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John T. Barron - One of the best experts on this subject based on the ideXlab platform.
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Cost and appropriateness of radionuclide exercise stress testing by Cardiologists and non-Cardiologists.
The American journal of cardiology, 1996Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:The hypothesis that a diagnostic evaluation performed by a generalist is less expensive than that performed by a specialist is untested. We retrospectively evaluated the indications and financial ramifications of radionuclide exercise stress testing by Cardiologists and nonCardiologists in 1,902 consecutive adults with normal resting electrocardiograms. Subjects completed radionuclide exercise tests for the diagnosis or management of coronary artery disease during a 14-month period. Tests were considered "indicated" or "not indicated" based on criteria determined from published reports and established practice guidelines. Savings in costs and charges were determined for a strategy of referral to a Cardiologist before ordering tests. Non-Cardiologists ordered more tests that were not indicated than Cardiologists (69.6% vs 36.2%, chi-square = 209.07, p < 0.00001). Non-Cardiologists also ordered tests that were not indicated in patients with (chi-square = 110.02, p < 0.00001) and without (chi-square = 110.02, p < 0.00001) and without (chi-square = 45.44, p < 0.00001) chest pain. Tests that were not indicated resulted in excess costs of $591,384 and excess charges of $1,082,400. Referral to a Cardiologist before ordering tests could have saved $63,257 in costs and $169,800 in charges. Both Cardiologists and non-Cardiologists overutilized radionuclide exercise stress test; however, non-Cardiologists were more likely to order tests that were not indicated. A strategy of referral to a Cardiologist before ordering tests may be cost-effective in this population.
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901-69 The Cost and Appropriateness of Radionuclide Exercise Stress Testing by Cardiologists and Non-Cardiologists
Journal of the American College of Cardiology, 1995Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:It is generally accepted that a patient with a normal baseline electrocardiogram (ECG) should undergo exercise stress testing (EST) to establish the diagnosis and prognosis of coronary artery disease (CAD), unless standard EST exclusion criteria are present. Initial evaluation with radionuclide EST (REST) is an unproven approach that is approximately three times more expensive than EST alone. The appropriateness and financial ramifications of REST at an urban university hospital were evaluated during a fourteen month period. Patients with clear indications for REST-previously positive EST, prior myocardial infarction, or previous percutaneous transluminal coronary angioplasty-were excluded. REST studies were performed for the diagnosis or management of CAD in 1902 patients, of whom 975 did not have chest pain. If the baseline ECG was normal and standard EST exclusion criteria (mitral valve prolapse, bundle-branch block, significant ST-segment deviation) were not present, REST was considered not indicated (N-IND). All Patients No CP IND N-IND IND N-IND CARD 649 369 1018 473 169 642 N-CARD 269 615 884 130 203 333 918 984 1902 603 372 975 x2 = 209, P l 00001 x2 = 110, P l 00001 Non-eardiologists (N-CARD) were more likely than Cardiologists (CARD) to order REST studies in patients without indications for isotopes. Assuming an excess charge of $11 00 per patient, an unnecessary $1,082,400 was billed in this population, $409.200 of which was for patients who did not have chest pain. Assuming a charge of $175 per patient, referral to a Cardiologist prior to REST would have saved $185,260 in this population. In conclusion, non-Cardiologists are more likely to inappropriately order REST studies than are Cardiologists, at a significant excess cost. Although Cardiologists also over utilize REST studies, referral to a Cardiologist prior to testing for CAD may be cost-effective.
James H. Stein - One of the best experts on this subject based on the ideXlab platform.
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Cost and appropriateness of radionuclide exercise stress testing by Cardiologists and non-Cardiologists.
The American journal of cardiology, 1996Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:The hypothesis that a diagnostic evaluation performed by a generalist is less expensive than that performed by a specialist is untested. We retrospectively evaluated the indications and financial ramifications of radionuclide exercise stress testing by Cardiologists and nonCardiologists in 1,902 consecutive adults with normal resting electrocardiograms. Subjects completed radionuclide exercise tests for the diagnosis or management of coronary artery disease during a 14-month period. Tests were considered "indicated" or "not indicated" based on criteria determined from published reports and established practice guidelines. Savings in costs and charges were determined for a strategy of referral to a Cardiologist before ordering tests. Non-Cardiologists ordered more tests that were not indicated than Cardiologists (69.6% vs 36.2%, chi-square = 209.07, p < 0.00001). Non-Cardiologists also ordered tests that were not indicated in patients with (chi-square = 110.02, p < 0.00001) and without (chi-square = 110.02, p < 0.00001) and without (chi-square = 45.44, p < 0.00001) chest pain. Tests that were not indicated resulted in excess costs of $591,384 and excess charges of $1,082,400. Referral to a Cardiologist before ordering tests could have saved $63,257 in costs and $169,800 in charges. Both Cardiologists and non-Cardiologists overutilized radionuclide exercise stress test; however, non-Cardiologists were more likely to order tests that were not indicated. A strategy of referral to a Cardiologist before ordering tests may be cost-effective in this population.
