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Comparative Effectiveness Research: A Necessary Tool for Implementing Imaging 3.0.
Radiologists should know the cost effectiveness and the risks-benefits of all tests they have juristiction over.
As a part of my attendance at AIRP this August, I had the opportunity to participate in the “Introduction to Comparative Effectiveness Research and Big Data Analytics for Radiology” mini-course, a new seminar created to illustrate how comparative effectiveness research can be applied to the practice of radiology. The course is supported by the Value of Imaging through Comparative Effectiveness (VOICE) program at New York University and grants from the National Institute of Health.
Presentations and discussions took place over two evenings during the first week of AIRP and were primarily led by Stella Kang, MD and Pina Sanelli, MD, MPH, FACR, two radiologists who are experts in comparative effectiveness research (CER). Sessions were mostly short, informal discussions designed to introduce attendees to basic concepts of CER and how they can be applied to address critical problems in health care.
The National Academy of Medicine defines comparative effectiveness as "the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels.”1 Those working in CER attempt to quantify the impact of our interventions using outcomes-based metrics. During the mini-course, Sanelli described it as “efficiency metrics in an effectiveness world” and Kang suggested CER is a tool to find the “intersection of efficacy and value.” While much of research in medicine is focused on clinical trials and technologic developments, CER is an attempt to apply those developments in real-world clinical settings.
In the Imaging 3.0 ® world of value-based practice and patient-centered care, comparative effectiveness methods provide a valuable opportunity to quantify exactly what sort of “value” radiologists can provide. One study from as early as 2001 suggested a potential savings of $1.2 billion per year from the use of CT angiography and CT perfusion studies in patients with acute cerebrovascular accident.2 Without access to this data, we are limited as radiologists in how to advocate best practices for our patients, as well as how to make the case for our own value as physicians. Charalel et al describes it aptly: “The value provided by the radiologist must be demonstrated to patients and the medical community. Failure to do so will risk the commoditization of imaging and places radiology in an unfavorable position as health care continues to transition to accountable, bundled care.”3
Additionally, CER provides an opportunity for more personalized and patient-centered radiology. By working with both patients and referring clinicians, radiologists can facilitate evidence-based decision-making and tailor care to the individual patient.4 Taking the time to provide education on predictive value of various imaging studies and protocols is not only useful for guiding care and possible therapies, but also improves cost effectiveness by eliminating unnecessary tests and reduces patient anxiety.
While we are not all experts in Bayesian analysis, familiarity with the principles of comparative effectiveness, and how they apply to interventions we offer patients, is a valuable tool. Radiologists can help guide development of personalized, data-driven medicine that embodies the Imaging 3.0 ® principles laid out by the ACR, but we must demonstrate that we can improve outcomes for both patients’ health and their wallets.
By Nathan Coleman, MD, radiology resident at Indiana University School of Medicine, Indianapolis
1. What Is Comparative Effectiveness Research?." Institute of Medicine. 2009. Initial National Priorities for Comparative Effectiveness Research. Washington, DC: The National Academies Press. doi: 10.17226/12648.
2. Charalel RA, Hentel KD, Min RJ, and Sanelli PC. Adding value to health care: where radiologists may contribute. AJNR Am J Neuroradiol. 2014;35(10):1883–1884. doi:10.3174/ajnr.A4068.
3. Gleason S, Furie KL, Lev MH, et al. Potential influence of acute CT on inpatient costs in patients with ischemic stroke. Acad Radiol. 2001;8(10):955–964. doi:10.1016/s1076-6332(03)80639-6.
4. Kang SK, Fagerlin A, and Braithwaite RS. A Roadmap for Personalized Care in Radiology. Radiology. 2015;277(3):638–643. doi:10.1148/radiol.2015151187.