Publications by authors named "Stephen J Swensen"

69 Publications

Web Exclusive. Annals Story Slam - Innovations: Practices That Build Trust - The Leader Index.

Ann Intern Med 2020 Feb;172(4):SS1

Mayo Clinic, Rochester, Minnesota (S.J.S.).

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http://dx.doi.org/10.7326/W20-0007DOI Listing
February 2020

Physician and Nurse Well-Being: Seven Things Hospital Boards Should Know.

J Healthc Manag 2018 Nov-Dec;63(6):363-369

chief wellness officer and associate dean, Stanford School of Medicine, Stanford University, Stanford, California professor emeritus, Mayo Clinic College of Medicine and senior fellow, Institute for Healthcare Improvement, Heber City, Utah board member, Stanford Lucile Packard Children's Hospital, Palo Alto, California board member, Stanford Health Care, Stanford, California board member, Stanford Lucile Packard Children's Hospital.

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http://dx.doi.org/10.1097/JHM-D-18-00209DOI Listing
February 2020

Esprit de Corps and Quality: Making the Case for Eradicating Burnout.

J Healthc Manag 2018 Jan/Feb;63(1):7-11

Stephen J. Swensen, MD, medical director, professionalism and peer support, Intermountain Healthcare, Salt Lake City, Utah; senior fellow, Institute for Healthcare Improvement, Cambridge, Massachusetts; and professor emeritus, Mayo Clinic College of Medicine, Rochester, Minnesota.

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http://dx.doi.org/10.1097/JHM-D-17-00197DOI Listing
November 2019

An Organizational Framework to Reduce Professional Burnout and Bring Back Joy in Practice.

Jt Comm J Qual Patient Saf 2017 06 27;43(6):308-313. Epub 2017 Feb 27.

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http://dx.doi.org/10.1016/j.jcjq.2017.01.007DOI Listing
June 2017

Looking Under the Streetlight? A Framework for Differentiating Performance Measures by Level of Care in a Value-Based Payment Environment.

Acad Med 2017 07;92(7):943-950

J.M. Naessens is professor of health services research, Mayo Clinic, and scientific director, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida. M.B. Van Such is principal analyst, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. R.E. Nesse is senior medical director for payment reform and professor of family medicine, Mayo Clinic, Rochester, Minnesota. J.A. Dilling is chief operating officer for quality, Baylor, Scott & White Health, Dallas, Texas. S.J. Swensen is professor of radiology and past director of quality, Mayo Clinic, Rochester, Minnesota. K.M. Thompson is assistant professor of emergency medicine and performance improvement officer, Mayo Clinic, Jacksonville, Florida. J.M. Orlowski is chief health care officer, Association of American Medical Colleges, Washington, DC. P.J. Santrach is associate professor of laboratory medicine and pathology and chief quality officer, Mayo Clinic, Rochester, Minnesota.

The majority of quality measures used to assess providers and hospitals are based on easily obtained data, focused on a few dimensions of quality, and developed mainly for primary/community care and population health. While this approach supports efforts focused on addressing the triple aim of health care, many current quality report cards and assessments do not reflect the breadth or complexity of many referral center practices.In this article, the authors highlight the differences between population health efforts and referral care and address issues related to value measurement and performance assessment. They discuss why measures may need to differ across the three levels of care (primary/community care, secondary care, complex care) and illustrate the need for further risk adjustment to eliminate referral bias.With continued movement toward value-based purchasing, performance measures and reimbursement schemes need to reflect the increased level of intensity required to provide complex care. The authors propose a framework to operationalize value measurement and payment for specialty care, and they make specific recommendations to improve performance measurement for complex patients. Implementing such a framework to differentiate performance measures by level of care involves coordinated efforts to change both policy and operational platforms. An essential component of this framework is a new model that defines the characteristics of patients who require complex care and standardizes metrics that incorporate those definitions.
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http://dx.doi.org/10.1097/ACM.0000000000001654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5483980PMC
July 2017

Regional Emphysema Score Predicting Overall Survival, Quality of Life, and Pulmonary Function Recovery in Early-Stage Lung Cancer Patients.

J Thorac Oncol 2017 05 23;12(5):824-832. Epub 2017 Jan 23.

Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota. Electronic address:

Introduction: Pulmonary emphysema is a frequent comorbidity in lung cancer, but its role in tumor prognosis remains obscure. Our aim was to evaluate the impact of the regional emphysema score (RES) on a patient's overall survival, quality of life (QOL), and recovery of pulmonary function in stage I to II lung cancer.

Methods: Between 1997 and 2009, a total of 1073 patients were identified and divided into two surgical groups-cancer in the emphysematous (group 1 [n = 565]) and nonemphysematous (group 2 [n = 435]) regions-and one nonsurgical group (group 3 [n = 73]). RES was derived from the emphysematous region and categorized as mild (≤5%), moderate (6%-24%), or severe (25%-60%).

Results: In group 1, patients with a moderate or severe RES experienced slight decreases in postoperative forced expiratory volume in 1 second, but increases in the ratio of forced expiratory volume in 1 second to forced vital capacity compared with those with a mild RES (p < 0.01); however, this correlation was not observed in group 2. Posttreatment QOL was lower in patients with higher RESs in all groups, mainly owing to dyspnea (p < 0.05). Cox regression analysis revealed that patients with a higher RES had significantly poorer survival in both surgical groups, with adjusted hazard ratios of 1.41 and 1.43 for a moderate RES and 1.63 and 2.04 for a severe RES, respectively; however, this association was insignificant in the nonsurgical group (adjusted hazard ratio of 0.99 for a moderate or severe RES).

Conclusions: In surgically treated patients with cancer in the emphysematous region, RES is associated with postoperative changes in lung function. RES is also predictive of posttreatment QOL related to dyspnea in early-stage lung cancer. In both surgical groups, RES is an independent predictor of survival.
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http://dx.doi.org/10.1016/j.jtho.2017.01.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5403545PMC
May 2017

Whole-Systems Approach to Patient Safety: Can We Do More?

J Am Coll Radiol 2016 Dec 7;13(12 Pt A):1501-1504. Epub 2016 Oct 7.

Department of Radiology, Mayo Clinic, Rochester, Minnesota.

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http://dx.doi.org/10.1016/j.jacr.2016.07.012DOI Listing
December 2016

DNA Repair after Exposure to Ionizing Radiation Is Not Error-Free.

Radiology 2016 07;280(1):322-3

Mayo Clinic, Rochester, Minn †

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http://dx.doi.org/10.1148/radiol.2016152738DOI Listing
July 2016

Longitudinal Study Evaluating the Association Between Physician Burnout and Changes in Professional Work Effort.

Mayo Clin Proc 2016 Apr;91(4):422-31

Department of Radiology, Mayo Clinic, Jacksonville, FL.

Objective: To longitudinally evaluate the relationship between burnout and professional satisfaction with changes in physicians' professional effort.

Participants And Methods: Administrative/payroll records were used to longitudinally evaluate the professional work effort of faculty physicians working for Mayo Clinic from October 1, 2008, to October 1, 2014. Professional effort was measured in full-time equivalent (FTE) units. Physicians were longitudinally surveyed in October 2011 and October 2013 with standardized tools to assess burnout and satisfaction.

Results: Between 2008 and 2014, the proportion of physicians working less than full-time at our organization increased from 13.5% to 16.0% (P=.05). Of the 2663 physicians surveyed in 2011 and 2776 physicians surveyed in 2013, 1856 (69.7%) and 2132 (76.9%), respectively, returned surveys. Burnout and satisfaction scores in 2011 correlated with actual reductions in FTE over the following 24 months as independently measured by administrative/payroll records. After controlling for age, sex, site, and specialty, each 1-point increase in the 7-point emotional exhaustion scale was associated with a greater likelihood of reducing FTE (odds ratio [OR], 1.43; 95% CI, 1.23-1.67; P<.001) over the following 24 months, and each 1-point decrease in the 5-point satisfaction score was associated with greater likelihood of reducing FTE (OR, 1.34; 95% CI, 1.03-1.74; P=.03). On longitudinal analysis at the individual physician level, each 1-point increase in emotional exhaustion (OR, 1.28; 95% CI, 1.05-1.55; P=.01) or 1-point decrease in satisfaction (OR, 1.67; 95% CI, 1.19-2.35; P=.003) between 2011 and 2013 was associated with a greater likelihood of reducing FTE over the following 12 months.

