Learning objectives
Evaluation of innovations for justification and appropriate imaging must consider all stakeholders.
Value based healthcare in the UK [1-4] looks for personalised,
technical and allocative value.
Only through demonstration of value to all parties will there be acceptance,
support and implementation.
Background
Estimates indicate that 10-40% of imaging procedures performed are inappropriate with limited or no benefit to patients or healthcare systems [5-10].
Strategies to improve justification include awareness of the issue,
evidence-based guidance for appropriate imaging and monitoring through clinical audit and quality improvement.
Clinical decision support (CDS) systems are accepted in clinical medicine for uniform,
safer and value-added prescription and clinical referral.
Fitting naturally into requesting workflow,
CDS provides efficient access to guidelines. Although measures using referral guidelines in the UK halve inappropriate imaging requests,...
Findings and procedure details
Considerable planning with weekly meetings was needed for the RCR-MedCurrent CDS pilot project at the London Northwest and Hillingdon Hospitals Trusts which serve a population of 1.2 million.
(Fig 1.)
Figure 1a
Figure 1b.
Figure 1 a&b. The location of the pilot project is in a diverse sector of greater London where there is a wide range in income,
ethnicity and education.
Provision of healthcare is by 4 primary care Clinical Commissioning Groups (Brent,
Ealing,
Harrow and Hillingdon),
working with 4 major hospitals (Central Middlesex,...
Conclusion
The success of a project is dependent on detail: planning,
stakeholder inclusion,
regular meetings and most importantly metrics for demonstration of value - personalised,
technical and allocative.
Personal information
Denis Remedios
Consultant Radiologist,
Northwick Park Hospital,
Harrow,
UK.
[email protected]
Steve Herman
Consultant Radiologist,
Toronto
President,
Founder &ChiefMedical Officer Medcurrent
[email protected]
Chris Williams
Consultant Radiologist,
Hillingdon Hospital,
[email protected]
Rihanna Taiwo
Implementation Lead – 7 Day Services
Strategy and Transformation Team
NW London Collaboration of CCGs
[email protected]
Paul Johnson
Director
GE Healthcare Finnamore
[email protected]
References
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Value Based Healthcare.
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Value Based Healthcare.
https://www.phc.ox.ac.uk/research/value-based-healthcare (accessed 28.12.17)
Healthcare value.
Oxford University Department for Continuing Education.
https://www.conted.ox.ac.uk/courses/healthcare-value
European Society of Radiology.
ESR concept paper on value-based radiology.
Insights Imaging.
2017 Oct; 8(5): 447–454.
doi:10.1007/s13244-017-0566-1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621991/
Influence of Royal College of Radiologists' guidelines on referral from general practice.
Royal College of Radiologists Working Party.
BMJ.
1993 Jan 9;306(6870):110-1.
http://www.ncbi.nlm.nih.gov/pubmed/8435606
Oakeshott P1,
Kerry SM,
Williams JE.
Randomized controlled trial of the effect of the Royal College of Radiologists' guidelines on general practitioners' referrals...