Marta Heilbrun - Profile on Academia.edu (original) (raw)

Papers by Marta Heilbrun

Quantifying the costs of telephone interruptions during diagnostic radiology: A mobile eye-tracking study

Journal of Vision, 2016

Fig. 1. VISCARETRAILS session on a dataset of pancreatic cancer patients. The central top display... more Fig. 1. VISCARETRAILS session on a dataset of pancreatic cancer patients. The central top display shows a Timed Word Tree with staging events (STAGE I, STAGE II, STAGE III, STAGE IV) and rooted in the death event (DEAD). Selecting the stage nodes, corresponding to severity and extent of disease, the bottom left plot presents survival curves indicating the fraction of each of the four sets of staged subjects that were still alive after t days, and the box-plot represents the distribution of the time distance the death event. This visualization confirms that this specific dataset follows the known patterns for pancreatic cancer patients and is obtained with just a few intuitive mouse gestures. Abstract — As a mandate in the 2009 ARRS act, all US health care systems are moving toward electronic health record (EHR) systems to capture and store patient data. The EHR is a rich source of health information about individual patients and/or populations. The ability to analyze and identify me...

The Application of Machine Learning to Quality Improvement Through the Lens of the Radiology Value Network

Journal of the American College of Radiology, 2019

Recent advances in machine learning and artificial intelligence offer promising applications to r... more Recent advances in machine learning and artificial intelligence offer promising applications to radiology quality improvement initiatives as they relate to the radiology value network. Coordination within the interlocking web of systems, events, and stakeholders in the radiology value network may be mitigated though standardization, automation, and a focus on workflow efficiency. In this article the authors present applications of these various strategies via use cases for quality improvement projects at different points in the radiology value network. In addition, the authors discuss opportunities for machine-learning applications in data aggregation as opposed to traditional applications in data extraction.

The Journal of Urology, 2018

catheter presence was 5.5 (interquartile range: 2-11) days. 86% of the catheters were introduced ... more catheter presence was 5.5 (interquartile range: 2-11) days. 86% of the catheters were introduced during hospitalization. The common indications for catheter insertion were urine output monitoring (58%), post-surgical status (20%) and urinary retention (14%). In a univariate model including postulated risk factors, a longer duration of catheter presence (p¼0.001), patient immobility (p¼0.025), internal ward hospitalization (p¼0.045) and other skin ulcers (p¼0.008) were all predictors of meatal and urethral damage, while catheter fixation (p¼0.041) and a post-operative indication (p¼0.037) were associated with reduced meatal and urethral damage.In a multivariate analysis, duration of catheter presence (p¼0.017) and lack of catheter fixation (p¼0.006) were significantly associated with meatal damage, with a trend for other skin ulcers (p¼0.052). CONCLUSIONS: Meatal damage is a common, preventable complication of indwelling catheters in males. Catheter fixation may have a preventative effect on this phenomenon. Longitudinal studies are needed to establish evidence-based guidelines on this matter.

Value in Health, 2010

insurance, physician type, region, pre-dialysis co-morbidities, and pre-dialysis costs were used ... more insurance, physician type, region, pre-dialysis co-morbidities, and pre-dialysis costs were used to evaluate the impact of pre-dialysis paricalcitol treatment on hospitalizations, outpatient services, and medication use in first year of dialysis. RESULTS: Multivariable analysis demonstrated predialysis paricalcitol use was associated with statistically significant reductions in all-cause hospitalizations (0.806, 95%CI: 0.684-0.950), all-cause outpatient services (0.953, 95%CI: 0.933-0.973) and CKDrelated hospitalizations (0.780, 95% CI: 0.635-0.958); CKD-related outpatient visits (0.962, 95% CI: 0.938-0.987); and CKD-related medications (0.922, 95% CI: 0.852-0.996) in the first year of dialysis compared with no predialysis VDR activator treatment. CONCLUSIONS: Paricalcitol treatment for SHPT prior to dialysis is associated with fewer CKD-related medications; and all-cause and CKD-related outpatient services and hospitalizations in the first year of dialysis compared to no VDR activator treatment. Payers should consider these findings when make coverage decisions regarding the use of paricalcitol. Further studies are needed to confirm these results.

