Efficacy and time-efficiency of a "sonographer-driven" contrast echocardiography protocol in a high-volume echocardiography laboratory

Background Contrast echocardiography (CE) has not gained widespread use despite numerous studies demonstrating its efficacy in the assessment of left ventricular (LV) function. Methods We sought to determine whether CE could be used in a high-volume echocardiography laboratory in a clinically effective and time efficient manner. We implemented a protocol with a feasibility phase and an established phase. Cost-benefit analyses were done on the basis of time use. Results During the feasibility and established phases, data on 119 and 672 patients, respectively, were obtained. After a “sonographer-driven” protocol, contrast studies represented 7% to 8% of the total number of routine transthoracic and stress studies. Stress studies accounted for only 15% of the total number of contrast studies. Obesity was the most common indication for contrast use. LV visualization indices and wall thickening assessment, as evaluated by 2 blinded readers, were significantly improved with CE compared with second harmonic imaging alone. The time to make the decision to use CE and the time taken to administer contrast decreased significantly from the feasibility phase to the established phase (8.3 ± 5 vs 7.6 ± 5 min, P < .01, and 13.4 ± 10 vs 10.2 ± 5 min, P < .001, respectively). On the basis of time use only, a cost analysis indicated that savings were obtained at a 10-minute reduction in study time. Conclusions A “sonographer-driven” CE protocol for LV assessment is feasible in high-volume echocardiography laboratories. It is clinically effective because it significantly improves LV global and regional wall motion visualization. A “sonographer-driven” CE protocol can reduce decision and administration times substantially, thus making CE time-efficient. (Am Heart J 2003;145:535-41.)     

Longitudinal Assessment of Cost in Health Care Interventions

We develop a method to estimate the cumulative cost of health interventions over a specified duration while controlling for a mix of patient-specific variables using data of total cost and associated length of treatment. A two-equation model for total cost and duration of treatment is estimated with the endogeneity of the latter accounted for in the model for cost. As an illustrative example, we apply our method to hospital costs and length of stay of patients undergoing cardiac procedures. Our method is relevant to economic evaluations of interventions since it accounts for the differential impact of treatment duration on total cost, in addition to patient characteristics. Our method allows greater use of total costs data, typically found in hospital records and claim files, that has not been previously attempted.     

Depression and mortality in nursing homes

To determine the prevalence rates of major depressive disorder and of depressive symptoms and their relationship to mortality in nursing homes, research psychiatrists examined 454 consecutive new admissions and followed them up longitudinally for 1 year. Major depressive disorder occurred in 12.6% and 18.1% had depressive symptoms; the majority of cases were unrecognized by nursing home physicians and were untreated. Major depressive disorder, but not depressive symptoms, was a risk factor for mortality over 1 year independent of selected physical health measures and increased the likelihood of death by 59%. Because depression is a prevalent and treatable condition associated with increased mortality, recognition and treatment in nursing homes is imperative.