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Biomedical subjects

B J Hillman

Publications and source records attributed to B J Hillman.

At least 19 recordsLinked to original sources
PubMed1992

Physicians' utilization and charges for outpatient diagnostic imaging in a Medicare population.

OBJECTIVES AND RATIONALE: For 10 common clinical presentations, we assessed differences in physicians' utilization of and charges for diagnostic imaging, depending on whether they performed imaging examinations in their offices (self-referral) or referred their patients to radiologists (radiologist-referral). METHODS: Using previously developed methodologies, we generated episodes of medical care from an insurance claims database. Within each episode, we determined whether diagnostic imaging had been performed, and if so, whether by a self-referring physician or a radiologist. For each of the 10 clinical presentations, we compared the mean imaging frequency, mean imaging charges per episode of care, and mean imaging charges for diagnostic imaging attributable to self- and radiologist-referral. RESULTS: Depending on the clinical presentation, self-referral resulted in 1.7 to 7.7 times more frequent performance of imaging examinations than radiologist-referral (P < .01, all presentations). Within all physician specialties, self-referral uniformly led to significantly greater utilization of diagnostic imaging than radiologist-referral. Mean imaging charges per episode of medical care (calculated as the product of the frequency of utilization and mean imaging charges) were 1.6 to 6.2 times greater for self-referral than for radiologist-referral (P < .01, all presentations). When imaging examinations were performed--including those performed in both physicians' offices and hospital outpatient departments--mean imaging charges were significantly greater for radiologists than for self-referring physicians in seven of the clinical presentations (P < .01). This result is related to the high technical charges of hospital outpatient departments; in office practice, radiologists' mean charges for imaging examinations were significantly less than those of self-referring physicians for seven clinical presentations (P < .01). CONCLUSIONS: Nonradiologist physicians who operate diagnostic imaging equipment in their offices perform imaging examinations more frequently, resulting in higher imaging charges per episode of medical care. These results extend our previous research on this subject by their focus on a broader range of clinical presentations; a mostly elderly, retired population; and the inclusion of higher-technology imaging examinations.

Aged↗
PubMed1992

Moonlighting during the radiology residency.

RATIONALE AND OBJECTIVES: The authors surveyed current residents and practicing radiologists to assess motivations for and attitudes about radiology moonlighting during residency. METHODS: One thousand one hundred current fourth-year radiology residents and 1,100 practicing radiologists who finished training within the past 10 years were surveyed. Information was solicited concerning motivations for and attitudes toward moonlighting and the effects of moonlighting on residents' training. Current residents were compared with former residents to assess changes in attitudes about moonlighting. RESULTS: There were no important differences in the practicing and training cohorts. Of each group, 52% moonlighted. Debt was the main motivating factor influencing a resident's decision to moonlight. Moonlighters owed significantly more money (average debt, $25,804) at the beginning of their residency than did non-moonlighters (average debt, $19,554). In addition, 72% of moonlighters had to begin loan repayments during training with average monthly payments of $284. Departmental policy was less of an influencing factor. There was no statistical difference in the way moonlighters and non-moonlighters spent their time with respect to clinical work, reading radiology, or participating in research. CONCLUSIONS: Residents moonlight primarily for financial reasons but also perceive a positive educational benefit. Although no significant negative effects on the residency were found in this study, rising debt, decreased forbearance of repayment, and possible resultant increases in the amount of time spent moonlighting, might eventually affect resident's productivity in more traditional residency activities.

Employment↗
PubMed1992

Fostering research by radiologists: recommendations of the 1991 Summit meeting.

At the annual Radiology Summit Meeting sponsored by the Intersociety Commission of the American College of Radiology, leaders of U.S. and Canadian radiologic organizations met in part to discuss ways to improve radiology research. Support by radiology departments and radiologic organizations is currently not sufficient to improve the research of the specialty. Five issues of central importance to improving research are (a) the need for a definition of radiology research, (b) a lack of financial resources, (c) a lack of mentors, (d) hesitancy to embark on a research career, and (e) conflicts between clinicians and researchers. The adoption of 31 recommendations regarding these five issues was urged.

Mentors↗
PubMed1992

Factors influencing women to undergo screening mammography.

Despite the fact that mammography is a valuable tool for early detection of breast cancer, the majority of age-eligible American women do not avail themselves of screening mammography. To better understand why women do or do not undergo mammography and to further develop guidelines for promoting breast cancer screening, the authors investigated what impact personal factors, attitudes, and health-related behaviors have on compliance with screening mammography by surveying 521 women for information related to health behavior, health concerns, sense of well-being, satisfaction with health care, and knowledge about breast cancer. Women who underwent mammography were more likely to have a regular physician, to practice breast self-examination, to be less concerned over the cost of mammography, to be generally satisfied with their health care, to believe they have a greater sense of control over their health, and to be more knowledgeable about mammography and breast cancer. Age, health behavior, sense of well-being, locus of control, and breast cancer experience helped differentiate between women who had undergone mammography and those who had not.