Conclusion: Among physicians in a large health care organization, burnout and declining satisfaction were strongly associated with actual reductions in professional work effort over the following 24 months.
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http://dx.doi.org/10.1016/j.mayocp.2016.02.001DOI Listing
April 2016

Impact of organizational leadership on physician burnout and satisfaction.

Mayo Clin Proc 2015 Apr 18;90(4):432-40. Epub 2015 Mar 18.

Office of Leadership and Organization Development, Mayo Clinic, Rochester, MN.

Objective: To evaluate the impact of organizational leadership on the professional satisfaction and burnout of individual physicians working for a large health care organization.

Participants And Methods: We surveyed physicians and scientists working for a large health care organization in October 2013. Validated tools were used to assess burnout. Physicians also rated the leadership qualities of their immediate supervisor in 12 specific dimensions on a 5-point Likert scale. All supervisors were themselves physicians/scientists. A composite leadership score was calculated by summing scores for the 12 individual items (range, 12-60; higher scores indicate more effective leadership).

Results: Of the 3896 physicians surveyed, 2813 (72.2%) responded. Supervisor scores in each of the 12 leadership dimensions and composite leadership score strongly correlated with the burnout and satisfaction scores of individual physicians (all P<.001). On multivariate analysis adjusting for age, sex, duration of employment at Mayo Clinic, and specialty, each 1-point increase in composite leadership score was associated with a 3.3% decrease in the likelihood of burnout (P<.001) and a 9.0% increase in the likelihood of satisfaction (P<.001) of the physicians supervised. The mean composite leadership rating of each division/department chair (n=128) also correlated with the prevalence of burnout (correlation=-0.330; r(2)=0.11; P<.001) and satisfaction (correlation=0.684; r(2)=0.47; P<.001) at the division/department level.

Conclusion: The leadership qualities of physician supervisors appear to impact the well-being and satisfaction of individual physicians working in health care organizations. These findings have important implications for the selection and training of physician leaders and provide new insights into organizational factors that affect physician well-being.
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http://dx.doi.org/10.1016/j.mayocp.2015.01.012DOI Listing
April 2015

An appeal for safe and appropriate imaging of children.

J Patient Saf 2014 Sep;10(3):121-4

From the *Mayo Clinic, Rochester, Minnesota; †Washington University School of Medicine, St. Louis, Missouri; ‡The Hastings Center, Garrison, New York; §Children's Hospitals Solutions for Patient Safety, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; ∥Citizen Advocacy Center Redding, Washington, DC; ¶Connecticut Center for Patient Safety, Redding, Connecticut; **Washington State Hospital Association, Seattle, Washington; ††Warren Alpert Medical School of Brown University, Providence, Rhode Island; ‡‡Consumer Reports Health, Yonkers, New York; and §§National Institute for Children's Health Quality; and ∥∥Department of Radiology, Mayo Clinic Jacksonville, Jacksonville, Florida.

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http://dx.doi.org/10.1097/PTS.0000000000000116DOI Listing
September 2014

Trends in computed tomography utilization rates: a longitudinal practice-based study.

J Patient Saf 2014 Mar;10(1):52-8

From the *Department of Emergency Medicine, Division of Emergency Medicine Research, †Knowledge and Evaluation Research Unit, ‡Department of Health Sciences, Division of Health Care Policy and Research, §Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota; ∥Texas Medical Institute of Technology, Austin, Texas; and ¶Department of Radiology, Mayo Clinic, Rochester, Minnesota.

Objectives: Computed tomography (CT) use has increased dramatically over the past 2 decades, leading to increased radiation exposure at the population level. We assessed trends in CT use in a primary care (PC) population from 2000 to 2010.

Methods: Trends in CT use from 2000 to 2010 were assessed in an integrated, multi-specialty group practice. Administrative data were used to identify patients associated with a specific primary care provider and all CT imaging procedures. Utilization rates per 1000 patients and CT rates by type and medical specialty were calculated.

Results: Of 179,032 PC patients, 55,683 (31%) underwent CT. Mean age (SD) was 31.0 (23.6) years; 53% were female patients. In 2000, 178.5 CT scans per 1000 PC patients were performed, increasing to 195.9 in 2010 (10% absolute increase, P = 0.01). Although utilization rates across the 10-year period remained stable, emergency department (ED) CT examinations rose from 41.1 per 1000 in 2000 to 74.4 per 1000 in 2010 (81% absolute increase, P < 0.01). CT abdomen accounted for more than 50% of all CTs performed, followed by CT other (19%; included scans of the spine, extremities, neck and sinuses), CT chest (16%), and CT head (14%). Top diagnostic CT categories among those undergoing CT were abdominal pain, lower respiratory disease, and headache.

