Timothy A. Simmers

New image processing and noise reduction technology allows reduction of radiation exposure in complex electrophysiologic interventions while maintaining optimal image quality: A randomized clinical trial

BACKGROUND Despite their carcinogenic potential, X-rays remain indispensable for electrophysiologic (EP) procedures. OBJECTIVE The purpose of this study was to evaluate the dose reduction and image quality of a novel X-ray technology using advanced image processing and dose reduction technology in an EP laboratory. METHODS In this single-center, randomized, unblinded, parallel controlled trial, consecutive patients undergoing catheter ablation for complex arrhythmias were eligible. The Philips Allura FD20 system allows switching between the reference (Allura Xper) and the novel X-ray imaging technology (Allura Clarity). Primary end-point was overall procedural patient dose, expressed in dose area product (DAP) and air kerma (AK). Operator dose, procedural success, and necessity to switch to higher dose settings were secondary end-points. RESULTS A total of 136 patients were randomly assigned to the novel imaging group (n = 68) or the reference group (n = 68). Baseline characteristics were similar, except patients in the novel imaging group were younger (58 vs 65 years, P < .01). Median DAP and AK were 43% and 40% lower in the novel imaging group, respectively (P < .0001). A 50% operator dose reduction was achieved in the novel imaging group (P < .001). Fluoroscopy time, number of exposure frames, and procedure duration were equivalent between the two groups, indicating that the image quality was similarly adequate in both groups. Procedural success was achieved in 91% of patients in both groups; one pericardial tamponade occurred in the novel imaging group. CONCLUSION The novel imaging technology, Allura Clarity, significantly reduces patient and operator dose in complex EP procedures while maintaining image quality.

Health insurance outcome-based purchasing: The case of hospital contracting for cardiac interventions in the Netherlands

ABSTRACT Innovative forms of value-based purchasing contracts, based on outcome instead of volume, are imperative to face the imminent cost crisis in health care. The objective of this study was to design and implement a model for an outcome-based purchasing contract between a hospital and a health insurance company. The model was implemented in 2015. A study cohort (n = 14,944) from patients with coronary artery disease or atrial fibrillation treated in 2014 was compared to a historical reference cohort from patients treated between 2010 and 2013. The outcome measures and the model are based on Porters value-based healthcare principles. Improvements in outcomes were observed, leading to a financial incentive to be spent on further quality improvement. Implementation of this model is a first step towards enabling inclusion of patient-relevant outcomes in purchasing for healthcare. It aligns the focus of health insurance companies and hospitals on patient value.