1 Department of Radiology, NYU Langone Medical Center, 660 First Ave, New York, NY 10016.
2 Hackensack Radiology Group, River Edge, NJ.
AJR Am J Roentgenol. 2018 Dec;211(6):1278-1282. doi: 10.2214/AJR.18.19885. Epub 2018 Oct 9.
The purpose of this study is to assess downstream costs associated with pancreatic cysts incidentally detected at MRI.
Two hundred patients with an incidental pancreatic cyst detected at MRI were identified. Downstream events (imaging, office visits, endoscopic ultrasound-guided fine-needle aspiration, or chemotherapy) were identified from the electronic medical record. Radiologists' recommendations and ordering physician management were classified relative to the American College of Radiology (ACR) incidental findings committee recommendations. Costs for the downstream events were estimated using national Medicare rates and a 3% annual discount rate. Mean costs were computed.
Estimated downstream costs averaged $460 per cyst ($872 per cyst with any follow-up testing). Nine patients had a clinically relevant outcome during follow-up (increase in cyst size, development of new cyst, or development of pancreatic cancer). Downstream cost per cyst with a clinically relevant outcome was $1364. Costs were greater when ordering physicians overmanaged ($842) versus when they were adherent ($631) or undermanaged ($252) relative to radiologist recommendation. Although costs were $252 when ordering physicians undermanaged relative to ACR incidental findings committee recommendations, costs were similar when ordering physicians were adherent ($811) or overmanaged ($845) relative to ACR incidental findings committee recommendations. Costs did not vary significantly according to whether radiologists recommended follow-up testing ($317-$491) or whether radiologist recommendations were adherent, undermanaged, or overmanaged relative to ACR incidental findings committee recommendations ($344-$528).
The findings suggest a role for targeted educational efforts, collaborative partnerships, and other initiatives to foster greater adherence to radiologist recommendations, including critical test results notification systems, automated reminders within electronic health systems, and stronger language within radiology reports when no follow-up testing is recommended.
本研究旨在评估 MRI 偶然发现的胰腺囊肿相关的下游成本。
本研究共纳入 200 例 MRI 偶然发现胰腺囊肿的患者。从电子病历中确定下游事件（影像学检查、门诊就诊、内镜超声引导下细针抽吸或化疗）。根据美国放射学院（ACR）偶然发现委员会的建议，对放射科医生的建议和开单医生的管理进行分类。使用国家医疗保险费率和 3%的年度贴现率来估算下游事件的成本。计算平均成本。
估计的下游成本平均为每个囊肿 460 美元（有任何后续检查的每个囊肿为 872 美元）。9 例患者在随访期间出现临床相关结果（囊肿增大、新囊肿形成或胰腺癌发生）。有临床相关结果的每个囊肿的下游成本为 1364 美元。与放射科医生的建议相比，当开单医生过度管理（842 美元）时，成本更高，而当他们遵守（631 美元）或管理不足（252 美元）时，成本较低。尽管与 ACR 偶然发现委员会的建议相比，当开单医生管理不足时成本为 252 美元，但当他们遵守（811 美元）或过度管理（845 美元）时，成本与 ACR 偶然发现委员会的建议相似。根据放射科医生是否建议进行后续检查（317-491 美元）或放射科医生的建议是否遵守、管理不足或过度管理相对于 ACR 偶然发现委员会的建议（344-528 美元），成本差异并不显著。
这些发现表明，需要有针对性的教育努力、合作伙伴关系和其他举措来促进对放射科医生建议的更大程度的遵守，包括关键检测结果通知系统、电子健康系统中的自动提醒以及在不建议进行后续检查时在放射科报告中使用更强烈的语言。
