{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:22:54Z","timestamp":1785414174903,"version":"3.56.0"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>To assess national expenditure associated with preterm-infant brain MRI and potential impact of reduction per <jats:italic>Choosing Wisely<\/jats:italic> campaign 2015 recommendation to \u201cavoid routine screening term-equivalent or discharge brain MRIs in preterm-infants\u201d. Cross-sectional U.S. trend data from the <jats:italic>Agency for Healthcare Research and Quality<\/jats:italic> (AHRQ), <jats:italic>Healthcare Cost and Utilization Project<\/jats:italic> (HCUP) <jats:italic>Kids\u2019 Inpatient Database<\/jats:italic> (KID) database (2006, 2009, 2012, 2016) was used to estimate overall national expenditure associated with brain MRI among infants with gestational age (GA) \u226436 weeks, and also when classified as \u2018not indicated\u2019 (NI-MRI) i.e., equivalent to routine use without clinical indications and regarded as low-value service (LVS). Associated cost was determined by querying CMS-database for physician-fee-schedules to find the highest global procedure-cost per cycle, then adjusting for inflation. Sensitivity-analyses were conducted to account for additional clinical charges associated with NI-MRI. 3,768 (0.26%) of 1,472,236 preterm-infants had brain MRI across all cycles (inflation-adjusted total $3,690,088). Overall proportion of brain MRIs increased across 2006\u20132012 from 0.25%-0.33% but decreased in 2016 to 0.16% (<jats:italic>P<\/jats:italic>&lt;0.001). Inflation-adjusted overall expenditure by cycle was: 2006, $1,299,130 (95% CI: $987,505, $1,610,755); 2009, $1,194,208 (95% CI: $873,487, $1,516,154); 2012, $931,836 (95% CI: $666,114, $1,197,156); and 2016, $264,648 (95% CI: $172,061, $357,280). Prevalence for NI-MRI in 2006, 2009, 2012 and 2016 was 86% (n = 809), 88% (n = 940), 89% (n = 1028) and 50% (n = 299), respectively; and 70% were in infants 35\u201336 weeks GA. NI-MRI prevalence was not different over time by payer-type (Medicaid, private), sex or race\/ethnicity (white, black, Hispanic); larger hospital size was significantly associated across 2006\u20132012 but this declined for all sizes in 2016, with most decline in larger hospitals (<jats:italic>P<\/jats:italic> for interaction &lt;0.05). NI-MRI expenditure sensitivity-analysis with addition of cycle median total-admission-charge to inflation-adjusted CMS-fee was $1,190,919\/$518,343, for 2012\/2016 cycles respectively. National MRI prevalence in preterm infants (both overall and LVS) and associated expenditure decreased substantially post recommendation; however, annual savings are modest and unlikely to be &gt;$1.2 million.<\/jats:p>","DOI":"10.1371\/journal.pone.0247857","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T18:26:16Z","timestamp":1614968776000},"page":"e0247857","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["An assessment of prevalence and expenditure associated with discharge brain MRI in preterm infants"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3695-9873","authenticated-orcid":true,"given":"Keith A.","family":"Dookeran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Groh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G.","family":"Ritacco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3748-5921","authenticated-orcid":true,"given":"Lydia R.","family":"Marcus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine Y.","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"issue":"14","key":"pone.0247857.ref001","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1001\/jama.2012.362","article-title":"Eliminating waste in US health care","volume":"307","author":"DM Berwick","year":"2012","journal-title":"JAMA: the journal of the American Medical Association"},{"issue":"7","key":"pone.0247857.ref002","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1097\/ACM.0000000000000270","article-title":"Engaging physicians and consumers in conversations about treatment overuse and waste: a short history of the choosing wisely campaign","volume":"89","author":"D Wolfson","year":"2014","journal-title":"Academic medicine: journal of the Association of American Medical Colleges"},{"issue":"11","key":"pone.0247857.ref003","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1377\/hlthaff.2017.0953","article-title":"Choosing Wisely: How To Fulfill The Promise In The Next 5 Years","volume":"36","author":"EA Kerr","year":"2017","journal-title":"Health affairs (Project Hope)"},{"issue":"2","key":"pone.0247857.ref004","doi-asserted-by":"crossref","first-page":"e482","DOI":"10.1542\/peds.2015-0737","article-title":"Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value","volume":"136","author":"T Ho","year":"2015","journal-title":"Pediatrics"},{"issue":"7","key":"pone.0247857.ref005","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1097\/ACM.0000000000000270","article-title":"Engaging Physicians and Consumers in Conversations About Treatment Overuse and Waste: A Short History of the Choosing Wisely Campaign","volume":"89","author":"D Wolfson","year":"2014","journal-title":"Academic Medicine"},{"key":"pone.0247857.ref006","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jpeds.2018.01.016","article-title":"Value-based care: the preference of outcome over prediction","volume":"196","author":"T Ho","year":"2018","journal-title":"The Journal of pediatrics"},{"key":"pone.0247857.ref007","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.jpeds.2017.06.029","article-title":"To screen preterm brains at term or not: that is the question","volume":"187","author":"PG Fisher","year":"2017","journal-title":"The Journal of pediatrics"},{"issue":"1","key":"pone.0247857.ref008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000492419","article-title":"Incidental Findings on Brain Magnetic Resonance Imaging in Preterm Infants","volume":"115","author":"A Buchiboyina","year":"2019","journal-title":"Neonatology"},{"issue":"1","key":"pone.0247857.ref009","doi-asserted-by":"crossref","first-page":"F73","DOI":"10.1136\/archdischild-2015-310333","article-title":"Incidental findings on routine brain MRI scans in preterm infants","volume":"102","author":"M Malova","year":"2017","journal-title":"Archives of disease in childhood Fetal and neonatal edition"},{"key":"pone.0247857.ref010","unstructured":"AHRQ. 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