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The impact of computed tomography on the utilization of neurological tests at a community hospital Cheung, Ignatius W. K.


One of the major issues in the health care industry is the continual rise in total health care expenditures relative to the Gross National Product. A significant portion of this rise has been attributed to the increasing use of medical technologies. As an increasing number of technological innovations are being developed for health care, and such new technologies are often complicated and expensive, the need for properly conducted evaluative studies becomes very important. It is essential to know whether a new technology is a substitute for less effective ones or is merely an add-on. Clear guidelines on under what conditions the new technology is applicable should be developed. For a diagnostic technology, the ideal model of evaluation should involve assessments of technical capability and safety, diagnostic accuracy, diagnostic impact, therapeutic impact, patient outcome, economic impact and availability. In the relatively short period since 1971, when computed tomography (CT) was first used clinically, it has become an important part of medical practice. This study attempts to assess the impact of CT on the utilization of related neurological tests at the Lions Gate Hospital. This is a community hospital serving a population of approximately 140,000 people. This study is a retrospective, before-after comparison of the utilization of neurological tests before and after the introduction of CT. Two groups of neurological patients, who were hospitalized during the study period 1973 to 1983/4, were assessed. These were the brain tumour group (ICD-9: 191, 198 and 225) and the cerebrovascular disease group (ICD-9: 430 to 438). The results of this study suggest that, for both groups of patients, CT is a complete replacement for pneumoencephalography and nuclear brain scanning, and is a partial replacement for electroencephalography and plain skull radiography. However, CT has had little impact on cerebral angiography which fell marginally in the brain tumour group and rose significantly in the cerebrovascular disease group. It has also been estimated that, over the study period, the average total cost of neurological tests (based on 1983/4 fee-dollars), on a per patient basis, remained the same for the brain tumour group but rose by 92% for the cerebrovascular disease group.

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