Determinants of Resource Utilization in a Tertiary Pediatric and Congenital Echocardiographic Laboratory

Area of Science:

• Cardiology
• Medical Imaging
• Quality Improvement

Background:

• Transthoracic echocardiograms (TTE) are crucial for pediatric and congenital heart disease diagnosis.
• Understanding factors influencing study completion time (TT) is essential for efficient laboratory operations.
• Current reimbursement models may not accurately reflect the resources required for complex echocardiographic studies.

Purpose of the Study:

• To determine the relationship between technical charges and total time for TTE studies.
• To identify patient and scan characteristics associated with prolonged TTE completion times.
• To develop a predictive scoring system for high TT TTE studies.

Main Methods:

• Analysis of a prospective quality improvement database including 1,686 TTE studies for development and 847 for validation.
• Data collection included total time for study completion (TT), patient demographics, scan characteristics, and technical charges.
• Multivariate analysis was used to identify independent predictors of high TT (≥85 minutes), followed by risk score development.

Main Results:

• Technical charges showed a poor correlation with TT (r=0.2).
• Several independent factors were associated with high TT, leading to a predictive model with an AUC of 0.78 (development) and 0.75 (validation).
• The developed risk score stratified studies into low, medium, and high TT prevalence groups (15%, 51%, and 81% respectively).

Conclusions:

• This study demonstrates a weak correlation between technical charges and TT in pediatric/congenital echocardiography.
• Identified risk factors and a validated scoring system can predict high TT studies.
• These findings can aid in resource allocation and inform reimbursement strategies for pediatric echocardiography.