March 25, 2013

Innovation grant leads to improvements for diagnosing shoulder problems

Overuse of expensive imaging ranks among the toughest problems driving America’s out-of-control health care cost. Nationally, data suggest at least 15 percent of high-end imaging tests are unnecessary, waste patients’ time, subject them to needless tests, and drive costs higher.

Group Health orthopedic surgeon Sean Adelman, MD, had a simple idea to help reverse this trend: Use a portable ultrasound device to diagnose certain shoulder injuries during patients’ visits instead of ordering a more expensive MRI. The Partnership for Innovation gave him $66,413 to prove this approach can work.

The Partnership for Innovation is a Group Health Foundation donor-funded program that allows Group Health providers and staff to test innovations with the potential to improve care, lower costs, and boost patient satisfaction. Researchers from Group Health Research Institute (GHRI) are involved in the development and evaluation of proposals, and they help analyze the results.

Dr. Adelman says he first “dabbled” with the idea of using ultrasound for shoulder problems when he was part of an Air Force surgical team sent to the Middle East right after 9/11. With no access to MRIs or other high-end imaging techniques, the surgeons used the handheld ultrasound devices instead.  

Later, while in private practice, Dr. Adelman came to believe the ultrasound device might actually be a more effective way than MRI to diagnose certain shoulder injuries. But it was only his personal theory until he came to Group Health in 2010. Here, where clinicians are encouraged to blend science with clinical practice, he found an environment that supported his passion for learning and improving care.

With his innovation grant, Dr. Adelman bought a portable ultrasound machine. As patients came to him with upper arm or shoulder problems, he would decide, based on symptoms whether to use the ultrasound or MRI. In addition, he points out, some patients with metal implants or extreme claustrophobia cannot undergo MRI, so ultrasound gave these patients a different option.

GHRI Senior Investigator Paul Fishman, PhD, analyzed Dr. Adelman’s one-physician pilot and found that over 10 months in 2011, patients avoided 35 MRI exams. “Even when you factor in $34,897 for his ultrasound machine, and conservatively estimate the cost of an MRI at $1,500, data show Group Health saved a minimum of $17,603,” says Dr. Fishman. “This doesn’t even count money saved by eliminating follow-up patient visits to interpret the MRI and plan a course of treatment.”

“I’m very pleased,” Dr. Adelman says. “The reality is, conservatively, we’re saving a ton of money. Patients are very appreciative, especially because—when they leave my office—they know what’s going on with their shoulder. They don’t have to wait to schedule a separate MRI.”

“There is no way I could have implemented my ultrasound study without the help of the Foundation’s donors,” Dr. Adelman adds. “The seed money from the Foundation has definitely reaped benefits. We’re now going to get more ultrasound machines and show more of our orthopedists how to work with them.”

Ultimately, Dr. Adelman says, all orthopedists should get trained in ultrasound diagnostic techniques, adding, “It may even require another Innovation grant to do the training phase here at Group Health.”

Any Group Health staff member—including physicians, nurses, pharmacists, researchers, or others—can apply for a grant from the Partnership for Innovation. A cross-functional team of Group Health leaders evaluates proposals. Once an application passes scrutiny, donors to the Group Health Foundation fund a pilot, usually at a Group Health medical center. After this real-world test, researchers from Group Health Research Institute analyze the results, and this information helps to determine if the innovation can be implemented system-wide.



by Dean Paton