Conclusions: Although utilization rates across the 10-year period remained stable, CT use in the ED substantially increased. CT abdomen and CT chest were the two most common studies performed and are potential targets for interventions to improve the appropriateness of CT use.
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http://dx.doi.org/10.1097/PTS.0b013e3182948b1aDOI Listing
March 2014

The business case for health-care quality improvement.

J Patient Saf 2013 Mar;9(1):44-52

Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.

The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.
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http://dx.doi.org/10.1097/PTS.0b013e3182753e33DOI Listing
March 2013

Improving hypertension control in diabetes: a multisite quality improvement project that applies a 3-step care bundle to a chronic disease care model for diabetes with hypertension.

Am J Med Qual 2013 Sep-Oct;28(5):365-73. Epub 2013 Jan 11.

1Mayo Clinic Health System, Owatonna, MN, Eau Claire, WI, and Tomah, WI.

Hypertension in diabetes patients leads to significant morbidity and mortality. Nonetheless blood pressure (BP) control in patients with diabetes remains disappointing. The authors applied a care bundle to decrease the proportion of patients with BP exceeding 130/80. Teams from 4 sites in 3 states (Minnesota, Florida, and Arizona) developed a bundle consisting of a standardized BP process, an order set, and a patient goal. Baseline data were collected in the first 12 weeks, followed by 6 weeks of implementing changes. The final 16 weeks represented the intervention. There was a statistically significant decrease in the proportion of patients with uncontrolled BP in 3 of 4 sites (P < .0001 in all 3 sites demonstrating improvement). There was a statistically significant improvement in the satisfaction survey (P = .0011). Implementing an evidence-based care bundle for hypertension in diabetes mellitus can improve BP outcomes.
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http://dx.doi.org/10.1177/1062860612469683DOI Listing
August 2014

More quality measures versus measuring what matters: a call for balance and parsimony.

BMJ Qual Saf 2012 Nov 14;21(11):964-8. Epub 2012 Aug 14.

Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.

External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers. Although benefits have accrued from the growth in quality measurement, the recent explosion in the number of measures threatens to shift resources from improving quality to cover a plethora of quality-performance metrics that may have a limited impact on the things that patients and payers want and need (ie, better outcomes, better care, and lower per capita costs). Here we propose a policy that quality measurement should be: balanced to meet the need of end users to judge quality and cost performance and the need of providers to continuously improve the quality, outcomes and costs of their services; and parsimonious to measure quality, outcomes and costs with appropriate metrics that are selected based on end-user needs.
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http://dx.doi.org/10.1136/bmjqs-2012-001081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3594932PMC
November 2012

Quality improvement in interventional radiology: an opportunity to demonstrate value and improve patient-centered care.

J Vasc Interv Radiol 2012 Apr 17;23(4):435-41; quiz 442. Epub 2012 Feb 17.

University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1479, Houston, TX 77030-4009, USA.

The changing healthcare environment offers an opportunity for interventional radiology (IR) to showcase its value-specifically, to demonstrate that IR often offers the better, safer, faster, and less expensive treatment option for various clinical scenarios. The best way to demonstrate the value of IR now and to maintain this value in the future is through implementation of patient-centered care built on standardized care delivery, continuous quality improvement, and effective team dynamics.
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http://dx.doi.org/10.1016/j.jvir.2011.12.028DOI Listing
April 2012

Patient-centered Imaging.

Am J Med 2012 Feb;125(2):115-7

Director for Quality, Mayo Clinic, Rochester, MN, USA.

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http://dx.doi.org/10.1016/j.amjmed.2011.06.002DOI Listing
February 2012

Genetic variants associated with the risk of chronic obstructive pulmonary disease with and without lung cancer.

Cancer Prev Res (Phila) 2012 Mar 1;5(3):365-73. Epub 2011 Nov 1.

Division of Epidemiology, Mayo Clinic, Rochester, MN 55905, USA.

