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Comparative Effectiveness Research in Radiology

Patients, Physicians and Policy Makers
Published:March 21, 2011DOI:https://doi.org/10.1016/j.acra.2011.01.021
      Health care costs continue to rise, with significant geographic differences in spending on health care and outcomes within the United States. The goal of comparative effectiveness research is to reduce health care spending without adversely effecting overall health according to the Congressional Budget Office. There are unique challenges and barriers to applying comparative effectiveness research to radiology, including rapidly changing technology, complex multistep care processes, and the burden of proving the impact of a diagnostic exam on patient outcome. Radiology shares other challenges of acceptance of comparative effectiveness research results (diffusion of new knowledge and successful implementation of changes in clinical practice) with all of health care, but with the added complication that radiologists do not order radiology exams.

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      References

        • Hillman B.J.
        • Goldsmith J.C.
        The Sorcerer’s Apprentice.
        Oxford University Press, New York2011
        • Fuchs V.R.
        • Sox Jr., H.C.
        Physician’s views of the relative importance of thirty medical innovations.
        Health Aff (Millwood). 2008; 20: 30-42
      1. US Government Accountability Office. Medicare Part B imaging services: rapid spending growth and shift to physician offices indicate need for CMS to consider additional management practices. Available at: http://www.gao.gov/new.items/d08452.pdf. Accessed November 14, 2010.

      2. Institute of Medicine. Report brief: initial national priorities for comparative effectiveness research. Available at: http://www.iom.edu/cerpriorities. Accessed November 7, 2010.

      3. Federal Coordinating Council for Comparative Effectiveness Research. Report to the president and Congress. Available at: http://www.hhs.gov/recovery/programs/cer/cerannualrpt.pdf. Accessed November 14, 2010.

      4. Society for Medical Decision Making. Background paper on comparative effectiveness research. Available at: http://www.smdm.org/documents/SMDMCERStatementMay2009_002.pdf. Accessed November 14, 2010.

      5. Congressional Budget Office. CBO research on the comparative effectiveness of medical treatments: issues and options for an expanded federal role. Available at: http://www.cbo.gov/ftpdocs/88xx/doc8891/12-18-ComparativeEffectiveness.pdf. Accessed November 14, 2010.

        • Wennberg J.
        • Gittelsohn A.
        Variations in medical care in small areas.
        Sci Am. 1982; 246: 120-134
      6. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2009 with special feature on medical technology. Available at: http://www.cdc.gov/nchs/data/hus/hus09.pdf. Accessed November 7, 2010.

      7. PricewaterhouseCoopers Health Research Institute. The price of excess: identifying waste in healthcare spending. Available at: http://www.pwc.com/us/en/healthcare/publications/the-price-of-excess.jhtml. Accessed March 1, 2010.

        • Pandharipande P.V.
        • Gazelle G.S.
        Comparative effectiveness research: what it means for radiology.
        Radiology. 2009; 253: 600-605
        • Hollingworth W.
        Radiology cost and outcomes studies: standard practice and emerging methods.
        AJR Am J Roentgenol. 2005; 185: 833-839
        • Lee D.W.
        • Foster D.A.
        The association between hospital outcomes and diagnostic imaging: early findings.
        J Am Coll Radiol. 2009; 6: 780-785
        • Batlle J.C.
        • Hahn P.F.
        • Thrall J.H.
        • et al.
        Patients imaged early during admission demonstrate reduced length of hospital stay: a retrospective cohort study of patients undergoing cross-sectional imaging.
        J Am Coll Radiol. 2010; 7: 269-276
        • Brandt-Zawadski M.
        • Kerlan R.K.
        Patient-centered radiology: use it or lose it!.
        Acad Radiol. 2009; 16: 521-523
        • Neiman H.L.
        Face of Radiology campaign.
        Acad Radiol. 2009; 16: 517-520
        • Pearson S.D.
        • Bach P.B.
        How Medicare could use comparative effectiveness research in deciding on new coverage and reimbursement.
        Health Aff (Millwood). 2010; 29: 1796-1804
        • Daschle T.
        • Greenberger S.S.
        • Lambrew J.M.
        Critical: What We Can Do About the Health-Care Crisis.
        Thomas Dune, New York2008
        • Johnson C.D.
        • Chen M.-H.
        • Toledano A.Y.
        • et al.
        Accuracy of CT colonography for detection of large adenomas and cancers.
        N Engl J Med. 2008; 359: 1207-1217
        • Dhruva S.D.
        • Phurrough S.E.
        • Salive M.E.
        • et al.
        CMS’s landmark decision on CT colonography—examining the relevant data.
        N Engl J Med. 2009; 360: 2699-2701
        • Thorpe K.E.
        • Howard D.H.
        The rise in spending among Medicare beneficiaries: the role of chronic disease prevalence and changes in treatment intensity.
        Health Aff (Millwood). 2006; 25: w378-w388
        • Hillman B.J.
        Coke vs Pepsi.
        J Am Coll Radiol. 2009; 6: 666
      8. US Preventive Services Task Force. Screening for breast cancer: recommendation statement. Available at: http://www.uspreventiveservicestaskforce.org/uspstf09/breastcancer/brcanrs.htm. Accessed November 8, 2010.

