Dilek BAŞAR, İlhan Can ÖZEN, Selcen ÖZTÜRK, Ekim GÜMELER, Deniz AKATA, Arbay Özden ÇİFTÇİ

Tekrarlanan MR Görüntülemelerinin Doğrudan ve Dolaylı Maliyet Etkileri: Hacettepe Üniversitesi Hastanelerinden Bulgular

Bu çalışma Hacettepe Üniversitesi Hastanelerinden elde edilen veriler aracılığıyla tekrarlanan MR incelemelerini araştırmaktadır. Çalışmadan elde edilen sonuçlar konsülte edilen MR’ların yaklaşık %34’ünün düşük kalite sebebiyle aynı yıl içinde tekrar edildiğini göstermiştir. Düşük kalite; hareket artefaktları, yanlış tarama tekniği veya dizisinin kullanımı, deneyimsiz okuyucu ve / veya kısaltılmış zaman aralıkları olarak tanımlanmaktadır. Söz konusu MR’ların %30’unda ise tanı değişikliği olmuştur. Sonuçlar çocuklar ve kadınlar için tekrar olasılığının daha yüksek olduğuna işaret etmektedir.

Anahtar Kelimeler:

Sağlık Politikası, Aşırı MR Kullanımı, Doğrudan ve Dolaylı Maliyetler, Türkiye

The Case of MRI Repetitions with Direct and Indirect Cost Implications: Evidence from Hacettepe University Hospitals

This study investigates the case of repeated MRIs using data from Hacettepe University Hospitals. Results indicate that almost 34% of MRI consultations have to be repeated within the same year due to suboptimal quality that hinders correct assessment and diagnosis. Suboptimal quality refers to; movement artefacts, use of wrong scan technique or sequence, inexperienced reader and/or shortened time intervals. In fact, almost 30% of those repetitions result in a change in diagnosis. Results suggest that the probability of repetition is higher among women and children.

Keywords:

Health Policy, MRI Overutilization, Direct and Indirect Costs, Turkey,

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Arıkan, A. & S. Çınarlı & F.Ş. Aykar & A. Sayan (2017), “Attitudes of Medical Malpractice in Pediatric Surgery”, The Journal of Pediatric Research, 4(3), 117.
Armao, D. & R.C. Semelka & J. Elias Jr (2012), “Radiology's ethical responsibility for healthcare reform: tempering the overutilization of medical screening and trimming down a heavyweight”, Journal of magnetic resonance screening, 35(3), 512-517.
Başar, D. & S. Öztürk & İ. Cakmak (2018), “An Application of the Behavioral Model to the Utilization of Health Care Services in Turkey: A Focus on Equity”, Panoeconomicus, Advance online publication, 1-22.
Bilimoria, K.Y. & J.W. Chung & C.A. Minami & M.W. Sohn & E.S. Pavey & J.L. Holl & M.M. Mello (2017), “Relationship between state malpractice environment and quality of health care in the United States”, The Joint Commission Journal on Quality and Patient Safety, 43(5), 241-250.
Cascade, P.N. & E.W. Webster & E.A. Kazerooni (1998), “Ineffective use of radiology: the hidden cost”, AJR. American journal of roentgenology, 170(3), 561-564.
Colla, C.H. & A.J. Mainor & C. Hargreaves & T. Sequist & N. Morden (2017), “Interventions aimed at reducing use of low-value health services: a systematic review”, Medical Care Research and Review, 74(5), 507-550.
Dinan, M.A. & L.H. Curtis & B.G. Hammill & E.F. Patz & A.P. Abernethy & A.M. Shea & K.A. Schulman (2010), “Changes in the use and costs of diagnostic screening among Medicare beneficiaries with cancer, 1999-2006”, Jama, 303(16), 1625-1631.
Eş, H. & Y. Özer & Z. Liman & A. Şanlı (2017), “General surgery malpractice claims in Turkey”, Romanian Journal of Legal Medicine, (2), 272-278.
Hendee, W.R. & G.J. Becker & J.P. Borgstede & J. Bosma & W.J. Casarella & B.A. Erickson & P.E. Wallner (2010), “Addressing overutilization in medical screening”, Radiology, 257(1), 240-245.
Hillman, B.J. & C.A. Joseph & M.R. Mabry & J.H. Sunshine & S.D. Kennedy & M. Noether (1990), “Frequency and costs of diagnostic screening in office practice-a comparison of self-referring and radiologist-referring physicians”, New England Journal of Medicine, 323(23), 1604-1608.
Hosmer, D.W. & S. Lemeshow (2000), Applied Logistic Regression, John Wiley & Sons.
Küçük, M. (2018), “Defensive medicine among obstetricians and gynaecologists in Turkey”, Journal of Obstetrics and Gynaecology, 38(2), 200-205.
Lang, K. & H. Huang & D.W. Lee & V. Federico & J. Menzin (2013), “National trends in advanced outpatient diagnostic screening utilization: an analysis of the medical expenditure panel survey, 2000-2009”, BMC Medical Screening, 13(1), 40.
Mafi, J.N. & K. Russell & B.A. Bortz & M. Dachary & W.A. Hazel Jr & A.M. Fendrick (2017), “Low-cost, high-volume health services contribute the most to unnecessary health spending”, Health Affairs, 36(10), 1701-1704.
Mello, M.M. & D.M. Studdert & T.A. Brennan (2003), “The new medical malpractice crisis”, New England Journal of Medicine, 348(23), 2281-2284.
Ozmen, P. & S. Sahin & M. Cetin & Y.Z. Turk (2015), “A Medical Malpractice Research Conducted in Turkey, Causes and the Role of Media”, Journal of Archives in Military Medicine, 3(2).
Sistrom, C. & N.L. McKay & J.B. Weilburg & S.J. Atlas & T.G. Ferris (2012), “Determinants of diagnostic screening utilization in primary care”, The American journal of managed care, 18(4), e135-44.
Smith-Bindman, R. & D.L. Miglioretti & E.B. Larson (2008), “Rising use of diagnostic medical screening in a large integrated health system”, Health Affairs, 27(6), 1491-1502.
Solaroglu, I. & Y. Izci & H.G. Yeter & M.M. Metin & G.E. Keles (2014), “Health transformation project and defensive medicine practice among neurosurgeons in Turkey”, PloS one, 9(10), e111446.
TCSB SAGM (2017), Sağlık İstatistikleri Yıllığı 2016, Ankara.
Tynan, A. & R.A. Berenson & J.B. Christianson (2008), “Health plans target advanced screening services: cost, quality and safety concerns prompt renewed oversight”, Issue Brief (Center for Studying Health System Change), (118), 1-4.