Use Of Low-osmolality Contrast Media Research Articles

Major Adverse Renal and Cardiovascular Events following Intra-Arterial Contrast Media Administration in Hospitalized Patients with Comorbid Conditions

Introduction: Several clinical studies and meta-analyses have demonstrated lower incidence of adverse renal and cardiovascular outcomes associated with the use of iso-osmolar contrast media (IOCM) than low-osmolar contrast media (LOCM) in patients with variable risk profiles undergoing intra-arterial interventional procedures. However, the association of contrast-type and major adverse renal and cardiovascular events (MARCE) has not been studied via comprehensive and robust real-world data analyses in patients with comorbid conditions considered at risk for post-procedural acute kidney injury (AKI). The objective of this study was therefore to retrospectively assess the MARCE rates comparing IOCM with LOCM in at-risk patients receiving iodinated intra-arterial contrast media using a real-world inpatient data source. Methods: Patients who underwent a diagnostic or treatment procedure with intra-arterial IOCM or LOCM administration were identified using the Premier Healthcare Database. Patient subgroups including those with diabetes, heart failure, chronic kidney disease (CKD) stages 1–4, CKD 3–4, or diagnosis of chronic total occlusion (CTO) were formed. Subgroups with combinations of diabetes and CKD 3–4 with and without CTO were also investigated. We compared the primary endpoint of MARCE (composite of AKI, AKI requiring dialysis, acute myocardial infarction, stroke/transient ischemic attack, stent occlusion/thrombosis, or death) after IOCM versus LOCM administration via adjusted multivariable regression analyses. Results: A total of 536,013 inpatient visits met the primary inclusion and exclusion criteria (IOCM = 133,192; LOCM = 402,821). After multivariable modeling, the use of IOCM was associated with a significantly lower incidence of MARCE than LOCM in patients with CKD 1–4, CKD 3–4, diabetes, or heart failure, with greatest absolute risk reduction (ARR) of 2.4% (p < 0.0001) in CKD 3–4 patients (relative risk reduction [RRR] = 13.8%, number needed to treat [NNT] = 43). Additionally, ARR associated with IOCM increased to 3.5% (p < 0.0001) in patients with combined comorbidities of diabetes and CKD 3–4 (RRR = 19.1%, NNT = 29). Statistically significant risk reduction was also found for the use of IOCM among patients who underwent revascularization for CTO (ARR = 1.6% [p < 0.0001], RRR = 22.3%, NNT = 62). Conclusion: Intra-arterial administration using IOCM in at-risk patients is associated with lower rates of MARCE than the use of LOCM. This difference is especially apparent in patients with a combination of CKD 3–4 and diabetes and in patients with CTO, providing real-world data validation with meaningful NNT in favor of IOCM.

Outcomes, risk factors and health burden of contrast-induced acute kidney injury: an observational study of one million hospitalizations with image-guided cardiovascular procedures.

BackgroundDespite the use of low-osmolar contrast media that have significantly reduced the occurrence of severe adverse reactions, contrast-induced (CI) acute kidney injury (AKI) remains the third cause of AKI in hospitals. We sought to estimate the frequency of CI-AKI among hospitalized patients undergoing image-guided cardiovascular procedures, to quantify the effect of risk factors on the development of this complication and to assess relative organizational and economic burden in healthcare.MethodsA retrospective cross-sectional population-based study using the extensive French hospital discharge database (PMSI) was carried out. Hospitalizations with image-guided cardiovascular procedures using a contrast media were identified in adults over a 2-year period (2012–2013). Suspected CI-AKI was defined as the presence, during hospitalization, of a diagnostic code of AKI (International Classification of Diseases, 10th revision [ICD-10] codes: N141, 142, N144, N990, N17, N19 or R392) or a code of renal replacement therapy procedure (Classification Commune des Actes Médicaux [CCAM] codes: JVJB001, JVJF002-005 and JVJF008) as creatinine criteria were not available.ResultsDuring 1,047,329 hospitalizations studied, 32,308 suspected CI-AKI were observed, yielding a frequency of 3.1 %. By multivariate analysis, factors that significantly increased the risk of suspected CI-AKI included cardiogenic shock (odds ratio [OR] = 20.5, 95 % confidence interval [95 % CI] [18.7; 22.5]), acute heart failure (OR = 2.5, 95 % CI [2.4; 2.6]) and chronic kidney disease (OR = 2.3, 95 % CI [2.2; 2.3]. Renal replacement therapy was initiated during 6,335 (0.6 %) hospitalizations. The mean length of stay and cost of hospitalizations associated with suspected CI-AKI was higher than in hospitalizations without suspected CI-AKI (20.5 vs 4.7 days, p < 0.00001 and €15,765 vs €3,352, p < 0.0001, respectively).ConclusionsThis is the first large-scale population-based study to estimate frequency and health burden of suspected CI-AKI occurring after image-guided cardiovascular procedures, and the first available data in a French population. We showed that this iatrogenic complication remains of high concern despite prevention efforts and contrast media product improvement. From our results, suspected CI-AKI is associated with particularly high mortality, significantly extends hospitalizations, and leads to additional costs reaching a total of €200M per year.