        • Hillman B.J.
        The problem with CER.
        J Am Coll Radiol. 2010; 7: 241-242
        • Sistrom C.L.
        • Dang P.A.
        • Weilburg J.B.
        • et al.
        Effect of Computerized order entry with integrated decision support on the growth of outpatient procedure volumes: seven-year time series analysis.
        Radiology. 2009; 251: 147-155
        • Rogers E.M.
        Diffusion of Innovation.
        Free Press, New York1995
        • Stiell I.G.
        • Greenberg G.H.
        • McKnight R.D.
        • et al.
        Decision rules for the use of radiography in acute ankle injuries: refinement and prospective validation.
        JAMA. 1993; 269: 1127-1132
        • Hejblum G.
        • Chalumeau-Lemoine L.
        • Ioos V.
        • et al.
        Comparison of routine and on-demand prescription of chest radiography in mechanically ventilated adults: a multicentre, cluster-randomized, two-period crossover study.
        Lancet. 2009; 374: 1687-1693
        • Grimshaw J.M.
        • Eccles M.P.
        • Walker A.E.
        Changing physicians’ behavior: what works and thoughts on getting more things to work.
        J Contin Educ Health Prof. 2002; 22: 237-243
        • Institute of Medicine, Committee on Quality of Health Care in America
        Crossing the Quality Chasm: A New Health System for the 21st Century.
        National Academy Press, Washington, DC2001
        • Smith W.R.
        Evidence for the effectiveness of techniques to change physician behavior.
        Chest. 2000; 118: 8S-17S
        • Kessler D.
        • McClellan M.
        Do doctors practice defense medicine?.
        Q J Econ. 1996; 111: 353-390
      9. Congressional Budget Office. Key issues in analyzing major health insurance proposals. Available at: http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf. Accessed November 7, 2010.

      10. Massachusetts Medical Society. Investigation of defensive medicine in Massachusetts. Available at: http://www.massmed.org/AM/Template.cfm?Section=Professional_Liability&CONTENTID=23557&TEMPLATE=/CM/ContentDisplay.cfm. Accessed November 7, 2010.

        • Chassin M.R.
        • Loeb J.M.
        • Schmaltz S.P.
        • et al.
        Accountability measures—using measurement to promote quality.
        N Engl J Med. 2010; 363: 683-688
      11. Rumberger JS, Hollenbeak CS, Kline D. Potential costs and benefits of smoking cessation in the United States. Available at: http://www.lungusa.org/stop-smoking/tobacco-control-advocacy/reports-resources/cessation-economic-Benefits/reports/SmokingCessationTheEconomicBenefits.pdf. Accessed October 7, 2010.

      12. US Preventive Services Task Force. Screening for obesity in children and adolescents. Available at: http://www.uspreventiveservicestaskforce.org/uspstf10/childobes/chobesrs.htm. Accessed November 7, 2010.

      13. Massachusetts Hospital Association. MHA policy to not hire tobacco-users. Available at: http://www.mhalink.org/AM/Template.cfm?Section=Newsroom&template=/CM/ContentDisplay.cfm&contentid=13254. Accessed November 10, 2010.