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The Radiologist Will See You Now: Patients’ Perceptions of an Outpatient Interventional Clinic
Current Problems in Diagnostic Radiology 45 (2016) 137–138
Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com
The Radiologist Will See You Now: Patients’ Perceptions of an Outpatient Interventional Clinic Salim Abboud, MDn, Sasan Partovi, MD, Dean Nakamoto, MD, Nami Azar, MD Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH
Patient satisfaction is becoming an increasingly important part of America’s healthcare system. Patient satisfaction is now a metric assessed for valuebased incentive payments by the Center for Medicare and Medicaid Services, and the healthcare market is becoming increasingly consumer-driven as patients are provided with more options regarding where they receive care as well as improved access to medical information. Radiologists, while less involved with direct patient care than other medical specialties, are not immune to the changing medical landscape and need to adapt to a progressively value- and patient-oriented healthcare system. At our institution, first-year radiology residents take an active role in our outpatient interventional radiology clinic by performing clinical histories and physical exams in a dedicated radiology clinic examination rooms. Stressing the various opportunities for patient interaction and the potential benefits of patient- centered radiology in the evolving healthcare system may increase its perceived value among both radiology residents as well as practicing radiologists. Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction withradiologists during the course of their care. & 2015 Mosby, Inc. All rights reserved.
Introduction Patient satisfaction is becoming an increasingly important part of America’s health care system. Patient satisfaction is now metric assessed for value-based incentive payments by the Center for Medicare and Medicaid Services, and the health care market is becoming increasingly consumer driven as patients are provided with more options regarding where they receive care as well as improved access to medical information.1,2 Furthermore, the rising cost of health care is spurring the use of cost-saving measures such as bundled payments that directly affects all health care providers. Although, radiologists are less involved with direct patient care than other medical specialties, they are not immune to the changing medical landscape and need to adapt to a progressively patient-oriented health care system by demonstrating the value and cost savings radiologists contribute to patient care.3 Our institution is a tertiary-care referral center that maintains an outpatient interventional radiology clinic to optimize preprocedural planning and workup of patients referred for various vascular and nonvascular interventions including tumor ablation, biopsy, and fluid-drainage procedures. The outpatient clinic sees on average three patients per day, and appointments are staffed by a junior radiology resident, an attending radiologist, and a radiology-registered nurse; the evaluation includes a review of pertinent prior imaging and laboratory values, as well as a physical
n Reprint requests: Salim Abboud, Department of Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address: [email protected] (S. Abboud).
http://dx.doi.org/10.1067/j.cpradiol.2015.10.003 0363-0188/& 2015 Mosby, Inc. All rights reserved.
examination and limited US of the area of interest if indicated. A procedure date is scheduled with the patient, and additional interim imaging and laboratory testing is also ordered if necessary. Importantly, patients are educated on their planned procedures and informed consent is obtained. In America’s increasingly consumer-oriented health care market, even the mere perception of improved service can improve the competitive edge of an individual caregiver or entire health system. Optimizing the patient-radiologist relationship should serve, it seems, to not only elevate radiology’s perceived value in the eye of American health care, but also the standing of the individual radiologist who chooses to embrace and nurture relationships with patients and to provide patients with the quality care they seek and deserve. Our group previously demonstrated that meeting with a radiologist before image-guided procedures yields myriad benefits including improving patients’ perceptions regarding the quality of their medical care, improving understanding of their medical conditions, and promoting better understanding of the role of radiologists in medicine.4 Such studies have important implications in an increasingly competitive and value-oriented health care market. In the face of increasing commoditization of radiologists’ services and decreasing reimbursement, the clinical role and indeed value of radiologists are increasingly questioned. Halting this process of commoditization and demonstrating our clinical value to patients and clinicians is fundamental to reaffirming and maintaining the central importance of our specialty in optimizing quality and value in patient care.1 How can we demonstrate increased value to both clinicians and patients? Promoting a robust patient-radiologist relationship
