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OBJECTIVE: We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics. METHODS: We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. We conducted individual postencounter interviews with clinician and parent participants utilizing video-stimulated recall to facilitate reflection of decision- making that occurred during the encounter. We utilized direct content analysis with open coding of interview transcripts to determine the salience of the 4-step SDM process and identify themes that confirmed, refuted, or modified this process. RESULTS: We videotaped 30 encounters and conducted 53 interviews. We found that clinicians' and parents' experiences of decision-making confirmed each SDM step. However, there was variation in the interpretation of each step and a need for flexibility in implementing the process depending on specific decisional contexts. CONCLUSIONS: The 4-step SDM process for pediatrics appears to be salient and may benefit from further guidance about the interpretation of each step and contextual factors that support a modified approach. [ABSTRACT FROM AUTHOR]

Introduction: Trauma center radiologists vary widely in the degree to which they provide secondary interpretations for transferred patients' advanced imaging. A general perception of uncertainty over reimbursement for these exams often results in reluctance to provide routine overreads. The purpose of this study is to assess the difference in reimbursement rates between primary interpretations and secondary interpretations in the emergency department (ED) setting., Materials and Methods: Billing records for the three CT procedures most commonly performed in a single, major level 1 trauma center ED from January 1, 2021, to December 31, 2021, constituted the dataset. Gross charges, total receipts, and payer status were recorded for each exam, and reimbursement rates calculated., Results: In total, 19,754 exams met the inclusion criteria. Primary interpretation was performed on 16,507 (83.6%) exams and secondary interpretation on 3247 (16.4%). For the three CPT codes examined, the average reimbursement percentage was 32.9% for primary interpretation and 43.5% for secondary interpretation. The average reimbursement percentage for commercial payers was 56.5% for primary interpretation and 65.9% for secondary interpretation. The average reimbursement percentage for Health Insurance Exchange payers was 58.5% for primary interpretation and 59.5% for secondary interpretation. The average reimbursement percentage for Medicaid was 24.7% for primary interpretation and 39.9% for secondary interpretation. The average reimbursement percentage for Medicare was 31.1% for primary interpretation and 30.2% for secondary interpretation. The average reimbursement percentage for self-paying patients was 2.3% for primary interpretation and 3.5% for secondary interpretation., Conclusion: Regardless of payer status, reimbursement for secondary interpretation of the three most common transfer patients' CT exams is near or greater than that of primary interpretations., (© 2022. The Author(s), under exclusive licence to American Society of Emergency Radiology (ASER).)

The ACR Council passed Resolution 47 at its 2020 annual meeting establishing a representative task force (TF) to explore the concept of the "multispecialty radiologist," previously proposed in 2012. The TF held eight virtual meetings over 8 months, considered data from a 2020 ACR Membership Tracking Survey, conducted a review of current literature, and collected anecdotal experience from TF members and ACR leadership. ACR legal counsel and a cross-section of ACR Commissions and Committees also provided input. The TF concluded that there is scant interest from the radiology community in the multispecialty radiologist title and no agreed-upon definition for the term. Radiologists may identify as diagnostic or subspecialty radiologists; however, the roles they fill in clinical practice include general, multispecialty, and subspecialized radiology. The TF proposes definitions for each of these terms to support radiologist recruitment aligned with optimal patient care in the practice community and to improve the quality of data collection about the field. To reduce ambiguity, the TF proposes adoption of the defined terms by the radiology community, including radiologist recruiters and employers, and suggests ways in which resident training and the ABR board examination can be adapted to support this new structure. Additionally, as part of an exploration of hyperspecialization and trainee preparedness for clinical practice, the TF discussed the challenges faced by community-based practices seeking to provide a full range of high-quality, radiologist-delivered diagnostic and interventional services to their patient populations., (Copyright © 2021 American College of Radiology. All rights reserved.)