Predicting contrast induced nephropathy post coronary intervention: A prospective cohort study

Abstract Objective The purpose of our study was to assess the incidence and predictors of contrast induced nephropathy (CIN) in unselected patients undergoing coronary intervention either coronary angiography (CA) or percutaneous coronary interventions (PCI), at Assiut university hospitals. Background CIN is a frequent, potentially lethal complication after coronary intervention. It is the 3rd most common cause of hospital-acquired acute renal failure. Patients and methods This is an observational prospective cohort study. Two hundred consecutive patients between December 2011 and August 2012 underwent CA and PCI were enrolled in the study. Blood samples were collected at baseline and 3 days after interventions. All patients were followed up for 2 weeks for major adverse events. Results CIN was observed in 23 (11.5%) patients. According to Mehran risk score, 84.5% of our patients had low risk for CIN, 15.5% had moderate risk for CIN, and no one had high risk score. Multivariate logistic regression analysis of predictors for CIN, showed that the use of high osmolar contrast media (CM) (Telebrix) was associated with 4 times higher incidence of CIN than the use of low osmolar CM (Ultravest) (OR = 4.07; 95% CI = 1.1–15.1). None of our patients had clinical signs or symptoms of acute renal failure, or required haemodialysis at 2 weeks of follow up. Conclusion Although most of our study population was at low risk, the incidence of CIN was relatively high due to the use of high osmolar CM. Further studies are needed for cost effectiveness in light of negligible clinical impact.

Prevention of contrast-induced nephropathy in diabetic patients with impaired renal function: A randomized, double blind trial of sodium bicarbonate versus sodium chloride-based hydration

AimsDiabetes mellitus and decreased renal function are important risk factors for contrast-induced nephropathy (CIN) in which oxidative stress damage may play a role. Alkalinization with sodium bicarbonate (NaHCO3) has been proposed as a means of reducing free-radical mediated renal injury; however, the effectiveness of NaHCO3 treatment to prevent CIN in high-risk patients remains uncertain. MethodsWe performed a prospective, randomized, double blind, sodium chloride (NaCl) hydration-controlled study of NaHCO3 in 120 diabetic patients with impaired renal function (serum creatinine ≥100μmol/L) undergoing an elective procedure with use of low-osmolar contrast media. The primary endpoint was the incidence of CIN defined as creatinine increase of ≥25% and/or ≥44μmol/L within 2 days after contrast. Secondary end-points were maximal changes in serum creatinine and estimated glomerular filtration rate. Urine F2-isoprostane levels were also assessed as measure of oxidative stress. ResultsThere were no significant group differences in baseline characteristics except for the marginally lower age of the NaHCO3 treated patients (63±11 vs. 67±10 years; p=0.05). CIN occurred in 7 (11.5%) and 5 (8.5%) patients of the NaHCO3 and NaCl groups, respectively (p=0.76; incidence rate ratio 1.35; 95% CI 0.37–5.41). No significant differences were seen in secondary outcome measures and changes in the parameter of oxidative stress. ConclusionsIn diabetic patients with renal function impairment sodium bicarbonate does not confer protection against contrast-induced nephropathy greater than sodium chloride-based hydration. Its specific role in mitigating oxidative stress damage in CIN is also not supported by our data.