138
S. Abboud et al. / Current Problems in Diagnostic Radiology 45 (2016) 137–138
represents an inroad to this goal, one that can be paved in part by more directly including our specialty in various stages of patient evaluation and demonstrating a clinically oriented radiologist’s contribution to excellence in medical care to both patients and clinicians. Some evidence suggests that both clinicians and patients appreciate having a radiology resident join medical teams for daily inpatient rounds, and that such interactions may improve a radiology resident’s ability to convey radiologic findings to referring physicians and improve rapport between radiologists and referring medical teams.5 Establishing a radiology clinic for patient evaluation before image-guided procedures may also be integral to this endeavor, and prior studies suggest that brief patient-radiologist interactions before diagnostic imaging examinations may also be helpful in this regard.6 For the patient, it connects a human face and name with a vastly important but technically complex portion of their health care. Importantly, such patient-radiologist interactions can improve patients’ understanding and perceived quality of their care. Indeed, prior research suggests that most patients want to meet with a radiologist before their scheduled image-guided procedure and that doing so can improve the perceived quality of care.4,6 The underpinnings of these findings are multiple; imaging technology has experienced such a dizzying expansion that seemingly simple processes such as choosing the appropriate imaging examination for a given clinical issue has become an increasingly nuanced and often time-consuming exercise that demands, beyond the requisite understanding of imaging modalities, extensive scrutiny of a specific patient’s clinical presentation and referring clinician’s suspicions. As imaging specialists, and radiologists are often most qualified to make such determinations. Our ability to communicate the reasoning behind certain imaging-related testing, as well as describe imaging findings in a manner most patients have not experienced during interactions with nonradiologists, is perhaps something appreciated by patients given the importance of imaging in medical evaluations. Given the pervasiveness of medical imaging in patient care, the potential of the radiologist to positively affect and optimize a patient’s health care experience is vast. Few studies have assessed whether a radiology clinic actually improves health care outcomes such as complication rate, radiation dose reduction, cost reduction, or other parameters of quality and value. Our group has previously shown that evaluation of patients in a dedicated outpatient clinic before image-guided lung lesion biopsy may improve biopsy success rates.7 Investigating such potential benefits of direct radiologist involvement in patient care is an area of future research vital to establishing the importance of radiology in an increasingly value-oriented and outcome-driven health care system. Time constraints are of course a definite obstacle to incorporating such interactions into a radiologist’s routine practice, particularly for noninterventionalists with reimbursement or performance evaluations directly tied to diagnostic productivity. Although adopting a new focus on optimizing the patient’s experience would demand flexibility, multitasking diverse activities—performing procedures between diagnostic reads, protocolling studies, or consulting with clinical services—is familiar territory for many practicing radiologists and residents in training. Dhanoa et al8 demonstrated that 43.8% of a
diagnostic radiologist’s time is spent on nondiagnostic activities including consulting clinicians, supervising studies, protocolling requisitions, as well as direct patient care. A greater emphasis on patient service and interaction should therefore be viewed to represent an evolution in workflow, rather than a disruptive change in job description that would negatively affect productivity as some might fear. Promoting a better understanding of these benefits and incorporating opportunities for patient interaction during radiology residency may further prime future radiologists for this new role. At our institution, first-year radiology residents take an active role in our interventional radiology clinic by performing clinical histories and physical examinations in a dedicated interventional radiology clinic examination rooms. Perceptions of participating residents do seem varied; some residents approach the opportunity with enthusiasm, whereas others regard it as something of a distraction from other educational opportunities. Of 30 residents polled, 47% and 50% agreed that participating in the interventional clinic was a valuable part of their radiology residency education and has improved their patient-interaction skills, respectively. Although not regularly employed at our institution, staffing the clinic with more senior radiology residents, given their greater understanding of protocols, radiologic findings, and the role of the clinic in a patient’s evaluation, may elevate the experience’s perceived value in the eyes of the resident as well as the patient. Again, stressing the various opportunities for patient interaction and the potential benefits of patient-centered radiology would help both radiology residents and practicing radiologists to thrive in an evolving health care system. Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction with radiologists during the course of their care. The potential for unprecedented levels of patient satisfaction, understanding, and appreciation of individual radiologists and radiology as a medical specialty should be more than enough motivation to meet any future challenges. References 1. Brandt-Zawadski M, Kerlan RK. Patient-centered radiology: Use it or lose it! Acad Radiol 2009;16:521–3. 2. Centers for Medicare & Medicaid Services, Baltimore, MD. Available at: 〈http:// www.hcahpsonline.org〉; Revised 26.02.13; Accessed 15.12.13. 3. Mukherji SK, Fockler T. Bundled payment. J Am Coll Radiol 2014;11:566–71. 4. Abboud S, Tanay P, Goletz J, et al. The Interventional CT and Ultrasound Clinic: Patient Perceptions. Association of University Radiologists 62nd Annual Meeting, 02.04.14. 5. Mamlouk MD, Anavim A, Goodwin SC. Radiology residents rounding with the clinical teams: A pilot study to improve the radiologist’s visibility as a consultant. J Am Coll Radiol 2014;11:326–8. 6. Miller P, Gunderman R, Lightburn J, et al. Enhancing patients’ experiences in radiology: Through patient-radiologist interaction. Acad Radiol 2013;20:778–81. 7. Abboud S, Ahmed Y, Partovi S, et al. Pre-procedural patient evaluation in an outpatient interventional radiology clinic improves success rates for ct-guided lung biopsies. World Conference on Interventional Oncology (Poster Presentation). May 6-9, 2015 New York, NY. 8. Dhanoa D, Dhesi TS, Burton KR, et al. The evolving role of the radiologist: The Vancouver Workload Utilization Evaluation Study. J Am Coll Radiol 2013;10: 764–9.
Current Problems in Diagnostic Radiology journal homepage: www.cpdrjournal.com
The Radiologist Will See You Now: Patients’ Perceptions of an Outpatient Interventional Clinic Salim Abboud, MDn, Sasan Partovi, MD, Dean Nakamoto, MD, Nami Azar, MD Department of Radiology, University Hospitals Case Medical Center, Cleveland, OH
Patient satisfaction is becoming an increasingly important part of America’s healthcare system. Patient satisfaction is now a metric assessed for valuebased incentive payments by the Center for Medicare and Medicaid Services, and the healthcare market is becoming increasingly consumer-driven as patients are provided with more options regarding where they receive care as well as improved access to medical information. Radiologists, while less involved with direct patient care than other medical specialties, are not immune to the changing medical landscape and need to adapt to a progressively value- and patient-oriented healthcare system. At our institution, first-year radiology residents take an active role in our outpatient interventional radiology clinic by performing clinical histories and physical exams in a dedicated radiology clinic examination rooms. Stressing the various opportunities for patient interaction and the potential benefits of patient- centered radiology in the evolving healthcare system may increase its perceived value among both radiology residents as well as practicing radiologists. Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction withradiologists during the course of their care. & 2015 Mosby, Inc. All rights reserved.
Introduction Patient satisfaction is becoming an increasingly important part of America’s health care system. Patient satisfaction is now metric assessed for value-based incentive payments by the Center for Medicare and Medicaid Services, and the health care market is becoming increasingly consumer driven as patients are provided with more options regarding where they receive care as well as improved access to medical information.1,2 Furthermore, the rising cost of health care is spurring the use of cost-saving measures such as bundled payments that directly affects all health care providers. Although, radiologists are less involved with direct patient care than other medical specialties, they are not immune to the changing medical landscape and need to adapt to a progressively patient-oriented health care system by demonstrating the value and cost savings radiologists contribute to patient care.3 Our institution is a tertiary-care referral center that maintains an outpatient interventional radiology clinic to optimize preprocedural planning and workup of patients referred for various vascular and nonvascular interventions including tumor ablation, biopsy, and fluid-drainage procedures. The outpatient clinic sees on average three patients per day, and appointments are staffed by a junior radiology resident, an attending radiologist, and a radiology-registered nurse; the evaluation includes a review of pertinent prior imaging and laboratory values, as well as a physical
n Reprint requests: Salim Abboud, Department of Radiology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address: [email protected] (S. Abboud).