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901-69 The Cost and Appropriateness of Radionuclide Exercise Stress Testing by Cardiologists and Non-Cardiologists
Journal of the American College of Cardiology, 1995Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:It is generally accepted that a patient with a normal baseline electrocardiogram (ECG) should undergo exercise stress testing (EST) to establish the diagnosis and prognosis of coronary artery disease (CAD), unless standard EST exclusion criteria are present. Initial evaluation with radionuclide EST (REST) is an unproven approach that is approximately three times more expensive than EST alone. The appropriateness and financial ramifications of REST at an urban university hospital were evaluated during a fourteen month period. Patients with clear indications for REST-previously positive EST, prior myocardial infarction, or previous percutaneous transluminal coronary angioplasty-were excluded. REST studies were performed for the diagnosis or management of CAD in 1902 patients, of whom 975 did not have chest pain. If the baseline ECG was normal and standard EST exclusion criteria (mitral valve prolapse, bundle-branch block, significant ST-segment deviation) were not present, REST was considered not indicated (N-IND). All Patients No CP IND N-IND IND N-IND CARD 649 369 1018 473 169 642 N-CARD 269 615 884 130 203 333 918 984 1902 603 372 975 x2 = 209, P l 00001 x2 = 110, P l 00001 Non-eardiologists (N-CARD) were more likely than Cardiologists (CARD) to order REST studies in patients without indications for isotopes. Assuming an excess charge of $11 00 per patient, an unnecessary $1,082,400 was billed in this population, $409.200 of which was for patients who did not have chest pain. Assuming a charge of $175 per patient, referral to a Cardiologist prior to REST would have saved $185,260 in this population. In conclusion, non-Cardiologists are more likely to inappropriately order REST studies than are Cardiologists, at a significant excess cost. Although Cardiologists also over utilize REST studies, referral to a Cardiologist prior to testing for CAD may be cost-effective.
Eugene Uretz - One of the best experts on this subject based on the ideXlab platform.
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Cost and appropriateness of radionuclide exercise stress testing by Cardiologists and non-Cardiologists.
The American journal of cardiology, 1996Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:The hypothesis that a diagnostic evaluation performed by a generalist is less expensive than that performed by a specialist is untested. We retrospectively evaluated the indications and financial ramifications of radionuclide exercise stress testing by Cardiologists and nonCardiologists in 1,902 consecutive adults with normal resting electrocardiograms. Subjects completed radionuclide exercise tests for the diagnosis or management of coronary artery disease during a 14-month period. Tests were considered "indicated" or "not indicated" based on criteria determined from published reports and established practice guidelines. Savings in costs and charges were determined for a strategy of referral to a Cardiologist before ordering tests. Non-Cardiologists ordered more tests that were not indicated than Cardiologists (69.6% vs 36.2%, chi-square = 209.07, p < 0.00001). Non-Cardiologists also ordered tests that were not indicated in patients with (chi-square = 110.02, p < 0.00001) and without (chi-square = 110.02, p < 0.00001) and without (chi-square = 45.44, p < 0.00001) chest pain. Tests that were not indicated resulted in excess costs of $591,384 and excess charges of $1,082,400. Referral to a Cardiologist before ordering tests could have saved $63,257 in costs and $169,800 in charges. Both Cardiologists and non-Cardiologists overutilized radionuclide exercise stress test; however, non-Cardiologists were more likely to order tests that were not indicated. A strategy of referral to a Cardiologist before ordering tests may be cost-effective in this population.
