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  1. Article ; Online: Clinical Decision Support: Opportunity or Armageddon?

    Blackmore, C Craig

    AJR. American journal of roentgenology

    2019  Volume 213, Issue 5, Page(s) 1021–1022

    Abstract: OBJECTIVE. ...

    Abstract OBJECTIVE.
    MeSH term(s) Decision Support Systems, Clinical ; Medicine ; Software ; Workflow
    Language English
    Publishing date 2019-07-16
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 82076-3
    ISSN 1546-3141 ; 0361-803X ; 0092-5381
    ISSN (online) 1546-3141
    ISSN 0361-803X ; 0092-5381
    DOI 10.2214/AJR.19.21765
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  2. Article ; Online: The Relationship Between Medicare Outpatient Efficiency Measure OP8 and Lumbar MRI Utilization.

    Blackmore, C Craig

    Journal of the American College of Radiology : JACR

    2018  Volume 16, Issue 3, Page(s) 276–281

    Abstract: Introduction: Quality-based reporting and payment are predicated on using valid metrics. We sought to determine the relationship between widely used lumbar imaging quality metric OP8 and underlying quality as measured through actual utilization of ... ...

    Abstract Introduction: Quality-based reporting and payment are predicated on using valid metrics. We sought to determine the relationship between widely used lumbar imaging quality metric OP8 and underlying quality as measured through actual utilization of lumbar MRI.
    Methods: We performed a multi-institutional cross-sectional study using hospital-level billing data from a major commercial insurance company, including 23 Washington State hospitals from July 1, 2014, to June 30, 2015, with more than 25 eligible visits. For each hospital, we determined the OP8 score using the CMS published specifications. We calculated actual utilization rate from the proportion of patients visiting primary care (internal medicine or family medicine, including physicians, nurse practitioners, and physician assistants) for uncomplicated low back pain who underwent lumbar MRI. For both measures, patients under age 18 or with complicated conditions (eg, infection, cancer, inflammatory arthropathy) were excluded. OP8 scores and utilization were compared using linear regression and correlation coefficients.
    Results: Hospital scores ranged from 28.0% to 55.3% on OP8 and from 0.7% to 4.2% on MRI utilization (with lower scores indicating better performance). There was no association between score on OP8 and actual utilization of lumbar MRI across hospitals in Washington State (attributable risk 0.00016, 95% confidence interval: -0.00026, 0.00059, P = .43).
    Discussion: Widely used imaging efficiency measure OP8 does not correlate with actual utilization of lumbar MRI. Better OP8 scores reflect use of antecedent conservative therapy regardless of whether MRI is overutilized. OP8 scores may be worse for institutions with aggressive control of inappropriate imaging.
    MeSH term(s) Cross-Sectional Studies ; Efficiency, Organizational ; Humans ; Insurance, Health/economics ; Low Back Pain/diagnostic imaging ; Lumbar Vertebrae/diagnostic imaging ; Magnetic Resonance Imaging/economics ; Medicare/economics ; Outpatients ; United States ; Utilization Review ; Washington
    Language English
    Publishing date 2018-12-28
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Multicenter Study
    ZDB-ID 2274861-1
    ISSN 1558-349X ; 1546-1440
    ISSN (online) 1558-349X
    ISSN 1546-1440
    DOI 10.1016/j.jacr.2018.10.026
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  3. Book ; Online: Evidence-Based Imaging

    Medina, L. Santiago / Blackmore, C. Craig

    Optimizing Imaging in Patient Care

    2006  

    Author's details by L. Santiago Medina, C. Craig Blackmore
    Keywords Nuclear medicine ; Oncology ; Radiology, Medical
    Language English
    Publisher Springer Science+Business Media, Inc
    Publishing place New York, NY
    Document type Book ; Online
    HBZ-ID TT050386811
    ISBN 978-0-387-25916-1 ; 978-0-387-31216-3 ; 0-387-25916-3 ; 0-387-31216-1
    DOI 10.1007/0-387-31216-1
    Database ZB MED Catalogue: Medicine, Health, Nutrition, Environment, Agriculture

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  4. Article ; Online: The quality movement or making radiology fun again.