http://dx.doi.org/10.1067/j.cpradiol.2015.10.003 0363-0188/& 2015 Mosby, Inc. All rights reserved.
examination and limited US of the area of interest if indicated. A procedure date is scheduled with the patient, and additional interim imaging and laboratory testing is also ordered if necessary. Importantly, patients are educated on their planned procedures and informed consent is obtained. In America’s increasingly consumer-oriented health care market, even the mere perception of improved service can improve the competitive edge of an individual caregiver or entire health system. Optimizing the patient-radiologist relationship should serve, it seems, to not only elevate radiology’s perceived value in the eye of American health care, but also the standing of the individual radiologist who chooses to embrace and nurture relationships with patients and to provide patients with the quality care they seek and deserve. Our group previously demonstrated that meeting with a radiologist before image-guided procedures yields myriad benefits including improving patients’ perceptions regarding the quality of their medical care, improving understanding of their medical conditions, and promoting better understanding of the role of radiologists in medicine.4 Such studies have important implications in an increasingly competitive and value-oriented health care market. In the face of increasing commoditization of radiologists’ services and decreasing reimbursement, the clinical role and indeed value of radiologists are increasingly questioned. Halting this process of commoditization and demonstrating our clinical value to patients and clinicians is fundamental to reaffirming and maintaining the central importance of our specialty in optimizing quality and value in patient care.1 How can we demonstrate increased value to both clinicians and patients? Promoting a robust patient-radiologist relationship
138
S. Abboud et al. / Current Problems in Diagnostic Radiology 45 (2016) 137–138
represents an inroad to this goal, one that can be paved in part by more directly including our specialty in various stages of patient evaluation and demonstrating a clinically oriented radiologist’s contribution to excellence in medical care to both patients and clinicians. Some evidence suggests that both clinicians and patients appreciate having a radiology resident join medical teams for daily inpatient rounds, and that such interactions may improve a radiology resident’s ability to convey radiologic findings to referring physicians and improve rapport between radiologists and referring medical teams.5 Establishing a radiology clinic for patient evaluation before image-guided procedures may also be integral to this endeavor, and prior studies suggest that brief patient-radiologist interactions before diagnostic imaging examinations may also be helpful in this regard.6 For the patient, it connects a human face and name with a vastly important but technically complex portion of their health care. Importantly, such patient-radiologist interactions can improve patients’ understanding and perceived quality of their care. Indeed, prior research suggests that most patients want to meet with a radiologist before their scheduled image-guided procedure and that doing so can improve the perceived quality of care.4,6 The underpinnings of these findings are multiple; imaging technology has experienced such a dizzying expansion that seemingly simple processes such as choosing the appropriate imaging examination for a given clinical issue has become an increasingly nuanced and often time-consuming exercise that demands, beyond the requisite understanding of imaging modalities, extensive scrutiny of a specific patient’s clinical presentation and referring clinician’s suspicions. As imaging specialists, and radiologists are often most qualified to make such determinations. Our ability to communicate the reasoning behind certain imaging-related testing, as well as describe imaging findings in a manner most patients have not experienced during interactions with nonradiologists, is perhaps something appreciated by patients given the importance of imaging in medical evaluations. Given the pervasiveness of medical imaging in patient care, the potential of the radiologist to positively affect and optimize a patient’s health care experience is vast. Few studies have assessed whether a radiology clinic actually improves health care outcomes such as complication rate, radiation dose reduction, cost