Rationing Rotational Magnet Cochlear Implant Technology in a Single Payer Healthcare System

2020 ◽  
pp. 000348942094323
Author(s):  
Justyn Pisa ◽  
Colin Andrews ◽  
Jordan B. Hochman
Keyword(s):  
Magnetic Resonance ◽  
Cochlear Implant ◽  
Unit Cost ◽  
Wait Times ◽  
Publicly Funded ◽  
Magnet Technology ◽  
Single Payer ◽  
Number Of Patients ◽  
Magnetic Resonance Imaging Mri ◽  
To Receive

Introduction: In a publicly funded health care system, fiscally responsible management of any program is required. This is especially pertinent as evolving technology and associated incremental costs, places pressure on device availability within a fixed funding envelope. The application of rotational magnet technology and associated escalating surgical wait times must be justified to patients and the single-payer system. We present a single cochlear implant center’s attempt at a rationing schema for magnetic resonance compatible cochlear implantation. Contrasting approaches to rationing care are evaluated and deliberated. Methods: Based on a comparison of magnetic resonance imaging (MRI) rates within the general population to our cochlear implant (CI) cohort, we attempt the development of a decision-making schema that maximizes the number of patients to receive a CI while rationing the distribution of a rotational magnet technology to similarly situated individuals most likely to benefit. Results: We elect to provide rotational magnet technology to select patient cohorts. This is based on the dominant imaging needs of these populations and the probability of requiring recurrent imaging studies. We consider this an ethical approach grounded in the egalitarian principle of equality of opportunity within cohorts of patients. Conclusion: Given finite resources, increasing per unit cost will unavoidably extend wait times for adult patients. Our approach does not afford similar implant devices for all patients, but rather all similarly situated individuals. Therefore, access to a scare medical resource requires program rigor and a formalized policy around candidacy for emergent technology.

Time-to-simulation for radiation oncology patients in an academic department.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 176-176
Author(s):  
Nirav S. Kapadia ◽  
Kathy Ann Lash
Keyword(s):  
Magnetic Resonance ◽  
Cancer Diagnosis ◽  
Radiation Oncology ◽  
Statistical Hypothesis ◽  
Wait Times ◽  
Patient Demographics ◽  
Number Of Patients ◽  
The Mean ◽  
Provider Factor ◽  
One Way Anova

176 Background: In 2011, one of the two clinical simulators in our department was decomissioned in order to enable the construction of a clinical magnetic resonance (MR) simulator. As result, our clinical simulator capacity decreased resulting in increased wait times for patients undergoing treatment planning. In turn, there was a perceived increase in the number of patients added onto the simulator schedule (add-ons) immediately following consultation. This created problems of workflow on the simulator and increased clinic wait times for previously scheduled patients. A clinical Lean team was formed with the intent of 1) quantifying the number of daily add-ons and 2) identifying predictors of add-ons so that the frequency of add-ons could be predicted and if possible, load-leveled. Methods: Over an eight-week period, frequency of simulator add-ons was correlated with de-identified patient data abstracted from the medical record using one-way ANOVA and student t-tests to assess the statistical hypothesis that a patient, disease, or provider factor increased the likelihood of a patient add-on. Interviews were conducted with the clinical staff to determine perceived frequency of add-ons, predictors of add-ons, and to evaluate the rationale for add-ons. Results: On average, 7.9 (range 7.3-8.7) simulations were performed daily in our department and 0.95 (0.7-1.4) patients were added onto the simulator daily. Patient demographics, day of consultation, inpatient vs outpatient status, treating and referring physician, as well as cancer diagnosis were examined. A statistical trend for add-on patients on Friday (p=0.064, vs. Monday) was found. One physician's patients accounted for 36% of the Friday add-ons over the eight week period. The physician was interviewed and her rationale for adding-on patients was determined. Conclusions: The mean number of add-on patients was determined to be acceptably low in our department and was on average less than one patient daily. A trend for an increased likelihoood of add-on patients with a particular Friday provider was noted and as such future efforts will be directed at mitigating the number of this physician's add-on patients.