    Blackmore, C Craig

    Emergency radiology

    2015  Volume 22, Issue 4, Page(s) 395–399

    Abstract: Quality can be seen as the link between what we do as radiologists and patient health. The radiology quality movement represents an opportunity for radiologists to have more direct influence on patient health, including the quality domains of safety, ... ...

    Abstract Quality can be seen as the link between what we do as radiologists and patient health. The radiology quality movement represents an opportunity for radiologists to have more direct influence on patient health, including the quality domains of safety, effectiveness, patient centeredness, timeliness, efficiency, and equitability. Focusing on quality allows emergency radiologists to extend outside of the confines of the reading room, thereby enhancing a rewarding and clinically relevant practice.
    MeSH term(s) Efficiency, Organizational ; Emergency Medicine/standards ; Humans ; Patient Safety ; Patient-Centered Care ; Quality Assurance, Health Care ; Radiology/standards ; United States
    Language English
    Publishing date 2015-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1425144-9
    ISSN 1438-1435 ; 1070-3004
    ISSN (online) 1438-1435
    ISSN 1070-3004
    DOI 10.1007/s10140-015-1298-5
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    Zs.A 4880: Show issues Location:
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  5. Article ; Online: Using Lean tools to improve the efficiency of awake fibreoptic intubation setup.

    Weigel, Wade A / Lyons, Andrew B / Liberman, Justin S / Blackmore, C Craig

    BMJ open quality

    2021  Volume 10, Issue 4

    Abstract: Background: Awake fibreoptic intubation is a complex advanced airway technique used by anaesthesiologists in the management of a difficult airway. The time to setup this important procedure can be significant which may dissuade its use by some providers. ...

    Abstract Background: Awake fibreoptic intubation is a complex advanced airway technique used by anaesthesiologists in the management of a difficult airway. The time to setup this important procedure can be significant which may dissuade its use by some providers. In our institution, the awake intubation setup process was highly variable and error prone.
    Methods: We deployed Lean methods to improve the efficiency and accuracy of the awake fibreoptic intubation setup process. A 2-day improvement event with a multidisciplinary team addressed the setup process, tested solutions and created standard work documents. Twenty awake fibreoptic intubation simulations were conducted before and after the intervention to quantify gains in setup efficiency and error reduction.
    Results: Variability in the setup process, including clinical locations visited, was reduced through creating a standardised process. The average time to for an awake fibreoptic intubation setup was reduced by approximately 50%, from 23 min to 11 min (p<0.001). In addition, awake fibreoptic intubation equipment set out without error increased in the postintervention simulations from 59% to 85% (p=0.003).
    Conclusion: Using Lean tools, we were able to make the setup of awake fibreoptic intubation not only more efficient, but also more accurate. A similar methodological approach may have value for other complex anaesthesia procedures.
    MeSH term(s) Fiber Optic Technology ; Humans ; Intubation, Intratracheal ; Wakefulness
    Language English
    Publishing date 2021-11-30
    Publishing country England
    Document type Journal Article
    ISSN 2399-6641
    ISSN (online) 2399-6641
    DOI 10.1136/bmjoq-2021-001432
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  6. Article ; Online: Feasibility and safety of a rapid-access transient ischemic attack clinic.

    Hermanson, Sarah / Vora, Nirali / Blackmore, C Craig / Williams, Barbara / Isenberg, Nancy

    Journal of the American Association of Nurse Practitioners

    2022  Volume 34, Issue 3, Page(s) 550–556

    Abstract: Background: In the United States, patients with transient ischemic attacks (TIAs) are commonly admitted to the hospital despite evidence that low-risk TIA patients achieve improved outcomes at lower costs at specialized rapid-access TIA clinics (RATCs).! ...