Chronic obstructive pulmonary disease (COPD) is a strong risk factor for lung cancer. Published studies about variations of genes encoding glutathione metabolism, DNA repair, and inflammatory response pathways in susceptibility to COPD were inconclusive. We evaluated 470 single-nucleotide polymorphisms (SNP) from 56 genes of these three pathways in 620 cases and 893 controls to identify susceptibility markers for COPD risk, using existing resources. We assessed SNP- and gene-level effects adjusting for sex, age, and smoking status. Differential genetic effects on disease risk with and without lung cancer were also assessed; cumulative risk models were established. Twenty-one SNPs were found to be significantly associated with risk of COPD (P < 0.01); gene-based analyses confirmed two genes (GCLC and GSS) and identified three additional genes (GSTO2, ERCC1, and RRM1). Carrying 12 high-risk alleles may increase risk by 2.7-fold; eight SNPs altered COPD risk without lung cancer by 3.1-fold and 4 SNPs altered the risk with lung cancer by 2.3-fold. Our findings indicate that multiple genetic variations in the three selected pathways contribute to COPD risk through GCLC, GSS, GSTO2, ERCC1, and RRM1 genes. Functional studies are needed to elucidate the mechanisms of these genes in the development of COPD, lung cancer, or both.
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http://dx.doi.org/10.1158/1940-6207.CAPR-11-0243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3414259PMC
March 2012

The Mayo Clinic Value Creation System.

Am J Med Qual 2012 Jan-Feb;27(1):58-65. Epub 2011 Sep 6.

Mayo Clinic, Rochester, MN 55905, USA.

The authors present Mayo Clinic's Value Creation System, a coherent systems engineering approach to delivering a single high-value practice. There are 4 tightly linked, interdependent phases of the system: alignment, discovery, managed diffusion, and measurement. The methodology is described and examples of the results to date are presented. The Value Creation System has been demonstrated to improve the quality of patient care while reducing costs and increasing productivity.
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http://dx.doi.org/10.1177/1062860611410966DOI Listing
May 2012

Controlling healthcare costs by removing waste: what American doctors can do now.

BMJ Qual Saf 2011 Jun 21;20(6):534-7. Epub 2011 Feb 21.

Mayo Clinic, Rochester, MN 55905, USA.

Healthcare costs are unsustainable. The authors propose a solution to control costs without rationing (deliberate withholding of effective care) or payment reductions to doctors and hospitals. Three physician-led strategies comprise this solution: reduce (1) overuse of health services, (2) preventable complications and (3) waste within healthcare processes. These challenges know no borders.
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http://dx.doi.org/10.1136/bmjqs.2010.049213DOI Listing
June 2011

Effect of emphysema on lung cancer risk in smokers: a computed tomography-based assessment.

Cancer Prev Res (Phila) 2011 Jan 30;4(1):43-50. Epub 2010 Nov 30.

Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, PR China.

The contribution of emphysema to lung cancer risk has been recognized, but the effect size needs to be further defined. In this study, 565 primary lung cancer cases were enrolled though a prospective lung cancer cohort at Mayo Clinic, and 450 controls were smokers participating in a lung cancer screening study in the same institution using spiral computed tomography (CT). Cases and controls were frequency matched on age, gender, race, smoking status, and residential region. CT imaging using standard protocol at the time of lung cancer diagnosis (case) or during the study (control) was assessed for emphysema by visual scoring CT analysis as a percentage of lung tissue destroyed. The clinical definition of emphysema was the diagnosis recorded in the medical documentation. Using multiple logistic regression models, emphysema (≥ 5% on CT) was found to be associated with a 3.8-fold increased lung cancer risk in Caucasians, with higher risk in subgroups of younger (<65 years old, OR = 4.64), heavy smokers (≥ 40 pack-years, OR = 4.46), and small-cell lung cancer (OR = 5.62). When using >0% or ≥ 10% emphysema on CT, lung cancer risk was 2.79-fold or 3.33-fold higher than controls. Compared with CT evaluation (using criterion ≥ 5%), the sensitivity, specificity, positive and negative predictive values, and the accuracy of the clinical diagnosis for emphysema in controls were 19%, 98%, 73%, 84%, and 83%, respectively. These results imply that an accurate evaluation of emphysema could help reliably identify individuals at greater risk of lung cancer among smokers.
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http://dx.doi.org/10.1158/1940-6207.CAPR-10-0151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018159PMC
January 2011

Perceptions of lung cancer risk and beliefs in screening accuracy of spiral computed tomography among high-risk lung cancer family members.