What are radiologists doing to prevent contrast-induced nephropathy (cin) compared with measures supported by current evidence? a survey of european radiologists on cin associated with computed tomography

Contrast-induced nephropathy (CIN) is a serious complication of the use of iodinated contrast media (CM), and is associated with increased morbidity and mortality. To investigate whether radiologists take sufficient measures to prevent CIN in computed tomography (CT). 2005 survey of 509 European radiologists who had > or =3 years' experience and performed > or =50 CT scans/week. The most common methods used to identify patients at risk of CIN were renal function measurements (64%), clinical judgment (55%), and patient questionnaires (31%); 9% made no routine attempt to identify at-risk patients. The most common preventive protocols used in at-risk patients included: intravenous (i.v.) saline volume repletion (59%) or oral hydration (52%) before/after CT; use of low-osmolar CM (LOCM; 40%) or isosmolar CM (IOCM; 36%); and N-acetylcysteine (20%); 8% used no hydration regimen. While 78% of respondents used < or =100 ml of CM in high-risk patients, 14% used < or =150 ml, and 9% set no volume limit. For 57% of respondents, osmolality was the most important attribute in choosing an iodinated CM in at-risk patients; 41% agreed that CIN risk is lower with IOCM versus LOCM (31% disagreed). A European radiologist survey identified a need for increased implementation of evidence-based protocols to improve CIN prevention: routine identification of at-risk patients; withdrawal of nephrotoxic drugs; use of volume repletion regimens; lowest possible volume of CM; and appropriate CM.

Nephrotoxicity of iso-osmolar versus low-osmolar contrast media is equal in low risk patients

Contrast media-induced nephropathy (CIN) is an increasing cause of hospital-acquired acute kidney injury and leads to a significant increase in mortality. There is uncertainty whether the use of iso-osmolar contrast media as opposed to the use of low-osmolar contrast media would be associated with a lower incidence of CIN. Therefore, we compared the nephrotoxicity of isoosmotic contrast media iodixanol with the low-osmotic contrast media iopromid in patients receiving contrast media during coronary angiography. In this prospective double-blind study we examined 221 patients with normal renal function who received up to 1,000 ml of contrast media during coronary angiography, and compared the effect of iodixanol and iopromid on inducing contrast media nephropathy. Patients received 800 ml fluid orally before contrast media administration and 1,000 ml saline i.v. thereafter. Creatinine clearance, serum creatinine and urine-N-acetyl-beta-D-glucosaminidase (NAG) concentration was obtained 24 h before and 48 h after contrast media administration. Decrease of 20% of the creatinine clearance, increase of 25% of serum creatinine and increase of 20% of the urine concentration of NAG was defined as CIN. Incidence of CIN assessed by decreased creatinine clearance was 22.2% in the iopromid group and 19.7% in the iodixanol group. CIN defined by increased serum creatinine was 6.9% in the iopromid group and 8.6% in the iodixanol group. The difference between these two groups was not significant. Subgroup analysis of the diabetic patients or the patients that received high dose of contrast media revealed no significant difference in the incidence of CIN between the two contrast media. The iso-osmolar and the low-osmolar contrast media exhibited the same incidence of CIN in our study population. If fluid administration is sufficient, the selection of either iopromid or iodixanol has no impact on the risk of developing CIN in patients with normal renal function, even when they are diabetic or receive a high dose of more than 500 ml contrast media.

ASGE Technology Status Evaluation Report: radiographic contrast media used in ERCP

ASGE Technology Status Evaluation Report: radiographic contrast media used in ERCP

Selective use of low-osmolality contrast media in computed tomography.

The aim of this study was to describe our experience and institutional savings with a selective use of low-osmolality contrast media (LOCM) in CT. From 1995 to 1998, a total of 19,834 contrast-enhanced CT examinations were performed at our institution. Contrast was injected with a power injector and large venous catheter, 20-G for 2- to 3-ml rate and 18-G for 3- to 5-ml rate. High-osmolality contrast media was used in 13,670 patients (71%). The LOCM was used in 5884 (29%) patients. Our guidelines for the use of LOCM included cardiac dysfunction, severe pulmonary impairment, history of allergy or prior moderate reaction to HOCM and severe debilitation. Prior to the injection of HOCM, 10 mg of metoclopramide (Primperan, Delagrange Quétigny, France) were administered to reduce nausea and vomiting. In the HOCM group there were 304 minor or mild adverse reactions (2.2%), and 10 severe adverse reactions (0.08%). In the LOCM there were 34 mild or moderate adverse reactions (0.59%) and 3 severe adverse reactions (0.05%). Significant differences in terms of mild adverse reactions were found between HOCM and LOCM (Fischer's test, p<0.001). No significant differences were found in terms of severe adverse reactions ( p=0.27). After subtracting the cost of treating additional adverse reactions, the net differential cost between universal and selective use of LOCM was 565,285 Euro (601,067 US dollars). This means a net increase of 41.4 Euro per patient or 414,000 Euro per 10,000 patients (438,840 US dollars). Selective use of LOCM in CT is safe and effective and results in a substantial reduction in costs.

