title: Effect of an imaging-based streamlined electronic healthcare process on quality and costs.
abstract: OBJECTIVE
  A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction.
  
  
  METHODS
  A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm.
  
  
  RESULTS
  Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile.
  
  
  CONCLUSIONS
  A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.
authors.affiliation: From Medical Informatics Group, Department of Radiology, David Geffen School of Medicine, University of California at Los Angeles, 924 Westwood Blvd., Suite 420, Los Angeles, CA 90024, USA.
authors.forename: Alex A T
authors.initials: AA
authors.lastname: Bui
authors.forename: Ricky K
authors.initials: RK
authors.lastname: Taira
authors.forename: Dana
authors.initials: D
authors.lastname: Goldman
authors.forename: John David N
authors.initials: JD
authors.lastname: Dionisio
authors.forename: Denise R
authors.initials: DR
authors.lastname: Aberle
authors.forename: Suzie
authors.initials: S
authors.lastname: El-Saden
authors.forename: James
authors.initials: J
authors.lastname: Sayre
authors.forename: Thomas
authors.initials: T
authors.lastname: Rice
authors.forename: Hooshang
authors.initials: H
authors.lastname: Kangarloo
mesh_terms: D004582:Electronics, Medical / Q000191:economics* / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data; D005194:Family Practice / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005431:Florida; D005500:Follow-Up Studies; D006264:Health Benefit Plans, Employee / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000191:economics* / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics / Q000706:statistics & numerical data; D018084:Ultrasonography, Interventional / Q000191:economics / Q000706:statistics & numerical data