    Abstract Background: In the United States, patients with transient ischemic attacks (TIAs) are commonly admitted to the hospital despite evidence that low-risk TIA patients achieve improved outcomes at lower costs at specialized rapid-access TIA clinics (RATCs).
    Local problem: All patients experiencing TIAs at a hospital system in the Pacific Northwest were being admitted to the hospital. This project aimed to implement an RATC to relocate care for low-risk TIA patients, showing feasibility and safety.
    Methods: Following implementation of the RATC, a retrospective chart review was performed. Outcomes included days to RATC; days to magnetic resonance imaging (MRI); final diagnosis; stroke-related admissions and deaths within 90 days of the RATC visit.
    Interventions: From 2016 to 2018, implementation of an RATC included patient triage tools; multidisciplinary collaboration between departments; a direct scheduling pathway; and emphasis on stroke prevention.
    Results: Ninety-nine patients were evaluated in the RATC, 69% (69/99) were referred from the emergency department. Sixty-six percent of patients were seen in the TIA clinic in 2 days or less, 19% at 3 days, and 15% at 4 days or more. Mean days to TIA clinic was 2.5 days (SD 2.4). Mean days (SD) to MRI was 2.1 days (SD 2.3). Forty-eight percent (48/99) had a final diagnosis of probable TIA, followed by 32% (32/99) who had other diagnoses; 15% (15/99) migraine variant; 4% (4/99) with stroke. Two percent (2/99) of patients had a stroke-related admission within 90 days, another 2% (2/99) died of non-stroke-related causes within 90 days of the RATC visit.
    Conclusions: Utilization of RATCs is feasible and safe. Nurse practitioners are integral in delivering this innovative, cost-effective model of care.
    Language English
    Publishing date 2022-03-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2716317-9
    ISSN 2327-6924 ; 1745-7599 ; 2327-6886 ; 1041-2972
    ISSN (online) 2327-6924 ; 1745-7599
    ISSN 2327-6886 ; 1041-2972
    DOI 10.1097/JXX.0000000000000622
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    Zs.A 2909: Show issues Location:
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  7. Article ; Online: Evidence-based imaging and cost-effectiveness analysis in cardiopulmonary imaging.

    Blackmore, C Craig

    Journal of thoracic imaging

    2012  Volume 27, Issue 5, Page(s) 272–276

    Abstract: Evidence-based imaging is a paradigm for using the best evidence to guide medical decision making. Evidence-based imaging centers on formulating a clinical question focused on a specific patient scenario, conducting a literature search and critical ... ...

    Abstract Evidence-based imaging is a paradigm for using the best evidence to guide medical decision making. Evidence-based imaging centers on formulating a clinical question focused on a specific patient scenario, conducting a literature search and critical review, summarizing the evidence, and using the information to guide medical decision making. Additional tools important to evidence-based imaging are clinical prediction rules, designed to provide evidence for when imaging should be used, and cost-effectiveness analysis, designed to quantify the economic and patient outcomes from medical interventions.
    MeSH term(s) Cost-Benefit Analysis ; Decision Making ; Evidence-Based Medicine ; Health Care Costs ; Heart/diagnostic imaging ; Humans ; Lung/diagnostic imaging ; Mass Screening/economics ; Radiography ; Radiology/economics ; Radiology/trends ; Radionuclide Imaging ; Treatment Outcome
    Language English
    Publishing date 2012-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 632900-7
    ISSN 1536-0237 ; 0883-5993
    ISSN (online) 1536-0237
    ISSN 0883-5993
    DOI 10.1097/RTI.0b013e31824dec5a
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    Zs.A 2187: Show issues Location:
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  8. Article ; Online: Using evidence to inform coverage decisions: the Washington State experience.

    Blackmore, C Craig

    Academic radiology

    2012  Volume 19, Issue 9, Page(s) 1055–1059

    Abstract: To address the high cost, insufficient quality, and overutilization of specific medical technologies, the Washington State Health Technology Assessment Program was founded in 2007. This program produces binding decisions on which medical procedures and ... ...

    Abstract To address the high cost, insufficient quality, and overutilization of specific medical technologies, the Washington State Health Technology Assessment Program was founded in 2007. This program produces binding decisions on which medical procedures and other technologies state-funded medical plans may cover. These evidence-based policy decisions are based on formal assessment of the medical evidence founded around the questions of technology effectiveness, safety, and cost. To date, the committee has evaluated a high proportion of radiologic technologies, with mixed decisions regarding coverage. Evidence-based policy can provide a valuable contribution to improving the quality of medical care through limiting public resources to those interventions of proven effectiveness.
    MeSH term(s) Decision Making ; Diagnostic Imaging/economics ; Diagnostic Imaging/standards ; Diagnostic Imaging/utilization ; Evidence-Based Medicine ; Health Policy ; Humans ; Practice Guidelines as Topic/standards ; Quality of Health Care ; State Health Plans ; Technology Assessment, Biomedical/methods ; Washington
    Language English
    Publishing date 2012-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1355509-1
    ISSN 1878-4046 ; 1076-6332
    ISSN (online) 1878-4046
    ISSN 1076-6332
    DOI 10.1016/j.acra.2012.03.027
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  9. Article ; Online: An Institutional CT Radiation Dose Reduction Quality Improvement Project.