Adverse reactions to iodinated contrast media

Adverse reactions to iodinated contrast media (ICM) are more likely to develop in patients with asthma, a history of allergy or contrast reaction and in those who are debilitated or medically unstable. These reactions can be divided into renal and general, and the latter are subdivided into acute and delayed. Acute general reactions can be minor, intermediate or severe. Fatal reactions are rare. The introduction of low-osmolality agents has caused an overall reduction in the number of non-fatal contrast reactions. Prompt recognition and treatment of acute adverse side effects to ICM is invaluable and may prevent a reaction from becoming severe. Familiarity with cardiopulmonary resuscitation is essential for successful management of life-threatening reactions. Contrast-media-induced renal impairment can be reduced with the use of low-osmolality contrast media and extracellular volume expansion. The use of ICM in diabetic patients receiving metformin should be carried out with care to avoid metformin-induced lactic acidosis. However, this problem is mainly observed in patients with diabetic nephropathy.

Contrast media-induced nephrotoxicity--questions and answers.

The intravascular administration of contrast media (CM) can produce acute haemodynamic changes in the kidney characterized by an increase in renal vascular resistance and a decrease in the glomerular filtration rate (GFR). These changes may lead to clinically significant reduction in renal function in patients with pre-existing risk factors such as diabetic nephropathy, congestive heart failure and dehydration. The pathophysiology of the renal haemodynamic effects of CM involves activation of the tubuloglomerular feedback (TGF) mechanism and the modulation of the intrarenal production of vasoactive mediators such as prostaglandins, nitric oxide, endothelin and adenosine. The TGF response is osmolality-dependent and accounts for about 50% of the acute functional effects of high osmolar CM on the kidney. Reduction in the synthesis of the endogenous vasodilators nitric oxide and prostaglandins increases the nephrotoxicity of CM. Endothelin and adenosine play a crucial role in mediating the acute functional effects of CM. Antagonists of these mediators attenuate the reduction in renal function induced by contrast agents. Vacuolization of the cells of the proximal tubules and necrosis of those of the medullary ascending limbs of loops of Henle are the main structural effects of CM in the kidney. The reduction in renal function induced by CM could be minimized by the use of low osmolar CM and adequate hydration. The prophylactic administration of calcium channel blockers and adenosine antagonists such as theophylline may also offer some protective effect.

Limit use of low-osmolality contrast media and save money

Limit use of low-osmolality contrast media and save money

Adverse events and cost savings three years after implementation of guidelines for outpatient contrast-agent use.

The ability of guidelines limiting the use of low-osmolality contrast media (LOCM) to save money without jeopardizing patient care was studies. In February 1993 an academic medical center implemented guidelines to reduce the use of LOCM for outpatient computed tomography and excretory urography; the guidelines limited LOCM to patients at high risk of adverse reactions to contrast agents. Data on contrast media received and frequency of adverse events were compiled from billing sheets and incident reports for March 1993 through February 1996. The number of patients receiving LOCM over the three years was 1325, and the number receiving high-osmolality contrast media (HOCM) was 4435. Of the HOCM recipients, 165 (3.7%) had adverse reactions; 0.4% of these reactions were major, 3.1% were minor, and 0.2% were extravasations. Among LOCM-treated patients, 35 (2.7%) had adverse reactions; 0.5% were major, 1.7% were minor, and 0.5% were extravasations. The only significant difference in adverse effects between the groups was in the frequency of minor reactions. The costs of HOCM and LOCM over the three years were $54,660 and $152,523, respectively. Had 90% of the 5760 patients received LOCM, the total cost of contrast agents would have been $603,723; thus, the estimated drug cost saving was $396,540, or $132,180 annually. With costs of treating adverse events factored in, the net annual cost saving was $132,093. Guidelines limiting the use of LOCM to high-risk patients saved an academic medical center an estimated $132,093 annually in drug costs for specific outpatient imaging procedures, without adversely affecting patient care.

Urothelial striations revisited.

