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Ryan Wood



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    OS05 - Mining the Gold! (ID 6)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track:
    • Presentations: 1
    • Coordinates: 5/27/2019, 10:30 AM - 11:30 AM, Area 4
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      OS05.02 - Predicting the Impact of Non-Medically-Necessary MRI Scans: Access and Demand (ID 73)

      Ryan Wood, Access to Care, Cancer Care Ontario; Toronto/CA

      • Abstract

      Purpose/Objectives:
      Access to Care (ATC) at Cancer Care Ontario (CCO) works in partnership with the Ministry of Health and Long-Term Care (ministry) to improve patients’ access to healthcare services. Given Ontario’s consistent MRI access issues, ATC leveraged the provincial Wait Time Information System (WTIS) and expert clinical input to evaluate the relationship between access and and non-medically necessary requisitions for Magnetic Resonance Imaging (MRI). The purpose of this presentation is to provide context on the issue of appropriate MRI care while outlining the approach for predicting the system impact of non-medically necessary scanning. The surprising results and recommended next steps for a high-performing system will be discussed.


      Methodology/Approach:
      We began with a survey of available literature and guidelines to inform indicator development for incidences of non-medically necessary scanning. A working group composed of ATC, CCO, ministry and clinical expertise leveraged this information to draft early indicators aimed at measuring these incidences (Figure 1). Using metadata from the WTIS, ATC identified MRI orders for potentially for non-medically necessary indications. Given measured incidence rates, linear regression was utilized to estimate the impact of this MRI activity both on demand and access. Figure 1: Examples of Early Draft Indicators for Non-Medically Necessary MRIs % of knee MRIs ordered for patients >60 years old % of hip MRIs ordered for patients >60 years old % knee MRI for patients who previously had a knee MRI within 7/30/180,365 days % of spine MRIs ordered for L-spine % L-spine MRI performed for patients who previously had a MRI for the same body part


      Finding/Results:
      The results were remarkable. With a focus on knee MRI, up to 18% of MRI orders were potentially not medically-necessary and significant variation in practice was noted among referrals received by 26 Ontario hospitals. Looking at MRI services as a whole, literature further indicated a range of 20% to 40% of MRI scans may not be medically-necessary. With data and clinical input, linear regressions identified a reduction in non-medically necessary scanning could have positive impacts. The potential range of improvements could support an additional 30,000-61,000 MRI operating hours annually, and the reduced demand could improve wait times by 100-150 days. capture.jpg


      Conclusion/Implications/Recommendations:
      These findings supported ministry interest in assessing the feasibility of an appropriate care framework for MRI services in Ontario. ATC is partnering with the ministry to develop key enablers and recommendations to begin this process, such as the development of a data strategy; establishment of a reporting and monitoring system; standardization of referral information; and development of tools to provide informationdirectly to physicians.


      140 Character Summary:
      Predictive analysis combined with clinical expertise demonstrates an appropriate MRI care framework has strong potential to improve MRI wait times.