    Smith, Philip / Blackmore, C Craig / Sicuro, Paul

    Journal of the American College of Radiology : JACR

    2019  Volume 16, Issue 11, Page(s) 1577–1581

    MeSH term(s) Aged ; Cohort Studies ; Databases, Factual ; Female ; Humans ; Male ; Middle Aged ; Practice Management, Medical/organization & administration ; Quality Improvement ; Radiation Dosage ; Radiation Exposure/prevention & control ; Radiation Protection/methods ; Radiation Protection/statistics & numerical data ; Retrospective Studies ; Tomography, X-Ray Computed/adverse effects ; Tomography, X-Ray Computed/statistics & numerical data ; United States
    Language English
    Publishing date 2019-05-21
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2274861-1
    ISSN 1558-349X ; 1546-1440
    ISSN (online) 1558-349X
    ISSN 1546-1440
    DOI 10.1016/j.jacr.2019.04.024
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  10. Article ; Online: Association of Use of Contract Nurses With Hospitalized Patient Pressure Injuries and Falls.

    Ferguson, Alice / Bradywood, Alison / Williams, Barbara / Blackmore, C Craig

    Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing

    2020  Volume 52, Issue 5, Page(s) 527–535

    Abstract: Background: Hospital-acquired pressure injuries (HAPIs) and falls are outcomes sensitive to quality of nursing care. Use of contract (traveler) nurses varies among organizations, but there is little research on the effect of contract nurses on nurse- ... ...

    Abstract Background: Hospital-acquired pressure injuries (HAPIs) and falls are outcomes sensitive to quality of nursing care. Use of contract (traveler) nurses varies among organizations, but there is little research on the effect of contract nurses on nurse-sensitive outcomes.
    Objectives: To explore the relationship between use of contract nurses and two key nurse-sensitive outcomes, HAPIs and falls.
    Research design: This was a cross-sectional study of unit-level nursing, patient, and hospital factors versus HAPIs and falls from a national nursing data consortium from 2015 to 2016. We used cluster analysis to identify similar units, and compared outcomes between clusters.
    Subjects: 605 nursing units in 166 hospitals, 3.2 patients per nurse, and 5.3% contract nurses.
    Measures: Prevalence and incidence of HAPIs and number of falls, adjusted by patient days.
    Results: For both prevalence and incidence of HAPIs, there was a statistically significant difference between the five independent cluster groups (p = .012 and p = .001, respectively). The cluster with the highest percentage of nurse travelers (>7%) had the highest HAPI prevalence (0.84%) and incidence (0.055 per 1,000 patient days) despite higher nurse staffing, compared to HAPI prevalence of 0.32% and incidence of 0.017 per 1,000 patient days in the cluster with the lowest percentage of nurse travelers (<2%). We did not identify a consistent relationship between use of contract nurses and falls.
    Conclusions: Use of contract nurses was associated with higher HAPI prevalence and incidence, independent of staffing levels.
    Clinical relevance: Our results suggest that institutions should either minimize the use of contract nurses, or engage in extensive training to confirm that contract nurses have understanding of the institutional practices around HAPIs.
    MeSH term(s) Accidental Falls/statistics & numerical data ; Adult ; Aged ; Contract Services/statistics & numerical data ; Cross-Sectional Studies ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Nursing Staff, Hospital/statistics & numerical data ; Personnel Staffing and Scheduling/organization & administration ; Pressure Ulcer/epidemiology ; Prevalence
    Language English
    Publishing date 2020-07-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2008214-9
    ISSN 1547-5069 ; 1527-6546
    ISSN (online) 1547-5069
    ISSN 1527-6546
    DOI 10.1111/jnu.12572
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