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901-69 The Cost and Appropriateness of Radionuclide Exercise Stress Testing by Cardiologists and Non-Cardiologists
Journal of the American College of Cardiology, 1995Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:It is generally accepted that a patient with a normal baseline electrocardiogram (ECG) should undergo exercise stress testing (EST) to establish the diagnosis and prognosis of coronary artery disease (CAD), unless standard EST exclusion criteria are present. Initial evaluation with radionuclide EST (REST) is an unproven approach that is approximately three times more expensive than EST alone. The appropriateness and financial ramifications of REST at an urban university hospital were evaluated during a fourteen month period. Patients with clear indications for REST-previously positive EST, prior myocardial infarction, or previous percutaneous transluminal coronary angioplasty-were excluded. REST studies were performed for the diagnosis or management of CAD in 1902 patients, of whom 975 did not have chest pain. If the baseline ECG was normal and standard EST exclusion criteria (mitral valve prolapse, bundle-branch block, significant ST-segment deviation) were not present, REST was considered not indicated (N-IND). All Patients No CP IND N-IND IND N-IND CARD 649 369 1018 473 169 642 N-CARD 269 615 884 130 203 333 918 984 1902 603 372 975 x2 = 209, P l 00001 x2 = 110, P l 00001 Non-eardiologists (N-CARD) were more likely than Cardiologists (CARD) to order REST studies in patients without indications for isotopes. Assuming an excess charge of $11 00 per patient, an unnecessary $1,082,400 was billed in this population, $409.200 of which was for patients who did not have chest pain. Assuming a charge of $175 per patient, referral to a Cardiologist prior to REST would have saved $185,260 in this population. In conclusion, non-Cardiologists are more likely to inappropriately order REST studies than are Cardiologists, at a significant excess cost. Although Cardiologists also over utilize REST studies, referral to a Cardiologist prior to testing for CAD may be cost-effective.
Joseph E. Parrillo - One of the best experts on this subject based on the ideXlab platform.
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Cost and appropriateness of radionuclide exercise stress testing by Cardiologists and non-Cardiologists.
The American journal of cardiology, 1996Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:The hypothesis that a diagnostic evaluation performed by a generalist is less expensive than that performed by a specialist is untested. We retrospectively evaluated the indications and financial ramifications of radionuclide exercise stress testing by Cardiologists and nonCardiologists in 1,902 consecutive adults with normal resting electrocardiograms. Subjects completed radionuclide exercise tests for the diagnosis or management of coronary artery disease during a 14-month period. Tests were considered "indicated" or "not indicated" based on criteria determined from published reports and established practice guidelines. Savings in costs and charges were determined for a strategy of referral to a Cardiologist before ordering tests. Non-Cardiologists ordered more tests that were not indicated than Cardiologists (69.6% vs 36.2%, chi-square = 209.07, p < 0.00001). Non-Cardiologists also ordered tests that were not indicated in patients with (chi-square = 110.02, p < 0.00001) and without (chi-square = 110.02, p < 0.00001) and without (chi-square = 45.44, p < 0.00001) chest pain. Tests that were not indicated resulted in excess costs of $591,384 and excess charges of $1,082,400. Referral to a Cardiologist before ordering tests could have saved $63,257 in costs and $169,800 in charges. Both Cardiologists and non-Cardiologists overutilized radionuclide exercise stress test; however, non-Cardiologists were more likely to order tests that were not indicated. A strategy of referral to a Cardiologist before ordering tests may be cost-effective in this population.
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901-69 The Cost and Appropriateness of Radionuclide Exercise Stress Testing by Cardiologists and Non-Cardiologists
Journal of the American College of Cardiology, 1995Co-Authors: James H. Stein, Eugene Uretz, Joseph E. Parrillo, John T. BarronAbstract:It is generally accepted that a patient with a normal baseline electrocardiogram (ECG) should undergo exercise stress testing (EST) to establish the diagnosis and prognosis of coronary artery disease (CAD), unless standard EST exclusion criteria are present. Initial evaluation with radionuclide EST (REST) is an unproven approach that is approximately three times more expensive than EST alone. The appropriateness and financial ramifications of REST at an urban university hospital were evaluated during a fourteen month period. Patients with clear indications for REST-previously positive EST, prior myocardial infarction, or previous percutaneous transluminal coronary angioplasty-were excluded. REST studies were performed for the diagnosis or management of CAD in 1902 patients, of whom 975 did not have chest pain. If the baseline ECG was normal and standard EST exclusion criteria (mitral valve prolapse, bundle-branch block, significant ST-segment deviation) were not present, REST was considered not indicated (N-IND). All Patients No CP IND N-IND IND N-IND CARD 649 369 1018 473 169 642 N-CARD 269 615 884 130 203 333 918 984 1902 603 372 975 x2 = 209, P l 00001 x2 = 110, P l 00001 Non-eardiologists (N-CARD) were more likely than Cardiologists (CARD) to order REST studies in patients without indications for isotopes. Assuming an excess charge of $11 00 per patient, an unnecessary $1,082,400 was billed in this population, $409.200 of which was for patients who did not have chest pain. Assuming a charge of $175 per patient, referral to a Cardiologist prior to REST would have saved $185,260 in this population. In conclusion, non-Cardiologists are more likely to inappropriately order REST studies than are Cardiologists, at a significant excess cost. Although Cardiologists also over utilize REST studies, referral to a Cardiologist prior to testing for CAD may be cost-effective.