Imaging for cochlear implants

1999 ◽  
Vol 113 (24) ◽  
pp. 21-23 ◽  
Author(s):  
P. D. Phelps ◽  
D. W. Proops
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cochlear Implant ◽  
Cochlear Implants ◽  
Computerized Tomography ◽  
Ct Scanning ◽  
Resonance Imaging ◽  
Labyrinthitis Ossificans ◽  
Weighted Magnetic Resonance Imaging ◽  
Magnetic Resonance Imaging Mri

AbstractAll patients in the Birmingham Cochlear Implant Programme underwent computerized tomography (CT) scanning and were assessed and images interpreted by the main author. Of the first 100 cases, 20 were considered to have abnormalities of the inner ears by CT imaging. It is concluded that the commonest abnormality was cochlear otospongiosis followed by labyrinthitis ossificans.Otospongiosis is well shown by CT which gives a good predicator of luminal patency.However, labyrinthus obliterans, although usually apparent on CT, is not reliably shown in all cases and T2 weighted magnetic resonance imaging (MRI) is better.

Top-Ten Tips for Imaging the Brachial Plexus with Ultrasound and MRI

2019 ◽  
Vol 23 (04) ◽  
pp. 405-418 ◽  
Author(s):  
James F. Griffith ◽  
Radhesh Krishna Lalam
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Brachial Plexus ◽  
Muscle Denervation ◽  
Resonance Imaging ◽  
Neural Injury ◽  
Clinical Indications ◽  
Magnetic Resonance Imaging Mri ◽  
High Level ◽  
Extensive Involvement

AbstractWhen it comes to examining the brachial plexus, ultrasound (US) and magnetic resonance imaging (MRI) are complementary investigations. US is well placed for screening most extraforaminal pathologies, whereas MRI is more sensitive and accurate for specific clinical indications. For example, MRI is probably the preferred technique for assessment of trauma because it enables a thorough evaluation of both the intraspinal and extraspinal elements, although US can depict extraforaminal neural injury with a high level of accuracy. Conversely, US is probably the preferred technique for examination of neurologic amyotrophy because a more extensive involvement beyond the brachial plexus is the norm, although MRI is more sensitive than US for evaluating muscle denervation associated with this entity. With this synergy in mind, this review highlights the tips for examining the brachial plexus with US and MRI.

Use of Magnetic Resonance Imaging (MRI) to Determine the 3D Geometry in the Human Rectum

Endoscopy ◽  
2004 ◽  
Vol 36 (10) ◽  
Author(s):  
BP McMahon ◽  
JB Frøkjær ◽  
A Bergmann ◽  
DH Liao ◽  
E Steffensen ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Resonance Imaging ◽  
3D Geometry ◽  
Human Rectum ◽  
Magnetic Resonance Imaging Mri

Role of Cardiac MRI in Detecting Familial Hypertrophic Cardiomyopathy: Review

2016 ◽  
Vol 1 (1) ◽  
pp. 4
Author(s):  
Marymol Koshy ◽  
Bushra Johari ◽  
Mohd Farhan Hamdan ◽  
Mohammad Hanafiah
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Genetic Disorder ◽  
Familial Hypertrophic Cardiomyopathy ◽  
Non Invasive ◽  
Wide Range ◽  
Proper Diagnosis ◽  
Magnetic Resonance Imaging Mri ◽  
Potential Use

Hypertrophic cardiomyopathy (HCM) is a global disease affecting people of various ethnic origins and both genders. HCM is a genetic disorder with a wide range of symptoms, including the catastrophic presentation of sudden cardiac death. Proper diagnosis and treatment of this disorder can relieve symptoms and prolong life. Non-invasive imaging is essential in diagnosing HCM. We present a review to deliberate the potential use of cardiac magnetic resonance (CMR) imaging in HCM assessment and also identify the risk factors entailed with risk stratification of HCM based on Magnetic Resonance Imaging (MRI).

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