Academic Radiology, 2009

Rationale and Objectives. Introduce radiology residents to evidence-based radiology (EBR) using a... more Rationale and Objectives. Introduce radiology residents to evidence-based radiology (EBR) using a journal club format based on the Radiology Alliance for Health Services Research/American Alliance of Academic Chief Residents in Radiology (RAHSR/ A3CR2) Critical Thinking Skills sessions and EBR series of articles published in Radiology in 2007. Materials and Methods. The club began with a presentation outlining the process that would occur in an alternating format, with topics and articles chosen by residents. In session A, questions were rephrased in a Patient/Population, Intervention, Comparison, Outcome format, and a literature search was performed. Articles were discussed in session B, with residents assigned by year to the tasks of article summary, technology assessment, and comparison to checklists (Standards for Reporting of Diagnostic Accuracy, Consolidated Standards of Reporting Trials, or Quality of Reporting of Meta-analysis). The residents collectively assigned a level of evidence to each article, and a scribe provided a summary. Results. Twenty-two residents participated, with 12/22 (55%) of residents submitting any question, 6/22 (27.3%) submitting more than one question, and 4 residents submitting questions in more than one session. Topics included radiation risk, emergency radiology, screening examinations, modality comparisons, and technology assessment. Of the 31 articles submitted for review, 15 were in radiology journals and 5 were published before 2000. For 2/9 topics searched, no single article that the residents selected was available through our library's subscription service. The maximum level of evidence assigned by residents was level III, ''limited evidence.'' In each session, the residents concluded that they became less confident in the ''right answer.'' They proposed that future reading recommendations come from attendings rather than literature searches. A journal club format is an effective tool to teach radiology residents EBR principles. Resistance comes from the difficulty in accessing good literature for review and in constructing good review questions.

Introduction: Altered renal function commonly affects patients with cirrhosis, a consequence of c... more Introduction: Altered renal function commonly affects patients with cirrhosis, a consequence of chronic liver disease. From lowdose contrast material-enhanced magnetic resonance (MR) renography, we can estimate the Glomerular Filtration Rate (GFR), an important parameter to assess renal function. Two-dimensional MR images are acquired every 2 seconds for approximately 5 minutes during free breathing, which results in a dynamic series of 140 images representing kidney filtration over time. This specific acquisition presents dynamic contrast changes but is also challenged by organ motion due to breathing. Rather than use conventional image registration techniques, we opted for an alternative method based on object detection. We developed a novel analysis framework available under a stand-alone toolkit to efficiently register dynamic kidney series, manually select regions of interest, visualize the concentration curves for these ROIs, and fit them into a model to obtain GFR values. Thi...

© 2010 Mosby, Inc. All rights reserved. Corresponding Author: Marta E. Heilbrun, MD, Dept. of Rad... more © 2010 Mosby, Inc. All rights reserved. Corresponding Author: Marta E. Heilbrun, MD, Dept. of Radiology, University of Utah, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140, Phone: 801-581-7553, Fax: 801-581-2414, marta.heilbrun@hsc.utah.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

As a mandate in the 2009 ARRS act, all US health care systems are moving toward electronic health... more As a mandate in the 2009 ARRS act, all US health care systems are moving toward electronic health record (EHR) systems to capture and store patient data. The EHR is a rich source of health information about individual patients and/or populations. The ability to analyze and identify meaningful patterns in this data has the potential to produce important knowledge. Yet, there is still a considerable gap between what answers are captured in this record and what answers can be effectively extracted from it. To reduce this gap, more intuitive ways of posing questions and obtaining answers are needed. In this paper we present VISCARETRAILS, a system based on timed word trees visualization that summarizes event paths relative to a given root event and are obtained through a simple drag-and-drop user interface. These summaries visually convey information about the nature, frequency and average timing of the event paths, and serve as a natural starting point to obtain further details and com...