Pompilio Faggiano - One of the best experts on this subject based on the ideXlab platform.
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Cardiovascular Risk Profile and Lifestyle Habits in a Cohort of Italian Cardiologists. Results of the SOCRATES Survey
Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace, 2015Co-Authors: Pompilio Faggiano, Pier Luigi Temporelli, Giovanni Battista Zito, Francesco Bovenzi, Furio Colivicchi, Francesco Fattirolli, Cesare Greco, Gian Francesco Mureddu, Carmine Riccio, Marino ScherilloAbstract:Objectives. To offer a snapshot of the personal health habits of Italian Cardiologists, the Survey on Cardiac Risk Profile and Lifestyle Habits in a Cohort of Italian Cardiologists (SOCRATES) study was undertaken. Background. Cardiologists’ cardiovascular profile and lifestyle habits are poorly known worldwide. Methods. A Web-based electronic self-reported survey, accessible through a dedicated website, was used for data entry, and data were transferred via the web to a central database. The survey was divided in 4 sections: baseline characteristics, medical illnesses and traditional cardiovascular risk factors, lifestyle habits and selected medication use. The e-mail databases of three national scientific societies were used to survey a large and representative sample of Italian Cardiologists. Results. During the 3-month period of the survey, 1770 out of the 5240 Cardiologists contacted (33.7%) completed and returned one or more sections of the questionnaire. More than 49% of the participants had 1 out of 5 classical risk factors (e.g. hypertension, hypercholesterolemia, active smoking, diabetes and previous vascular events). More than 28% of respondents had 2 to 5 risk factors and only 22.1% had none and therefore, according to age and sex, could be considered at low-intermediate risk. Despite the reported risk factors, more than 90% of Cardiologists had a self-reported risk perception quantified as mild, such as low or intermediate. Furthermore, overweight/obesity, physical inactivity and stress at work or at home were commonly reported, as well as a limited use of cardiovascular drugs, such as statins or aspirin. Conclusions. The average cardiovascular profile of Italian Cardiologist is unlikely to be considered ideal or even favorable according to recent statements and guidelines regarding cardiovascular risk. Thus, there is a large room for improvement and a need for education and intervention.
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cardiovascular risk profile and lifestyle habits in a cohort of italian Cardiologists from the socrates survey
American Journal of Cardiology, 2013Co-Authors: Pier Luigi Temporelli, Giovanni Battista Zito, Pompilio FaggianoAbstract:Cardiologists' cardiovascular profile and lifestyle habits are poorly known worldwide. To offer a snapshot of the personal health habits of Italian Cardiologists, the Survey on Cardiac Risk Profile and Lifestyle Habits in a Cohort of Italian Cardiologists (SOCRATES) was undertaken. A Web-based electronic self-reported survey, accessible through a dedicated Web site, was used for data entry, and data were transferred through the Web to a central database. The survey was divided into 4 sections: baseline characteristics, medical illnesses and traditional cardiovascular risk factors, lifestyle habits, and selected medication use. The e-mail databases of 3 national scientific societies were used to survey a large and representative sample of Italian Cardiologists. During the 3-month period of the survey, 1,770 of the 5,240 Cardiologists contacted (33.7%) completed and returned ≥1 sections of the questionnaire. More than 49% of the participants had 1 of the 5 classic risk factors (hypertension, hypercholesterolemia, active smoking, diabetes, and previous vascular events). More than 28% of respondents had 2 to 5 risk factors, and only 22.1% had none and therefore, according to age and gender, could be considered at low to intermediate risk. Despite the reported risk factors, >90% of Cardiologists had a self-reported risk perception quantified as mild, such as low or intermediate. Furthermore, overweight and obesity, physical inactivity, and stress at work or at home were commonly reported, as well as limited use of cardiovascular drugs, such as statins or aspirin. In conclusion, the average cardiovascular profile of Italian Cardiologist is unlikely to be considered ideal or even favorable according to recent statements and guidelines regarding cardiovascular risk.