To confirm that use of low-osmolality contrast media (LOCM) in urography increases the frequency with which striations occur in otherwise healthy adults. Two series of urograms obtained in 207 adult patients (101 men, 106 women) at two institutions after the administration of either LOCM or high-osmolality contrast media (HOCM) were reviewed. At the first, 106 patients had received LOCM; at the second, 101 had received HOCM. Protocols were similar. Urograms were evaluated for the presence and extent of striations. Of 106 LOCM urograms, 16 (15%) showed striations. Of 101 HOCM urograms, only two (2%) showed striations. The difference in striations shown between the two groups was significant (P < .002). Striations were most common in renal pelves and distal ureters and on radiographs obtained after voiding. Detection of urothelial striations on LOCM urograms in adults is most often normal. Increased prevalence of striations is likely due to decreased urinary tract distention associated with LOCM use.

Cost-effectiveness and safety of selective use of low-osmolality contrast media

We estimated our potential institutional savings by switching from universal to selective use of low-osmolality contrast media. A total of 42,598 radiocontrast studies (26,595 with high-osmolality contrast agents and 16,003 with low-osmolality contrast agents [LOCA]) were performed over 42 months. Every radiocontrast reaction was classified and documented. All costs associated with the subsequent treatment of adverse reactions were recorded and added to the cost of contrast agents. The actual cost of contrast agent administration was determined and compared with the theoretical cost of total conversion to LOCA. The overall rate of adverse reactions was 1.18%. The cost of radiocontrast materials and treatment of adverse reactions was $2,599,593. Over the same period, total conversion to LOCA would have cost $5,968,507. Our institution saved an estimated $962,548 annually through the selective use of LOCA. The incremental cost of treating adverse reactions associated with selective use was minimal compared with the cost of total conversion to LOCA.

Low-osmolar contrast media in the 1990s. Guidelines for urography in a cost-sensitive environment.

The author reviews the clinical, ethical, medicolegal, and economic consequences of the routine versus limited use of low-osmolar contrast media for patients undergoing urographic and other radiologic studies. A comprehensive review of the literature since the introduction of low-osmolar contrast media was conducted, focussing on medical decision making and the economic impact of those decisions on radiologic studies requiring the administration of water-soluble contrast agents. Compared with high-osmolar ionic contrast media, routine use of low-osmolar agents for intravascular injection during diagnostic imaging results in fewer idiosyncratic reactions in patients and potentially less renal injury in a subgroup of critically ill patients. The high cost of low-osmolar agents relative to the overall cost of the examination has prevented the universal adoption of this class of agents in the United States. Economic pressures on private and government-based insurance plans, as well as on managed-care systems responsible for a variety of patient populations, continue to limit the availability of low-osmolar agents to the individual patient.

Radiographic Contrast Media: An Introduction to Its Use, Adverse-Effect Profile, and Economic Impact

Objective To provide an overview of the development, chemistry, adverse-effect profile, and economic impact of radiographic contrast media (CM). Data Sources Information was collected by conducting a MEDLINE search for clinical trials, reviews, and other articles pertaining to the use of CM. References cited in published review articles and manufacturer's product information also were used. Study Selection Studies, review articles, and editorials were selected for review if they addressed the synthesis, clinical use, or economic impact of CM. Comparative studies conducted in humans were used to address the adverse-effect profile of CM. Data Extraction Data were extracted from reviews and editorials when the information from multiple sources was consistent and pertained to the purpose of this review. Comparative reviews addressing adverse reactions were reviewed by the author for appropriate methodology and reporting of results. Data Synthesis Radiographic CM are iodine-containing compounds that can be injected intravascularly or intrathecally for multiple diagnostic tests. CM are differentiated according to water solubility, viscosity, radiopacity, and osmolality. In the past decade, low-osmolality CM (LOCM) have been developed that may impart fewer adverse effects, such as flushing, nausea, vomiting, allergic reactions, cardiovascular effects, and nephrotoxicity. The use of LOCM has steadily increased since their introduction in 1985. The cost of LOCM is approximately 10- to 20-fold higher than previously available CM. This represents a growing financial burden to the healthcare system. Conclusions CM are an integral tool in diagnostic medicine. LOCM appear to be safer than previous agents; however, they are also more expensive. Balancing safety and financial concerns will be a recurring issue facing both the medical society and third-party payers when selecting appropriate CM to administer to patients.