Structured Reporting: The Value Concept for Radiologists

Narrative reporting has been the mainstay of the radiologist’s work for as long as the domain of ... more Narrative reporting has been the mainstay of the radiologist’s work for as long as the domain of radiology has been in existence. Structured radiology reporting, containing coded and consistent information, will facilitate information exchange in the digital health record. This chapter will define structured reporting, review recent legislation that incentivizes structured reporting, and discuss the quality and value propositions that are supported by structured reporting. Constrained vocabularies and coded terminologies, including the American College of Radiology’s disease-specific Imaging Reporting and Data Systems (IRADS) and the Radiological Society of North America’s RadLex™, are described. Data exchange tools including the Management of Radiology Report Templates (MRRT) and Common Data Elements (CDEs) are discussed. Benefits of machine learning from report analysis are discussed. Limitations to implementation and realizing the full benefits of structured reporting are also ac...

Annotation of Critical Findings from Radiology Reports: Towards Automated Communication Through the Electronic Health Record

The communication of critical findings observed in radiology imaging studies between the radiolog... more The communication of critical findings observed in radiology imaging studies between the radiologist and the ordering provider is a key factor in providing efficacious patient care [1]. Currently, the most common form of communication is a physician-to-physician telephone conversation, initiated by the radiologist at the time of image interpretation. This process may be tedious, slow, and inefficient.

Academic Radiology

Rationale and Objectives: To quantify the costs and work of diagnostic radiology (DR) residents u... more Rationale and Objectives: To quantify the costs and work of diagnostic radiology (DR) residents using the radiology key performance indicator turnaround time (TAT) as the outcome measure. Materials and Methods: In an Institutional Review Board-approved study, the annual cost of a DR resident was determined using salary, benefits, and a cost allocation of faculty effort. The volume of cases reported in the 2015À16 academic year and median and interquartile range (IQR) TAT for a trainee preliminary (Complete to Prelim, C-P) or an attending final (Complete to Final, C-F) radiology report were measured and stratified by time of day and patient location. Wilcoxon rank-sum tests were used (significance, p values < 0.05). Results: The annual cost of a DR resident was 99,109,3499,109, 34% greater than direct salary/benefits and 27% of the direct salary/benefits cost of an attending. The total per minute cost of rendering care was 99,109,344.36 with both trainee ($0.70/minute) and faculty ($3.66/minute). Residents participated in 139,084/235,417 (59%) imaging studies. The C-P TAT was 74 (IQR, 27À180) minutes compared to 51 (IQR, 18À129) minutes C-F TAT of faculty working alone and C-F TAT of 213 (IQR, 71À469) minutes with a resident (p < 0.001). The C-P TAT vs C-F TAT between 4 pmÀ9 am and weekends with residents is 44 (IQR, 18À119) minutes vs 60 (IQR, 18À179) minutes without. Conclusion: The cost of training DR residents exceeds the salary and benefits allocated to their training. Residents increase the absolute professional labor cost of caring for a patient. Overall TAT is slower with residents but the care delivered by residents after-hours is faster.

MP04-01 OPTIMAL Cut-Off Points for Laceration Size and Peri-Renal Hematoma Rim Distance to Predict Bleeding Interventions After High-Grade Renal Trauma

Journal of Urology

ACR Appropriateness Criteria® Acute Pyelonephritis

Journal of the American College of Radiology

Pyelonephritis refers to infection involving the renal parenchyma and renal pelvis. In most patie... more Pyelonephritis refers to infection involving the renal parenchyma and renal pelvis. In most patients, uncomplicated pyelonephritis is diagnosed clinically and responds quickly to appropriate antibiotic treatment. If treatment is delayed, the patient is immunocompromised, or for other reasons, microabscesses that form during the acute phase of pyelonephritis may coalesce, forming a renal abscess. Patients with underlying diabetes are more vulnerable to complications, including emphysematous pyelonephritis in addition to abscess formation. Additionally, diabetics may not have the typical flank tenderness that helps to differentiate pyelonephritis from a lower urinary tract infection. Additional high-risk populations may include those with anatomic abnormalities of the urinary tract, vesicoureteral reflux, obstruction, pregnancy, nosocomial infection, or infection by treatment-resistant pathogens. Treatment goals include symptom relief, elimination of infection to avoid renal damage, and identification of predisposing factors to avoid future recurrences. The primary imaging modalities used in patients with pyelonephritis are CT, MRI, and ultrasound. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Cost Implications of Oral Contrast Administration in the Emergency Department: A Time-Driven Activity-Based Costing Analysis

