Journal ArticleDOI
Central Venous Access: Evolving Roles of Radiology and Other Specialties Nationally Over Two Decades
Reads0
Chats0
TLDR
Over the past 2 decades, CVA procedures on Medicare beneficiaries have increased considerably and radiology is now the dominant overall provider, although volumes remain small and midlevel practitioners have experienced >100-fold growth for most services.Abstract:
Purpose The aim of this study was to evaluate national trends in central venous access (CVA) procedures over 2 decades with regard to changing specialty group roles and places of service. Methods Aggregated claims data for temporary central venous catheter and long-term CVA device (CVAD) procedures were extracted from Medicare Physician/Supplier Procedure Summary Master Files from 1992 through 2011. Central venous catheter and CVAD procedure volumes by specialty group and place of service were studied. Results Between 1992 and 2011, temporary and long-term CVA placement procedures increased from 638,703 to 808,071 (+27%) and from 76,444 to 316,042 (+313%), respectively. For temporary central venous catheters, radiology (from 0.4% in 1992 to 32.6% in 2011) now exceeds anesthesiology (from 37% to 22%) and surgery (from 30.4% to 11.7%) as the dominant provider group. Surgery continues to dominate in placement and explantation of long-term CVADs (from 80.7% to 50.4% and from 81.6% to 47.7%, respectively), but radiology's share has grown enormously (from 0.7% to 37.6% and from 0.2% to 28.6%). Although volumes remain small ( 100-fold growth for most services. The inpatient hospital remains the dominant site for temporary CVA procedures (90.0% in 1992 and 81.2% in 2011), but the placement of long-term CVADs has shifted from the inpatient (from 68.9% to 45.2%) to hospital outpatient (from 26.9% to 44.3%) setting. In all hospital settings combined, radiologists place approximately half of all tunneled catheters and three-quarters all peripherally inserted central catheters. Conclusions Over the past 2 decades, CVA procedures on Medicare beneficiaries have increased considerably. Radiology is now the dominant overall provider.read more
Citations
More filters
Journal ArticleDOI
Guía Clínica Española del Acceso Vascular para Hemodiálisis
Jose Ibeas,Ramon Roca-Tey,Joaquín Vallespín,Teresa Moreno,Guillermo Moñux,Anna Martí-Monrós,José Luis del Pozo,Enrique Gruss,Manel Ramírez de Arellano,Néstor Fontseré,María Dolores Arenas,Merino Jl,José García-Revillo,Pilar Caro,Cristina López-Espada,Antonio Giménez-Gaibar,Milagros Fernández-Lucas,Pablo Valdés,Fidel Fernández-Quesada,Natalia de la Fuente,David Hernán,Patricia Arribas,María Dolores Sánchez de la Nieta,M. I. Martínez,A. Barba +24 more
TL;DR: The Guia del Acceso Vascular para Hemodialisis (GEMAV) as mentioned in this paper was realizado en 2005, con el aim of realizar un abordaje consensuado.
Journal ArticleDOI
Diagnostic Radiology Resident and Fellow Workloads: A 12-Year Longitudinal Trend Analysis Using National Medicare Aggregate Claims Data
Falgun H. Chokshi,Danny R. Hughes,Jennifer M. Wang,Mark E. Mullins,C. Matthew Hawkins,Richard Duszak +5 more
TL;DR: The number of imaging examinations interpreted by diagnostic radiology residents and fellows on Medicare beneficiaries increased on average by 26% per trainee, with growth largely accounted for by disproportionate increases in more complex services (CT and MRI).
Journal ArticleDOI
Expanding Roles of Nurse Practitioners and Physician Assistants As Providers of Nonvascular Invasive Radiology Procedures
Richard Duszak,D. Gail Walls,D. Gail Walls,Jennifer M. Wang,Jennifer Hemingway,Danny R. Hughes,William Small,Michael A. Bowen +7 more
TL;DR: Although APPs perform a relatively small portion of commonly performed nonvascular invasive radiology procedures nationally, paid Medicare claims for those services have increased dramatically over nearly 2 decades, and at a faster pace than that for all providers as a whole.
Journal ArticleDOI
Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room
Jennifer R. LaRoy,Sarah B. White,Thejus T. Jayakrishnan,Stephanie L. Dybul,Dirk Ungerer,Kiran K. Turaga,Parag J. Patel +6 more
TL;DR: In this paper, the authors compare complications and cost of chest port insertion in an interventional radiology (IR) suite versus in surgery in an operating room (OR) to determine patients' demographic information and chest port-related complications and/or infections.
Journal ArticleDOI
Generalist versus Subspecialist Workforce Characteristics of Invasive Procedures Performed by Radiologists.
TL;DR: Among radiologists, generalists perform far more procedures in more geographic locations and are more likely to serve patients with less complex service needs than are interventionalists or other subspecialists.
References
More filters
Journal ArticleDOI
Preventing complications of central venous catheterization
David C. McGee,Michael K. Gould +1 more
TL;DR: This review explains strategies for minimizing the frequency of complications related to the use of a central venous catheter and techniques for catheter insertion by the internal jugular and subclavian routes.
Making health care safer: a critical analysis of patient safety practices.
TL;DR: This project aimed to collect and critically review the existing evidence on practices relevant to improving patient safety and identify practices with the strongest supporting evidence that decrease the risks associated with hospitalization, critical care, or surgery.
Journal ArticleDOI
The Risk of Bloodstream Infection in Adults With Different Intravascular Devices: A Systematic Review of 200 Published Prospective Studies
TL;DR: These data, based on prospective studies of adults, show that all types of IVDs pose a risk of IVD-related BSI and can be used for benchmarking rates of infection caused by the various types of intravascular devices in use at the present time.
Journal ArticleDOI
Complications of central venous catheters: internal jugular versus subclavian access--a systematic review.
TL;DR: There are more arterial punctures but less catheter malpositions with the internal jugular compared with the subclavian access and there is no evidence of any difference in the incidence of hemato- or pneumothorax and vessel occlusion.
Journal ArticleDOI
Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous Access.
Stephen M. Rupp,Jeffrey L. Apfelbaum,Casey D. Blitt,Robert A. Caplan,Richard T. Connis,Karen B. Domino,Lee A. Fleisher,Stuart A. Grant,Jonathan B. Mark,Paradise Valley,David G. Nickinovich,Avery Tung +11 more
TL;DR: Practice Guidelines provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data that assist the practitioner and patient in making decisions about health care.