Grants Funded

Abstract
The increased use of Magnetic Resonance Imaging (MRI) serves as a major contributor to the United States' rapidly increasing healthcare costs. Physicians have begun to rely on this expensive imaging modality for screening purposes rather than to investigate specific diagnoses. The objective of this study is to determine whether MRIs are appropriate or cost effective as a diagnostic tool in patients with wrist injuries.
The specific aims of this project are (1) to determine whether an MRI ordered by a physician to investigate a potential wrist ligament injury would influence a treatment decision beyond what could be determined by a series of standard radiographs and clinical examination, and (2) to assess the approximate additional cost of unnecessary MRIs (where the results have not affected the ultimate treatment recommendation).
First, we will collect the medical records of all patients with suspected wrist ligament injuries who had an MRI scan at the University of Michigan Health System between June 2009 and June 2104. We will review the collected information to compare the diagnosis and treatment recommendations before and after the MRI. If the treatment recommendation based on clinical examination and plain x-rays is different from the treatment recommendation after an MRI, then the MRI scan will be said to have impacted the treatment decision. Second, we will calculate a procedural cost utility by multiplying our institutional fixed unit cost for upper-extremity MRI by the ratio of total studies performed by the number of impact studies. An impact study is defined as an MRI that influences a treatment decision.
The findings from this study will be used to guide physicians in the appropriate use of MRI for diagnosing wrist ligament injuries. We hope that increasing awareness about the proper use of MRI will limit its use for screening purposes, and will contribute to an overall reduction in healthcare expenditures.

Biography
Dr. Brett F. Michelotti is the current Hand and Microvascular Surgery Fellow in the Section of Plastic Surgery, University of Michigan Health Systems. He completed his undergraduate degree at Pennsylvania State University and his medical education at the University of Pittsburgh, School of Medicine where he was elected to the medical honor society, Alpha Omega Alpha. Dr. Michelotti completed his integrated plastic surgery residency training at the Penn State Hershey Medical Center. Dr. Michelotti was the recipient of several awards including: the Resident Best Clinical Paper Award in 2012 and 2013, the American Association of Clinical Anatomists-Blue Box Award in 2013, the Stephen H. Miller, MD Award- Plastic surgery resident teaching award in 2013, the American Society for Surgery of the Hand/American Foundation for Surgery of the Hand Annual Meeting Scholarship in 2014, the Operation Smile Stryker Fellowship in 2014, and the Joint Outstanding Paper Presentation at the Annual Meeting of the AAHS/ASPN/ASRM in 2014. He has published 15 peer-reviewed articles and 2 book chapters, and has contributed to over 40 peer-reviewed research presentations. Dr. Michelotti was awarded the American Association for Hand Surgery’s Pilot Research Grant in 2012, a Graduate Medical Education Innovation Grant in 2013, a DePuy Synthes Directed Grant in 2014, a Penn State Hershey Medical Center Department of Surgery Institutional Grant in 2014.