Journal of the American College of Radiology : JACR, Jan 26, 2018

To quantify the monetary and time costs associated with oral contrast administration in the emerg... more To quantify the monetary and time costs associated with oral contrast administration in the emergency department (ED) for patients with nontraumatic abdominal pain and to evaluate the cost savings associated with an institutional policy change in the criteria for oral contrast administration. A HIPAA-complaint, institutional review board-approved time-driven activity-based costing analysis was performed using both prospective time studies and retrospective data obtained from a quaternary care center. Retrospective data spanned a 1-year period (January 1, 2016, to December 31, 2016). A process map was generated. Examination volume-related data, labor costs, and material costs were determined and applied to a base-case model. Univariate and multivariate sensitivity analyses were conducted. Multivariate analysis was used to estimate the cost savings associated with a policy change eliminating oral contrast for patients with body mass index ≥ 25 kg/m, no prior abdominal surgery within 3...

An Aast-Mitc Analysis of Pancreatic Trauma: Staple or Sew? Resect or Drain?

The journal of trauma and acute care surgery, Jan 21, 2018

Pancreatic trauma results in high morbidity and mortality, in part, due to delay in diagnosis and... more Pancreatic trauma results in high morbidity and mortality, in part, due to delay in diagnosis and subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy in diagnosing pancreatic injury and the morbidity and mortality associated with varying operative strategies. We created a multi-center, pancreatic trauma registry from 18 level 1 and 2 trauma centers. Adult, blunt or penetrating injured patients from 2005-2012 were analyzed. Sensitivity and specificity of CT scan identification of main pancreatic duct injury was calculated against operative findings. Independent predictors for mortality, ARDS and pancreatic fistula and/or pseudocyst were identified through multivariate regression analysis. The association between outcomes and operative management was measured. We identified 704 pancreatic injury patients of whom 584 (83%) underwent a pancreas-related procedure. CT grade modestly correlated with OR grade (r ...

ACR Appropriateness Criteria(®) Renal Transplant Dysfunction

Journal of the American College of Radiology : JACR, 2017

Renal transplantation is the treatment of choice in patients with end-stage renal disease because... more Renal transplantation is the treatment of choice in patients with end-stage renal disease because the 5-year survival rates range from 72% to 99%. Although graft survival has improved secondary to the introduction of newer immunosuppression drugs and the advancements in surgical technique, various complications still occur. Ultrasound is the first-line imaging modality for the evaluation of renal transplants in the immediate postoperative period and for long-term follow-up. In addition to depicting many of the potential complications of renal transplantation, ultrasound can also guide therapeutic interventions. Nuclear medicine studies, CT, and MRI are often helpful as complementary examinations for specific indications. Angiography remains the reference standard for vascular complications and is utilized to guide nonsurgical intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annua...

Dissecting Costs of CT Study: Application of TDABC (Time-driven Activity-based Costing) in a Tertiary Academic Center

Academic radiology, Jan 14, 2016

The lack of understanding of the real costs (not charge) of delivering healthcare services poses ... more The lack of understanding of the real costs (not charge) of delivering healthcare services poses tremendous challenges in the containment of healthcare costs. In this study, we applied an established cost accounting method, the time-driven activity-based costing (TDABC), to assess the costs of performing an abdomen and pelvis computed tomography (AP CT) in an academic radiology department and identified opportunities for improved efficiency in the delivery of this service. The study was exempt from an institutional review board approval. TDABC utilizes process mapping tools from industrial engineering and activity-based costing. The process map outlines every step of discrete activity and duration of use of clinical resources, personnel, and equipment. By multiplying the cost per unit of capacity by the required task time for each step, and summing each component cost, the overall costs of AP CT is determined for patients in three settings, inpatient (IP), outpatient (OP), and emerg...