.
(18/28)
OBJECTIVES: (1) To describe a unique initiative to implement a standardized system of electronic decision support for ambulatory orders for hightech diagnostic imaging (HTDI) statewide, and (2) to evaluate the impact of a pilot version of that system, plus prior notification on the volume of such orders. STUDY DESIGN: Description of the initiative and analysis of aggregated claims data. METHODS: Claims data for HTDI studies were aggregated from the main health plans in the state from 2003 to 2010 by the regional quality improvement collaborative that also facilitated the pilot and subsequent initiative being implemented in 2011 throughout Minnesota. RESULTS: Aggregate ambulatory statewide orders for HTDI tests increased from 32 to 41 per 1000 members from 2003 to 2006 (9% per year) at which point the rate leveled off through 2010. This trajectory change was simultaneous with implementation of an electronic medical record-based decision-support system for all ambulatory HTDI orders from 45% of the physicians in the state, as well as a prior notification/authorization approach by payers for the rest of the HTDI orders. CONCLUSIONS: Although it is not possible to disentangle the effects of these separate approaches, the much greater physician acceptance of the decision support system has led payers to financially support the creation of a unique statewide implementation of a version of this system to replace prior notification/authorization approaches. (+info)
A framework for clinical evaluation of diagnostic technologies.
(19/28)
Most new diagnostic technologies have not been adequately assessed to determine whether their application improves health. Comprehensive evaluation of diagnostic technologies includes establishing technologic capability and determining the range of possible uses, diagnostic accuracy, impact on the health care provider, therapeutic impact and impact on patient outcome. Guidelines to determine whether each of these criteria have been met adequately are presented. Diagnostic technologies should be disseminated only if they are less expensive, produce fewer untoward effects and are at least as accurate as existing methods, if they eliminate the need for other investigations without loss of accuracy, or if they lead to institution of effective therapy. Establishing patient benefit often requires a randomized controlled trial in which patients receive the new test or an alternative diagnostic strategy. Other study designs are logistically less difficult but may not provide accurate assessment of benefit. Rigorous assessment of diagnostic technologies is needed for efficient use of health care resources. (+info)
Hospital adoption of medical technology: an empirical test of alternative models.
(20/28)
OBJECTIVE: This study examines hospital motivations to acquire new medical technology, an issue of considerable policy relevance: in this case, whether, when, and why hospitals acquire a new capital-intensive medical technology, magnetic resonance imaging equipment (MRI). STUDY DESIGN: We review three common explanations for medical technology adoption: profit maximization, technological preeminence, and clinical excellence, and incorporate them into a composite model, controlling for regulatory differences, market structures, and organizational characteristics. All four models are then tested using Cox regressions. DATA SOURCES: The study is based on an initial sample of 637 hospitals in the continental United States that owned or leased an MRI unit as of 31 December 1988, plus nonadopters. Due to missing data the final sample consisted of 507 hospitals. The data, drawn from two telephone surveys, are supplemented by the AHA Survey, census data, and industry and academic sources. PRINCIPAL FINDING: Statistically, the three individual models account for roughly comparable amounts of variance in past adoption behavior. On the basis of explanatory power and parsimony, however, the technology model is "best." Although the composite model is statistically better than any of the individual models, it does not add much more explanatory power adjusting for the number of variables added. CONCLUSIONS: The composite model identified the importance a hospital attached to being a technological leader, its clinical requirements, and the change in revenues it associated with the adoption of MRI as the major determinants of adoption behavior. We conclude that a hospital's adoption behavior is strongly linked to its strategic orientation. (+info)
Service mix in the hospital outpatient department: implications for Medicare payment reform.
(21/28)
OBJECTIVE: To determine if implementation of a PPS for Medicare hospital outpatient department (HOPD) services will have distributional consequences across hospital types and regions, this analysis assesses variation in service mix and the provision of high-technology services in the HOPD. DATA: HCFA's 1990 claims file for a 5 percent random sample of Medicare beneficiaries using the HOPD was merged, by hospital provider number, with various HCFA hospital characteristic files. STUDY DESIGN: Hospital characteristics examined are urban/rural location, teaching status, disproportionate-share status, and bed size. Two analyses of HOPD services are presented: mix of services provided and the provision of high-technology services. The mix of services is measured by the percentage of services in each of 14 type-of-service categories (e.g., medical visits, advanced imaging services, diagnostic testing services). Technology provision is measured by the percentage of hospitals providing selected high-technology services. FINDINGS/CONCLUSIONS: The findings suggest that the role hospital types play in providing HOPD services warrants consideration in establishing a PPS. HOPDs in major teaching hospitals and hospitals serving a disproportionate share of the poor play an important role in providing routine visits. HOPDs in both major and minor teaching hospitals are important providers of high-technology services. Other findings have implications for the structure of an HOPD PPS as well. First, over half of the services provided in the HOPD are laboratory tests and HOPDs may have limited control over these services since they are often for patients referred from local physician offices. Second, service mix and technology provision vary markedly among regions, suggesting the need for a transition to prospective payment. Third, the organization of service supply in a region may affect service provision in the HOPD suggesting that an HOPD PPS needs to be coordinated with payment policies in competing sites of care (e.g., ambulatory surgical centers). (+info)
The privatization of Canadian health care is moving into high gear.
(22/28)
The future of Canada's public health care system has been the source of much debate in the past year. Several signs, ranging from laser-surgery clinics in Ontario to the possible opening of a new private hospital in Toronto, indicate that the trend toward privatization is growing. Dr. Hugh Scully, former chair of a CMA working group that looked at the issue, expects the trend toward privatization to continue because "it simply isn't the case that the coverage people have come to expect will continue to be provided through the public purse." Dr. Jeffery Machat, a laser-surgery specialist from Windsor, Ont., thinks privatization brings needed investment to Canada's health care system. (+info)
Access to hospitals with high-technology cardiac services: how is race important?
(23/28)
OBJECTIVES: Relatively few hospitals in the United States offer high-technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services. METHODS: Records of 11,410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed. RESULTS: Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and "distance-adjusted" probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital. CONCLUSIONS: Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals. (+info)
The dynamics of technological change in medicine.
(24/28)
This paper contrasts a dynamic and interactive view of technological change with the linear model of medical innovation that is still so deeply ingrained in many policy discussions. In particular, it focuses on the role of feedback mechanisms between the users and the developers of medical technology and the demand and supply forces (including competition among medical specialties) determining this feedback. It explores three distinct mechanisms by which technological change may contribute to rising health care spending: intensity of use of existing technology, introduction of new technologies, and expanded application of these new technologies. (+info)