Costs of Low-Osmolar Contrast Media

To the Editor. — Incomplete data in the hands of practicing physicians can lead to costly misallocations of health care resources. Since their introduction in the United States in 1986, low-osmolar contrast media (LOCM) have risen to just over half of the intravenous enhancement contrast agents used in the United States (William Hendee, PhD, unpublished data, November 1990). Although most practicing radiologists would agree that the newer contrast agents seem to be associated with greater comfort and safety, many radiologists are unaware of how costly a total switchover to these agents may be. Drs Jacobson and Rosenquist 1 reported a cost-benefit analysis of selective use of LOCM and addressed the costs of treating nonfatal reactions by using fatal reactions as one measure of safety. These researchers estimated that if all identified low-risk patients (80% or more of all patients) received LOCM instead of conventional media, the cost of each life

The safety and cost‐effectiveness of low osmolar contrast media: Can economic analysis determine the real worth of a new technology?

To estimate the reduction in mortality associated with a reduced adverse reaction rate following the substitution of older high osmolar radiocontrast media (HOCM) by the newer and more expensive low osmolar contrast media (LOCM), and to assess the cost-effectiveness of switching from HOCM to LOCM in patients with and without underlying risk factors for adverse reactions from radiocontrast agents. Data from large prospective studies of adverse reactions to HOCM and LOCM were used to estimate the expected number of deaths and severe non-fatal reactions in a hypothetical population receiving one million intravenous radiocontrast injections with HOCM, and the expected reduction in the frequency of these outcomes after substitution by LOCM in high-risk and low-risk groups respectively. Life-years lost with each radiocontrast-related death were estimated from an audit of fatal adverse reaction reports submitted to the Adverse Drug Reactions Advisory Committee. The direct costs considered in the study were the increased costs of LOCM and the hospital costs of treating radiocontrast reactions which were estimated from an audit of cases admitted to public hospitals in Newcastle. The literature search included Medline (1966-1989) and bibliographies of original and review articles. We included only studies which were prospective, monitored patients in a formal way, described a mechanism for the recording of adverse events and were of sufficient size to have been capable of detecting severe reactions to radiocontrast agents. Data were extracted independently by two investigators, unblinded, with disagreements resolved by consensus. Mortality data from individual reports were pooled and exact confidence intervals were calculated on the assumption of a Poisson distribution. In the case of comparative studies the relative risks of severe reactions in low-risk versus high-risk patients and with LOCM compared with HOCM were treated for homogeneity, and pooled odds ratios and 95% confidence intervals (CI) were calculated by combining the logarithms of the odds ratios weighted by their variances. The mortality after intravenous administration of HOCM was estimated from all studies to be 23.3 (95% CI, 2.4-33.1) per million injections. However, the mortality was 11.7 per million (95% CI, 2.4-34.1) in studies published since 1986. The mortality after the use of LOCM was estimated as 3.9 per million (95% CI, 0.1-21.7).(ABSTRACT TRUNCATED AT 400 WORDS)

Selective Use of Low-Osmolar Contrast Media

Two thousand thirty-four consecutive patients presented for excretory urography within a 22-month period. Of 57 observed adverse reactions (incidence 2.8%), 54 occurred in 1219 low-risk patients injected with conventional ionic contrast media (HOCM) (incidence 4.4%) while three reactions were noted in the 815 high-risk patients receiving low-osmolar contrast media (LOCM) (incidence 0.4%). Despite strict enforcement of an unchanging list of high-risk criteria by the same pool of radiologists, LOCM use was not constant, increasing in use over time from 26.5% to 55.3% of urograms. In addition, frequency of LOCM selection increased transiently (from 33% to 52%) following a single life-threatening reaction to HOCM. Our results suggest that strict guidelines for use of LOCM are subject to loose individual physician interpretation. Physicians' perceptions of safety made it increasingly difficult to withhold LOCM and progressively more patients were included in high-risk groups.

Integrating Technology Assessment and Medical Practice Evaluation into Hospital Operations

The Johns Hopkins Program for Medical Technology and Practice Assessment, established in 1986, assesses the clinical efficacy, safety, and cost of specific technologies; evaluates the costs and benefits of alternative approaches to management of clinical problems; and examines the clinical and economic impact of health care program innovations. For example, program faculty have conducted analyses of clinical economic, and health policy issues related to radiographic contrast media. The director of the program chairs a committee that formulates guidelines for the appropriate use of low-osmolality contrast media and that will develop a mechanism to ensure compliance with guidelines. Program faculty are currently studying variations in the pre-, intra-, and postoperative management of patients with cataract and the relationship between such variations and outcomes. Faculty are also attempting to develop an improved mechanism for paying health maintenance organizations that enroll Medicare beneficiaries. Program activities have had a direct impact on decision making within the Johns Hopkins Health System.