Acad Radiol 2010 Aug;17(8):1012-25

Department of Psychiatry and Psychology, Mayo Clinic Rochester, Rochester, MN 55905, USA.

Rationale And Objectives: Spiral computed tomography (SCT) is being evaluated as a screening tool for lung cancer. Our objective was to describe the effect of participation in SCT screening on participants' risk perceptions, worry, and expectations regarding the accuracy of the screening result.

Materials And Methods: We surveyed 60 individuals with lung cancer family history who were participating in an SCT study for the primary purpose of improving genetic linkage analysis at baseline, and then 1 and 6 months post-SCT.

Results: Of the 60 participants, 40 received normal results, 19 received non-negative results requiring follow-up, and 1 was diagnosed with lung cancer. At baseline, participants reported high levels of perceived lung cancer risk (64%), were concerned about developing lung cancer (94%), and the majority (84%) were not OK with receiving a non-negative SCT result when they really didn't have cancer. At 1 month post-SCT, those with a non-negative screen (n = 19) had lowered their expectations of test accuracy regarding non-negative results (54%) and reported increased levels in worry/concern (100%) and perceived risk (75%), but these effects diminished over time and returned almost to baseline levels at 6 months.

Conclusions: Persons at very high empiric risk for lung cancer expect their SCT screening test to be accurate and present with high levels of lung cancer risk perception and worry/concern overall. Our findings suggest a need for risk counseling and discussion on the limitations of screening tests to accurately detect lung cancer.
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http://dx.doi.org/10.1016/j.acra.2010.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897823PMC
August 2010

Are airflow obstruction and radiographic evidence of emphysema risk factors for lung cancer? A nested case-control study using quantitative emphysema analysis.

Chest 2010 Dec 26;138(6):1295-302. Epub 2010 Mar 26.

Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.

Objectives: Several studies have identified airflow obstruction as a risk factor for lung cancer independent of smoking history, but the risk associated with the presence of radiographic evidence of emphysema has not been extensively studied. We proposed to assess this risk using a quantitative volumetric CT scan analysis.

Methods: Sixty-four cases of lung cancer were identified from a prospective cohort of 1,520 participants enrolled in a spiral CT scan lung cancer screening trial. Each case was matched to six control subjects for age, sex, and smoking history. Quantitative CT scan analysis of emphysema was performed. Spirometric measures were also conducted. Data were analyzed using conditional logistic regression making use of the 1:6 set groups of 64 cases and 377 matched control subjects.

Results: Decreased FEV(1) and FEV(1)/FVC were significantly associated with a diagnosis of lung cancer with ORs of 1.15 (95% CI, 1.00-1.32; P = .046) and 1.29 (95% CI, 1.02-1.62; P = .031), respectively. The quantity of radiographic evidence of emphysema was not found to be a significant risk for lung cancer with OR of 1.042 (95% CI, 0.816-1.329; P = .743). Additionally, there was no significant association between severe emphysema and lung cancer with OR of 1.57 (95% CI, 0.73-3.37).

Conclusions: We confirm previous observations that airflow obstruction is an independent risk factor for lung cancer. The absence of a clear relationship between radiographic evidence of emphysema and lung cancer using an automated quantitative volumetric analysis may result from different population characteristics than those of prior studies, radiographic evidence of emphysema quantitation methodology, or absence of any relationship between emphysema and lung cancer risk.
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http://dx.doi.org/10.1378/chest.09-2567DOI Listing
December 2010

Flying in the plane you service: patient-centered radiology.

J Am Coll Radiol 2010 Mar;7(3):216-21

Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.

If you were about to undergo a radiologic procedure, what 5 things would you want? The authors propose a construct for patient-centered radiology. Five wishes of a prospective radiology patient are described: 1) the information to choose, 2) the right examination, 3) a safe examination, 4) effective communication of correctly interpreted results, and 5) a fair price. The authors posit that the American practice of radiology would be considerably different if our profession practiced patient-centered radiology.
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http://dx.doi.org/10.1016/j.jacr.2009.10.017DOI Listing
March 2010

Quality: the Mayo Clinic approach.

Am J Med Qual 2009 Sep-Oct;24(5):428-40. Epub 2009 Jul 7.

