The Effect of Advanced Diagnostic Imaging on Mortality and Length of Stay in Tehran General University Hospitals
Abstract
Background: As fast and accurate techniques, advanced medical imaging technologies (AMIT) allow healthcare professionals to better diagnose and treat various health conditions, which translates into higher use of non-invasive operational procedures. Objectives: The current study intended to investigate the effect of inpatient use of MRI and CT scan on the inpatient mortality and length of stay (LOS) in Tehran general university hospitals.
Methods: Data were collected from all general university hospitals in Tehran in 2017. A multiple linear regression model was constructed for each combination of technology and outcomes (i.e., mortality and LOS), and all models were controlled for patients’ demographic and clinical characteristics and structural profile of hospitals. In calculating hospital standardized mortality ratio (HSMR) for each of 72 diagnosis groups related to death, a binary logistic regression model was fitted with predictors including LOS, admission type, comorbidity level, sex, and age.
Results: The use of CT varied from 0.39 to 149.35, and MRI from 0.24 to 80.23 exams per 100 discharges. The HSMR ranged from 76.8% to 146%, and the average length of stay (ALOS) was 3 - 8.46 days. MRI and CT had no significant effect on the HSMR and ALOS.
Conclusions:Further use of AMIT was not linked with improved efficiency and quality but was associated with better resource management in healthcare organizations. Effective management of the AMIT use requires clear rules and regulations with assertive commitment, in addition to establishing clinical guidelines with the support of insurance companies.
References
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1. Heidenreich PA. Assessing the value of a diagnostic test. Archives of Internal Medicine. 2009;169:1262-1264.doi:10.1001/archinternmed.2009.208.
2. Lee DW, Foster DA. The association between hospital outcomes and diagnostic imaging: early findings. Journal of the American College of Radiology.2009;6:780-785. doi: 10.1016/j.jacr.2009.08.007.
3. Hillman BJ, Goldsmith JC. The uncritical use of high technology medical imaging. New England Journal of Medicine. 2010;361:4-6. doi:10.1056/NEJMp1003173.
4. America’s Health Insurance Plans. Ensuring Quality through Appropriate Use of Diagnostic Imaging. Washington, DC: AHIP;2008.
5. Flynn TW, Smith B, Chou R. Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as much harm as good. J Orthop Sports Phys Ther .2011;41:838-846. doi:10.2519/jospt.2011.3618.
6. Zargar Balaye Jame S. Evidence informed policy making in selection, importing and use of advanced medical technologies and factors affecting in (dissertation). Health College, university of Tehran medical of science; 2013.
7. Salari H, Ostovar R, Esfandiari A, Keshtkaran A, Sari AA, Manesh HY, et al. Evidence for policy making: clinical appropriateness study of lumbar spine MRI prescriptions using RAND appropriateness method. Int J Health Policy Manag. 2013;1:17. doi:10.15171/ijhpm.2013.04.
8. Ebrahimipour H, Mirfeizi SZ, Vejdani M, Vafaee-Najar A, Kachooei AR, Ariamanesh As, et al. Evaluation of Medical costs resulting from Magnetic Resonance Imaging inappropriate prescriptions for Knee joint, using RAND Method in Ghaem Hospital- 2013. Hakim Research Journal. 2015;17:278-286.
9. Baker LC, Atlas SW, Afendulis CC. Expanded use of imaging technology and the challenge of measuring value. Health Affairs.2008;27:1467-1478. doi:10.1377/hlthaff.27.6.1467.
10. Garcés GAS. Adoption and use of high dent tech medical imaging in Ontario hospitals: the determinants of adoption and the relationship between use and in‐patient mortality and length of stay (dissertation). Institute of Health Policy Management and Evaluation, University of Toronto; 2014.
11. Hearld LR, Alexander JA, Fraser I, Jiang J. How do hospital organizational structure and processes affect quality of care? A critical review of research methods. Medical Care Research and Review. 2008;65:259-299. doi:10.1177/1077558707309613.
