A comparison of in-house and regionalized computerized tomography scanning: Clinical impact and cost

A. Elixhauser, D. M. Reker, K. N. Gillespie, James Fletcher, F. D. Wolinsky

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were ontained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part ofd the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that Va hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.

Original languageEnglish
Pages (from-to)177-196
Number of pages20
JournalHealth Services Research
Volume25
Issue number1 II
StatePublished - 1990
Externally publishedYes

Fingerprint

Tomography
Costs and Cost Analysis
efficiency
costs
utilization
regionalization
analysis of variance
fee
compromise
diagnostic
cancer
mortality
Disease
Hospital Administrators
trend
Fees and Charges
Ownership
Quality of Health Care
Veterans
Group

ASJC Scopus subject areas

  • Health Policy
  • Nursing(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Elixhauser, A., Reker, D. M., Gillespie, K. N., Fletcher, J., & Wolinsky, F. D. (1990). A comparison of in-house and regionalized computerized tomography scanning: Clinical impact and cost. Health Services Research, 25(1 II), 177-196.

A comparison of in-house and regionalized computerized tomography scanning : Clinical impact and cost. / Elixhauser, A.; Reker, D. M.; Gillespie, K. N.; Fletcher, James; Wolinsky, F. D.

In: Health Services Research, Vol. 25, No. 1 II, 1990, p. 177-196.

Research output: Contribution to journalArticle

Elixhauser, A, Reker, DM, Gillespie, KN, Fletcher, J & Wolinsky, FD 1990, 'A comparison of in-house and regionalized computerized tomography scanning: Clinical impact and cost', Health Services Research, vol. 25, no. 1 II, pp. 177-196.
Elixhauser, A. ; Reker, D. M. ; Gillespie, K. N. ; Fletcher, James ; Wolinsky, F. D. / A comparison of in-house and regionalized computerized tomography scanning : Clinical impact and cost. In: Health Services Research. 1990 ; Vol. 25, No. 1 II. pp. 177-196.
@article{f493d744bc2f4344b6d8fabfdb7b90be,
title = "A comparison of in-house and regionalized computerized tomography scanning: Clinical impact and cost",
abstract = "Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were ontained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part ofd the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that Va hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.",
author = "A. Elixhauser and Reker, {D. M.} and Gillespie, {K. N.} and James Fletcher and Wolinsky, {F. D.}",
year = "1990",
language = "English",
volume = "25",
pages = "177--196",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
number = "1 II",

}

TY - JOUR

T1 - A comparison of in-house and regionalized computerized tomography scanning

T2 - Clinical impact and cost

AU - Elixhauser, A.

AU - Reker, D. M.

AU - Gillespie, K. N.

AU - Fletcher, James

AU - Wolinsky, F. D.

PY - 1990

Y1 - 1990

N2 - Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were ontained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part ofd the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that Va hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.

AB - Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were ontained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing services. Finally, a high-efficiency in-house machine was used. Clinical outcomes and costs of diagnosing 181 bronchogenic cancer patients were compared across the three time periods to identify any differences associated with regionalization of CT services. Patient groups were homogeneous with respect to sociodemographic characteristics, clinical presentation, and severity of disease. The first part of the analysis investigated whether the site of CT scanning affected clinical outcomes. Diagnostic procedures, surgical results, mortality, and length of stay were compared using one-way analysis of variance. Significant differences were found only for conventional tomography and CT utilization rates. While conventional tomography declined across the periods, CT utilization increased, exceeding national trends. The second part ofd the analysis examined the costs of CT scanning. During the regionalized period, the hospital paid a fixed fee of $519 per scan. Estimated costs of in-house scans were $285 in the low-efficiency and $141 in the high-efficiency periods. Charge-based payments made to the external facility and differences in the volumes of patients scanned internally account for the cost differences. The analysis showed that while regionalized CT scanning did not compromise the quality of care for these VA patients, it was more costly. Results suggest that Va hospital administrators should carefully consider ownership and payment arrangements when comparing regionalized and in-house provision of services.

UR - http://www.scopus.com/inward/record.url?scp=0025374842&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025374842&partnerID=8YFLogxK

M3 - Article

C2 - 2109740

AN - SCOPUS:0025374842

VL - 25

SP - 177

EP - 196

JO - Health Services Research

JF - Health Services Research

SN - 0017-9124

IS - 1 II

ER -