Department of Radiology, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.

Developing highly reliable care for patients requires changes in some traditional beliefs of medical practice, an evolution toward a "system" of health care, the disciplined application of scientific principles, modifications in the way all future providers are trained, and a fundamental understanding by leadership that quality must become a business strategy and core work, not an expense or regulatory requirement. Quality at Mayo is defined as a composite of outcomes, safety, and service. A 4-part strategic construct focusing on Culture, Infrastructure, Engineering, and Execution has been developed to guide improvement activities and to ensure a comprehensive approach to better patient care. The Mayo Clinic experience has led to a greater understanding of the leadership commitment, organizational challenges, and the breadth of initiatives necessary to achieve highly reliable care.
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http://dx.doi.org/10.1177/1062860609339521DOI Listing
November 2009

5-year lung cancer screening experience: growth curves of 18 lung cancers compared to histologic type, CT attenuation, stage, survival, and size.

Chest 2009 Dec 6;136(6):1586-1595. Epub 2009 Jul 6.

Department of Biostatistics, Mayo Clinic, Rochester, MN.

Background: Although no study has prospectively documented the rate at which lung cancers grow, many have assumed exponential growth. The purpose of this study was to document the growth of lung cancers detected in high-risk participants receiving annual screening chest CT scans.

Methods: Eighteen lung cancers were evaluated by at least four serial CT scans (4 men, 14 women; age range, 53 to 79 years; mean age, 66 years). CT scans were retrospectively reviewed for appearance, size, and volume (volume [v] = pi/6[ab(2)]). Growth curves (x = time [in days]; y = volume [cubic millimeters]) were plotted and subcategorized by histology, CT scan attenuation, stage, survival, and initial size.

Results: Inclusion criteria favored smaller, less aggressive cancers. Growth curves varied, even when subcategorized by histology, CT scan attenuation, stage, survival, or initial size. Cancers associated with higher stages, mortality, or recurrence showed fairly steady growth or accelerated growth compared with earlier growth, although these growth patterns also were seen in lesser-stage lung cancers. Most lung cancers enlarged at fairly steady increments, but several demonstrated fairly flat growth curves, and others demonstrated periods of accelerated growth.

Conclusions: This study is the first to plot individual lung cancer growth curves. Although parameters favored smaller, less aggressive cancers in women, it showed that lung cancers are not limited to exponential growth. Tumor size at one point or growth between two points did not appear to predict future growth. Studies and equations assuming exponential growth may potentially misrepresent an indeterminate nodule or the aggressiveness of a lung cancer.
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http://dx.doi.org/10.1378/chest.09-0915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789925PMC
December 2009

Feasibility of using a walking workstation during CT image interpretation.

J Am Coll Radiol 2008 Nov;5(11):1130-6

Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.

Objective: Two-thirds of the US population is overweight or obese. Sedentary lifestyles and occupations are one factor in the development of obesity. Methods to help reduce sedentary work environments may help reduce obesity. The purpose of this study was to determine the feasibility of using a walking workstation during computed tomographic image interpretation.

Methods: Two radiologists reinterpreted 100 clinical computed tomographic examinations they had previously interpreted, each while walking at 1 mph on a treadmill using an electronic workstation. Ten cases were reviewed per session. The time period between the initial conventional interpretations and the reinterpretations was greater than one year, to reduce recall bias. Discrepant findings were ranked according to a classification system based on clinical importance on a scale ranging from 1 to 6. Discrepant findings classified as greater than or equal to 3 were considered significant. Detection rates for the initial interpretations and reinterpretations were determined for each reviewer and compared using a paired t-test.

Results: A total of 1,582 findings were reported (825 by reviewer 1 and 757 by reviewer 2). There were 459 findings with clinical importance of 3 or higher. For reviewer 1 (91 cases of at least one important finding), the mean detection rates were 99.0% for the walking technique and 88.9% for the conventional interpretations (P = .0003). For reviewer 2 (89 cases with at least one important finding) the mean detection rates were 99.1% for the walking technique and 81.3% for the conventional interpretations (P < .0001).

Conclusion: The use of a walking workstation for the interpretation of cross-sectional images is feasible. Further studies are needed to assess the potential impact on diagnostic accuracy.
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http://dx.doi.org/10.1016/j.jacr.2008.05.003DOI Listing
November 2008