Purpose: While several studies analyze radiology malpractice lawsuits, none specifically examines the site of service. The purpose of this study is to estimate the relative likelihood of a lawsuit arising from a radiology study performed in emergency (ED), inpatient (IP) and outpatient (OP) settings., Methods: Referrals from a malpractice review consulting company over a six year period were compared to the 2016 Medicare Part B file and stratified by site of service. The proportion of exams for each site of service was estimated, and using absolute differences in proportions and odds ratios (ORs), differences in the place of service were calculated., Results: The Cleareview cohort contained 25 (17%) IP, 56 (38%) OP, and 68 (46%) ED exams. In 2016, Medicare assigned benefits for 27,009,053 (20%) IP, 84,075,848 (62%) OP and 23,964,794 (18%) ED exams. The ORs (Cleareview: Medicare) of the ED to IP, OP, and IP+OP were 3.07 (95% CI: 1.56-6.03), 4.26 (95% CI: 2.76-6.59), 3.89 (95% CI: 2.60-5.83), respectively. By contrast, the OR for IP:OP between Cleareview and Medicare was not significantly different than 1 (OR: 1.39, 95% CI: 0.68-2.83, P = .38)., Discussion: Radiological studies performed in the ED accounted for a disproportionate number of liability claims against radiologists. Further study is warranted to confirm this finding with a more robust data set., (Copyright © 2019 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Audit studies suggest that racial discrimination disadvantages black individuals in educational/professional advancement. We hypothesized that prospective black male doctoral students would experience greater disparity in responses when seeking access to National Cancer Institute (NCI)-funded principal investigators (PI) compared with prospective white males. Primary aim was to explore response and acceptance rates for black versus white men seeking cancer research mentorship. Identical e-mails were sent to 1,028 randomly selected PIs affiliated with 65 NCI-designated cancer centers from "Lamar Washington" (black; n = 515) or "Brad Anderson" (white; n = 513). Primary outcomes: (i) responses within one week; and (ii) type of response. We used logistic regression to examine effects of condition (black/white) on primary outcomes. Approximately 48.3% and 50.0% of the sample responded to "Lamar" and "Brad," respectively. For responders, 40.9% and 43.7% and "agreed" to meet with Lamar and Brad, respectively. This design did not detect bias by PIs against black prospective male students. Cancer Res; 78(17); 4809-11. ©2018 AACR ., (©2018 American Association for Cancer Research.)

Objective: Peer review is an important and necessary part of radiology. There are several options to perform the peer review process. This study examines the reproducibility of peer review by comparing two scoring systems., Materials and Methods: American Board of Radiology-certified radiologists from various practice environments and subspecialties were recruited to score deidentified examinations on a web-based PACS with two scoring systems, RADPEER and Cleareview. Quantitative analysis of the scores was performed for interrater agreement., Results: Interobserver variability was high for both the RADPEER and Cleareview scoring systems. The interobserver correlations (kappa values) were 0.17-0.23 for RADPEER and 0.10-0.16 for Cleareview. Interrater correlation was not statistically significantly different when comparing the RADPEER and Cleareview systems (p = 0.07-0.27). The kappa values were low for the Cleareview subscores when we evaluated for missed findings (0.26), satisfaction of search (0.17), and inadequate interpretation of findings (0.12)., Conclusion: Our study confirms the previous report of low interobserver correlation when using the peer review process. There was low interobserver agreement seen when using both the RADPEER and the Cleareview scoring systems.

Objective: As the use of medical images in applications other than direct patient care increases, the need for deidentified images grows. Federal regulations govern the requirements for deidentification, and software developers offer several methods for deidentification., Conclusion: However, there are numerous ways for protected health information to be included in images other than in DICOM headers. Either such information must be obscured or the images containing the information must be deleted to comply with deidentification requirements.

Context: In primary, acute-care visits, patients frequently present with more than 1 concern. Various visit factors prevent additional concerns from being articulated and addressed., Objective: To test an intervention to reduce patients' unmet concerns., Design: Cross-sectional comparison of 2 experimental questions, with videotaping of office visits and pre and postvisit surveys., Setting: Twenty outpatient offices of community-based physicians equally divided between Los Angeles County and a midsized town in Pennsylvania., Participants: A volunteer sample of 20 family physicians (participation rate = 80%) and 224 patients approached consecutively within physicians (participation rate = 73%; approximately 11 participating for each enrolled physician) seeking care for an acute condition., Intervention: After seeing 4 nonintervention patients, physicians were randomly assigned to solicit additional concerns by asking 1 of the following 2 questions after patients presented their chief concern: "Is there anything else you want to address in the visit today?" (ANY condition) and "Is there something else you want to address in the visit today?" (SOME condition)., Main Outcome Measures: Patients' unmet concerns: concerns listed on previsit surveys but not addressed during visits, visit time, unanticipated concerns: concerns that were addressed during the visit but not listed on previsit surveys., Results: Relative to nonintervention cases, the implemented SOME intervention eliminated 78% of unmet concerns (odds ratio (OR) = .154, p = .001). The ANY intervention could not be significantly distinguished from the control condition (p = .122). Neither intervention affected visit length, or patients'; expression of unanticipated concerns not listed in previsit surveys., Conclusions: Patients' unmet concerns can be dramatically reduced by a simple inquiry framed in the SOME form. Both the learning and implementation of the intervention require very little time.

This article uses conversation analysis to investigate the problem-presentation phase of 302 visits between primary-care physicians and patients with acute problems. It analyzes the social-interactional organization of problem presentation, focusing on how participants recognize and negotiate its completion. It argues that physicians and patients mutually orient to the presentation of current symptoms--that is, concrete symptoms presented as somehow being experienced in the here-and-now--as a locus of transition between the patient-controlled problem-presentation phase of the visit and the physician-controlled information-gathering phase. This is a resource for physicians to distinguish between complete and incomplete presentations, and for patients to manipulate this distinction.