12. Lipitz-Snyderman A, Steinwachs D, Needham DM, Colantuoni E, Morlock LL, Pronovost PJ. Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis. BMJ. 2011;342. doi:https://doi.org/10.1136/bmj.d219
13. Abedini Z, Sari AA, Foroushani AR, Jaafaripooyan E. Diffusion of advanced medical imaging technology, CT, and MRI scanners, in Iran: A qualitative study of determinants. Int J Health Plann Mgmt. 2018;1–14. doi:10.1002/hpm.2657.
14. OECD/EU. Health at a Glance: Europe 2016 ‐ State of Health in the EU Cycle OECD Publishing Paris, 2016; Available from: https://www.oecd.org/els/health-systems/Health-at-a-Glance-Europe-2016-CHARTSET.pdf.
15. Canadian Institute for Health Information (CIHI). Hospital Standardized Mortality Ratio. Technical Notes, 2016; Available from: https://www.cihi.ca/sites/default/files/document/hsmr-tech-notes-sept-2019-en-web.pdf
16. Canadian Institute for Health Information. DAD Resource Intensity Weights and Expected Length of Stay for CMG+ 2009. Case Mix. Ottawa, Ontario: CIHI, 2009; Available from: https://www.cihi.ca/en/resource-indicators-dad-resource-intensity-weights-and-expected-length-of-stay.
17. Lysdahl KB, Børretzen I. Geographical variation in radiological services: a nationwide survey. BMC health services research. 2OO7;7:1-11.doi:https://doi.org/10.1186/1472-6963-7-21.
18. Olsson S. Diffusion, utilization and regional variation in the use of CT and MRI in Sweden. Comput Methods Programs Biomed. 2001;66:129-35. doi:10.1016/s0169-2607(01)00155-9.
19. Kung PT, Tsai WC, Yaung CL, Liao KP. Determinants of computed tomography and magnetic resonance imaging utilization in Taiwan. International journal of technology assessment in health care. 2005;21:81-88. doi:10.1017/S0266462305050105.
20. Cournane S, Creagh D, Hare N, Sheehyc N, Silke B. MRI in Acutely Ill Medical Patients in an Irish Hospital: Influence on Outcomes and Length of Hospital Stay. Journal of the American College of Radiology. 2014;11:698-702. doi:10.1016/j.jacr.2014.01.014.
21. Safavi KC, Li SX, Dharmarajan K, Venkatesh AK, Strait KM, Lin H. Hospital variation in the use of noninvasive cardiac imaging and its association with downstream testing, interventions, and outcomes. JAMA Internal Medicine. 2014;174:546-553. doi: 10.1001/jamainternmed.2013.14407.
22. Battle JC, Hahn PF, Thrall JH, Lee SI. Patients imaged early during admission demonstrate reduced length of hospital stay: a retrospective cohort study of patients undergoing cross-sectional imaging. Journal of the American College of Radiology. 2010;7:269-276. doi: 10.1016/j.jacr.2009.11.024.
23. Brandt M, Walluscheck KP, Jahnke T, Graw K, Cremer J, Hülsbeck SM. Endovascular repair of ruptured abdominal aortic aneurysm: feasibility and impact on early outcome. Journal of vascular and interventional radiology. 2005;16:1309-1312. doi: 10.1097/01.RVI.0000175332.44635.49.
24. Varlotto JM, Flickinger JC, Niranjan A, Bhatnagar A, Kondziolka D, Lunsford LD. The impact of whole-brain radiation therapy on the long-term control and morbidity of patients surviving more than one year after gamma knife radiosurgery for brain metastases. International Journal of Radiation Oncology* Biology* Physics. 2005;62:1125-1132. doi:10.1016/j.ijrobp.2004.12.092.
25. Sistrom CL. The appropriateness of imaging: a comprehensive conceptual framework. Radiology. 2009; 251:367-649. doi:10.1148/radiol.2513080636.
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| Issue | Vol 4, No 4 (2020) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/htaa.v4i4.6870 | |
| Keywords | ||
| Advanced Diagnostic Imaging Mortality Length of Stay Tehran General Hospitals | ||
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How to Cite
1.
Jaafaripooyan E, Akbari sari A, Rahimiforoushani A, Abedini Z. The Effect of Advanced Diagnostic Imaging on Mortality and Length of Stay in Tehran General University Hospitals. Health Tech Ass Act. 2021;4(4).
