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UVMFLOWNET  August 2000

UVMFLOWNET August 2000

Subject:

Re: Life Line Screening

From:

Dinah Vince <[log in to unmask]>

Reply-To:

UVM Flownet <[log in to unmask]>

Date:

Thu, 17 Aug 2000 18:04:27 -0400

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (156 lines)

I will attempt to address as many of your concerns as possible.
QA studies - Our study population consisted of 238 carotid artery screening
participants.  We obtained medical release forms from 146 people with
positive screening results and obtained diagnostic ultrasound/arteriogram
follow-up reports.  At the same time, an independent vascular lab was paid
to perform complete diagnostic studies on 92 individuals who had negative
screening results.  Individuals with disease greater than 60% by diagnostic
studies (preferably arteriograms) were defined as positive. Disease less
than 60% by diagnostic studies were defined as negative.  Results:
Sensitivity - 100%, Specificity - 94%, Positive Predictive Value -95%, and
Negative Predictive Value - 100%.  As with any screening test one desires a
high degree of sensitivity and specificity.  There is a trade-off between
these however, and to avoid missing true positives for the desire of
increased specificity, one allows for some decreased specificity.
    We are planning a follow-up study with Kettering Hospital in the Dayton,
Ohio area.   As you can imagine, it is very time consuming and resource
intensive to collect the medical records of our positive screens.
Additionally, we do incur a fairly large expense as we must pay for the
diagnostic studies of our negative screens that are performed in an
accredited vascular lab. But we do realize the importance of having this
information to the overall quality tracking of the program.
    Customer satisfaction surveys are included with every positive finding.
One for the screening participant and one for their physician.
    Our QC procedures are too lengthy to list but they consist of rechecking
all abnormal findings by another tech, spot checks of all screening results
from two teams per week by me, to quarterly visits by Regional Managers, to
bi-yearly having our physicians read and review screens from another
interpreting physician.
    We are not affiliated with Dr. Lavenson, but refer to his work in
Vascular Ultrasound Today, May 1997, " Carotid Screening, Preparing for the
Future"
    We have met with Dr. Edward Bluth and he is very interested in our work.
He has just completed a study of screening for stroke using Power Doppler.
His exams take 2 to 7 minutes.  Interesting work.  You can look it up on
Intellihealth, June 5, 2000.
    Our carotid protocol uses peak systolic velocity measurements.  We do
not take 2D measurements. We do not give percentages.  We grade the amount
of plaque to the following categories: None, Mild, Mild to Moderate,
Moderate, Moderate to Severe, and Severe.  If the individual falls into the
last two categories we recommend further evaluation.  That's where you come
in.  Our studies are screening in nature - not diagnostic. We look for
undetected disease in the asymptomatic population.
    The majority of our techs are ARDMS registered with many years of
experience.  The rest are "candidates" and are required to become registered
within 1 year.  They go through a rigorous training program and do not
perform carotid studies unsupervised until they meet our criteria and
requirements.
    In closing, there are others out there who have tried to copy what we
originated and what we do.  I question that their commitment to quality is
as focused and as sincere as that of the current Life Line Screening
Company. We want to be the premiere screening company in the country.
The only way to do that is to give value and accuracy.  The public sees the
value in our program and we understand the responsibility this brings to our
efforts.

Dinah Vince, BS, RDMS, RVT
National Director of Medical Operations
Life Line Screening



From: CS Thomas <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, August 11, 2000 11:09 PM
Subject: Re: vascular screening company


> Dear All,
> As with even our diagnostic criteria's, all aspects of ultrasound should
be
> re evaluated and allowed a fresh look. Where would we be if the original
> results (using the original equipment) for carotid duplex held the
existing
> judgment..... We would still be doing angio's on EVERY patient.
> I agree with Dinah, before making a blanket judgment on previous history,
> visit the environment for yourself.
> As for the advertisement...
> Marketing is a tricky business with very thin lines between truth and
> imagination. Take the Philips big screen TV ad. At face value would lead
you
> to believe all those three people need in life is a couch and TV in a 8x5
ft
> room. Give people credit for common sense. And if the practice has
improved
> the way Dinah describes, the ads just get them there, it sounds to me like
> ample council regarding follow up is given to every patient.
> Insurance companies do not pay for exams of asymptomatic patients,
therefore
> screenings would identify patients with disease, that with follow up by
> conventional vascular labs COULD possibly save someone's life.
> But, Out of curiosity Dinah, what equipment is currently being used by
your
> company? And I would suggest that the credentialing certificates of your
> people be posted for the patients you scan to view.
> Just my opinion,
> Catherine Thomas, RDMS, RVT
> Singapore
>
> -----Original Message-----
> From: UVM Flownet [mailto:[log in to unmask]]On Behalf Of Kelly
> Estes
> Sent: Saturday, August 12, 2000 9:11 AM
> To: [log in to unmask]
> Subject: Re: vascular screening company
>
>
> Dinah,
>     I was asked to respond on camera to a news segment for a Charlotte
> evening news program in 1998. They had attended one of the "screenings"
and
> videotaped the equipment and "technologists". The person performing the
> screenings stated that they were registered on camera, however under
further
> prodding they admitted to being registered in another modality, not
> vascular, however, they were REGISTRY ELIGIBLE. The manager (not sure if
> that was his actual title) also stated when I called him pretending to be
a
> potential customer, that all persons were registered.......... by
Ultrasound
> Diagnostic School in  Tampa, FLA. Now.......I don't think I am wrong, but
I
> don't believe that UDS is in the Ultrasound registry business. I think
this
> was a direct and intentional misleading statement to gain business.
>     Also, the examinations were performed with an ATL model which I had
> never seen. Carotids were being performed with a 5MhZ sector cardiac
> transducer. I timed one examination....from the start of gel on the neck,
> the technologist exclaimed in all of 5 seconds that the patient was free
of
> disease since his number was under 100.
>     I had the pleasure of working with another sonographer who worked for
> the company also prior to joining our facility, she joined our
> echocardiography laboratory with NO registries. She obtained her RCS while
> working with our facility. Her wishes were to cross train into our
vascular
> laboratory, so we obliged. Now this person had WORKED screening pts with
> Life Line Screening. She had no idea what she was doing. We trained her
for
> a few months until she realized all that she did not know and gave it up.
> She currently performs echo only.
>     As I stated earlier, most of this was in 1998. You stated that new
> management has taken over and that the service is much better now. I think
> that what you do could be a positive endeavor under proper management and
> PROPERLY credentialed persons.
>     Our lab had also performed followups on clients that had attended Life
> Line Screening examinations. At first the results were not correlating at
> all (carotid only is what we were referred) but towards the end it was
about
> 50/50. I haven't seen one in over a year now to comment on at this time.
>
>
> _________________________________________________________
> Do You Yahoo!?
> Get your free @yahoo.com address at http://mail.yahoo.com
>

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