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A Randomized Controlled Trial

Robert L. Bree, MD; Ella A. Kazerooni, MD; Steven J. Katz, MD, MPH

JAMA. 1996;276(19):1595-1598.

Abstract
Objective.
—To determine if a mandatory radiology consultation service can decrease radiology resource use on inpatient internal medicine services.

Design and Setting.
—Randomized controlled trial on 4 internal medicine services at a university hospital.

Patients and Other Participants.
—Six radiologists performed the intervention on 2 internal medicine services over a 12-month period. A total of 1022 patients were admitted to the 2 intervention services and 1178 patients were admitted to the 2 control services. Each was staffed by an attending internist and 3 house officers.

Intervention.
—Each radiology examination required approval by the attending radiologist before it was performed.

Main Outcome Measure.
—Relative resource costs (relative value units [RVUs]), number of examinations per patient, proportion of patients with 1 or more tests, and mean length of stay (LOS).

Results.
—Mean RVUs for the intervention group were 356.1, and for the control group, 336.0 (P=.5). Mean examinations per patient for both groups was 4.4. Mean LOS for the intervention group was 6.0 days, and for the control group, 6.1 days (P=.8).

Conclusions.
—An inpatient radiology consultation service, with a goal to reduce resource use, did not achieve its goal. A more appropriate use of time and expense for radiology utilization management may be in the outpatient setting.

Author Affiliations
From the Department of Radiology (Drs Bree and Kazerooni), and the Departments of Internal Medicine and Health Care Management and Policy and the Consortium for Health Outcomes, Innovation, and Cost Effectiveness Studies (CHOICES) (Dr Katz), University of Michigan Medical Center, Ann Arbor.

Footnotes
Reprints: Robert L. Bree, MD, University of Michigan Medical Center, Department of Radiology, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0030.

Topics in Radiology. section editors: Ronald G. Evens, MD, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo; Charles B. Clayman, MD, Contributing Editor, JAMA.

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