reduction, or other parameters of quality and value. Our group has previously shown that evaluation of patients in a dedicated outpatient clinic before image-guided lung lesion biopsy may improve biopsy success rates.7 Investigating such potential benefits of direct radiologist involvement in patient care is an area of future research vital to establishing the importance of radiology in an increasingly value-oriented and outcome-driven health care system. Time constraints are of course a definite obstacle to incorporating such interactions into a radiologist’s routine practice, particularly for noninterventionalists with reimbursement or performance evaluations directly tied to diagnostic productivity. Although adopting a new focus on optimizing the patient’s experience would demand flexibility, multitasking diverse activities—performing procedures between diagnostic reads, protocolling studies, or consulting with clinical services—is familiar territory for many practicing radiologists and residents in training. Dhanoa et al8 demonstrated that 43.8% of a
diagnostic radiologist’s time is spent on nondiagnostic activities including consulting clinicians, supervising studies, protocolling requisitions, as well as direct patient care. A greater emphasis on patient service and interaction should therefore be viewed to represent an evolution in workflow, rather than a disruptive change in job description that would negatively affect productivity as some might fear. Promoting a better understanding of these benefits and incorporating opportunities for patient interaction during radiology residency may further prime future radiologists for this new role. At our institution, first-year radiology residents take an active role in our interventional radiology clinic by performing clinical histories and physical examinations in a dedicated interventional radiology clinic examination rooms. Perceptions of participating residents do seem varied; some residents approach the opportunity with enthusiasm, whereas others regard it as something of a distraction from other educational opportunities. Of 30 residents polled, 47% and 50% agreed that participating in the interventional clinic was a valuable part of their radiology residency education and has improved their patient-interaction skills, respectively. Although not regularly employed at our institution, staffing the clinic with more senior radiology residents, given their greater understanding of protocols, radiologic findings, and the role of the clinic in a patient’s evaluation, may elevate the experience’s perceived value in the eyes of the resident as well as the patient. Again, stressing the various opportunities for patient interaction and the potential benefits of patient-centered radiology would help both radiology residents and practicing radiologists to thrive in an evolving health care system. Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction with radiologists during the course of their care. The potential for unprecedented levels of patient satisfaction, understanding, and appreciation of individual radiologists and radiology as a medical specialty should be more than enough motivation to meet any future challenges. References 1. Brandt-Zawadski M, Kerlan RK. Patient-centered radiology: Use it or lose it! Acad Radiol 2009;16:521–3. 2. Centers for Medicare & Medicaid Services, Baltimore, MD. Available at: 〈http:// www.hcahpsonline.org〉; Revised 26.02.13; Accessed 15.12.13. 3. Mukherji SK, Fockler T. Bundled payment. J Am Coll Radiol 2014;11:566–71. 4. Abboud S, Tanay P, Goletz J, et al. The Interventional CT and Ultrasound Clinic: Patient Perceptions. Association of University Radiologists 62nd Annual Meeting, 02.04.14. 5. Mamlouk MD, Anavim A, Goodwin SC. Radiology residents rounding with the clinical teams: A pilot study to improve the radiologist’s visibility as a consultant. J Am Coll Radiol 2014;11:326–8. 6. Miller P, Gunderman R, Lightburn J, et al. Enhancing patients’ experiences in radiology: Through patient-radiologist interaction. Acad Radiol 2013;20:778–81. 7. Abboud S, Ahmed Y, Partovi S, et al. Pre-procedural patient evaluation in an outpatient interventional radiology clinic improves success rates for ct-guided lung biopsies. World Conference on Interventional Oncology (Poster Presentation). May 6-9, 2015 New York, NY. 8. Dhanoa D, Dhesi TS, Burton KR, et al. The evolving role of the radiologist: The Vancouver Workload Utilization Evaluation Study. J Am Coll Radiol 2013;10: 764–9.