Adult↗
PubMed1992

Efficacy of digital radiography for the detection of pneumothorax: comparison with conventional chest radiography.

As part of our continuing evaluation of the clinical applicability of digital radiography, we compared the abilities of radiologists to detect pneumothoraces on conventional chest radiographs with their performances when using three formats of digitally obtained images. Twenty-three frontal-view chest radiographs with pneumothoraces and 22 other chest radiographs, either normal or showing miscellaneous abnormalities, were interpreted by five experienced radiologists in each of four formats: conventional film-screen chest radiographs, small-format (17.8 x 21.6 cm) computed radiographs, large-format (35.6 x 43.1 cm) computed radiographs, and digital images viewed on an interactive electronic workstation. The receiver-operating-characteristic curve areas for each observer for the four types of images were compared by a z test on a critical ratio, and the mean sensitivity and specificity values were compared by the sign rank test. The mean areas under the receiver-operating-characteristic curves ranged from 0.869 for the digital workstation to 0.915 for film-screen images. The differences observed among formats were not statistically significant. Mean specificities also were not significantly different, ranging from 0.90 for large-format computed radiographs to 0.96 for the digital workstation. Mean sensitivity ranged from 0.65 for the digital workstation to 0.82 for film-screen images. Radiologists interpreting digital workstation images were significantly less sensitive in detecting pneumothoraces than with film-screen and small-format computed images (p = .06). In this study, radiologists detected pneumothoraces equally well on conventional film-screen radiographs and digital images printed on film; however, they detected pneumothoraces less well on electronic viewing consoles. This latter finding reflects an important practical difference in the working behavior of radiologists interacting with a digital workstation.

Humans↗
PubMed1991

Clinical experience in the use of photostimulable phosphor radiographic systems.

The experience with CR systems gained at the three institutions described in this report demonstrates numerous advantages over the conventional screen-film system. These include: (1) a reduction in the radiation exposure delivered to the patient (25% to 50%); (2) a decrease in the number of repeat examinations needed, especially in portable units where technical difficulties are common with screen-film examinations; this is attributable to the linear, wider dynamic range of CR systems compared with screen-film combinations; (3) the capability to archive electronically all images by means of a digital optical storage system; (4) automatic electronic setting of the laser scanner for the latitude and sensitivity on each image; (5) the digital images are available for transmission to all image display workstations on a local or wide-area network; and (6) the ability to adjust interactively the display parameters to best depict images and pathology as well as salvage technically suboptimal examinations. Several disadvantages of CR systems compared with conventional screen-film examinations have also been identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1991

[Armageddon].

Explore the source record for details and available documents.

Humans↗
PubMed1990

Frequency and costs of diagnostic imaging in office practice--a comparison of self-referring and radiologist-referring physicians.

BACKGROUND: To assess possible differences in physicians' practices with respect to diagnostic imaging, we compared the frequency and costs of imaging examinations as performed by primary physicians who used imaging equipment in their offices (self-referring) and as ordered by physicians who always referred patients to radiologists (radiologist-referring). METHODS: Using a large, private insurance-claims data base, we analyzed 65,517 episodes of outpatient care by 6419 physicians for acute upper respiratory symptoms, pregnancy, low back pain, or (in men) difficulty urinating. The respective imaging procedures studied were chest radiography, obstetrical ultrasonography, radiography of the lumbar spine, and excretory urography, cystography, or ultrasonography. RESULTS: For all four clinical presentations, the self-referring physicians obtained imaging examinations 4.0 to 4.5 times more often than the radiologist-referring physicians (P less than 0.0001 for all four). For chest radiography, obstetrical ultrasonography, and lumbar spine radiography, the self-referring physicians charged significantly more than the radiologists for imaging examinations of similar complexity (P less than 0.0001 for all three). The combination of more frequent imaging and higher charges resulted in mean imaging charges per episode of care that were 4.4 to 7.5 times higher for the self-referring physicians (P less than 0.0001). These results were confirmed in a separate analysis that controlled for the specialty of the physician. CONCLUSIONS: Physicians who do not refer their patients to radiologists for medical imaging use imaging examinations more frequently than do physicians who refer their patients to radiologists, and the charges are usually higher when the imaging is done by the self-referring physician. From our results it is not possible to determine which group of physicians uses imaging more appropriately.

Ambulatory Care↗