Transcript Slide 1

presents
Scottsdale Medical Imaging
Mission
To be nationally recognized as a premiere
provider of service oriented patient care
using medical imaging, image guided
intervention, and state-of-the-art technology.
Mission
To be leaders in medical imaging
and intervention through clinical
excellence, cutting-edge technology,
innovation, and research. Serve our
patients and referring clinicians in a
collegial work environment.
Values
Service:
We are committed to providing excellent service and
compassionate care with responsible stewardship of
our resources and traditions.
Integrity:
We honor commitments and maintain the highest
standards of behavior.
Quality:
We pursue excellence in patient care and service.
Innovation: We improve quality of imaging services by adopting
new technology and participating in research.
Equity:
We strive for equality of effort and benefit.
Quality Assurance
18th Century Style
(When reimbursement rates were a lot lower than today)
“It is not only the admission of kindly warmth
into the internal parts of the body, which prove
advantageous, but it is a stimulus to excite
irritability and restore the languid peristaltic
motion of the intestines.”
Royal Humane Society of London
Just as Treatments Change,
So Does the Perception of Quality Care
The Tobacco Enema
(circa 1790)
Administered orally in conjunction:
– Cordial mixture
– Spirits of hartshorn
– Camphorated spirits
– Enemetic tartar
The State of Health Care
Quality Today
“Health organizations must embrace a culture of continuous measurement
and quality improvement. Such a culture shift requires that health
professionals be trained to minimize waste, decrease error, and ultimately
improve quality of care. Educational experiences should be provided
whereby health professionals define best practices by reviewing currently
available information and literature; compare these with current practice
to identify gaps in performance; develop policies, procedures, and
standards to organize care around the best practices; and then
continuously monitor these with the aim of improving care.”
“Educating Health Professionals to Improve Quality of Care”
Institute of Medicine
ARRS
Mission Statement
The mission of the Society is to advance medicine
through the science of radiology and its allied
sciences by enabling the creation and exchange of
knowledge and information in the field through its
journal, meetings and other means.
As the nation’s oldest radiology membership
organization, the ARRS has been at the
forefront of serving as a critical source of
information for the rising tide of quality
assurance and practice improvement.
“Quality Assurance: an idea whose time has
come.” AJR, 1979; 133:989–992
Coming Fall 2007
ARRS’ Online PQI Register
ARRS PQI Register
…an inclusive repository for practical relevant
information and links to information about:
patient safety,
quality assurance,
practice improvement programs
and reporting mechanisms in radiology
with insightful opinions and commentary from
ARRS leaders and industry experts.
We’re Not Trying To Tell You
How To Achieve PQI
We want to provide you with the resources
you need to find the answers
to your PQI questions
Knowledge is of two kinds.
We know a subject ourselves, or we know
where we can find information upon it.
Samuel Johnson
As in Medicine,
Patient Safety Comes First
ARRS PQI Register: A must-read article
“The Delicate Balance between Radiation
Exposure and Imaging Efficacy,”
ARRS InPractice - Summer 2007
As in Medicine,
Patient Safety Comes First
As radiologists take a more visible role in
today’s health care delivery system, the means
and methodologies by which they treat patients
have generated greater scrutiny, primarily in the
critical areas of utilization and patient safety.
More Time,
More Information
• This is only the beginning.
• As a key information and practice resource, the
ARRS PQI Register will continually update its
information with new links, fresh commentary, and
the latest news.
• Ensure that you and your practice meet whatever
challenges you face in complying with the new
generation of performance measures.
“Evidence-Based Quality
Radiology”
What is the “evidence” and
where do we find it?
Medical Evaluation of
Quality as a Disease!
HISTORY – PHYSICAL – DIAGNOSIS – TREATMENT
• When/Where Did This Start?
• What Does It Look Like?
(Hx)
(PE)
• To What Does This Apply?
(ROS)
•
•
•
•
(SHx)
(Rx)
Whose Idea Was It Anyway?
What Is The Treatment
What Will It Cost Doctors?
Does My Insurance Cover It?
• Is There Any Evidence Base – Cost /Benefit?
A Lot of Questions,
Precious Few Answers
• Whose data do we use?
• Does it apply to me?
• Is it “scientific?"
• Is it “faith-based?"
• Have the persons determining the evidence
ever personally met a payroll, written a
check for malpractice insurance premiums,
or interpreted diagnostic images?
“Clinical medicine is awash in novelty,
but without the capacity to distinguish
what truly works…Our culture is embedded
with the strong belief that more is better
and that the physician knows best.
The study of practice variations uncovers
a very different, more nuanced reality.”
John E. Wennberg
Health Affairs
October 7, 2004
With the exponential growth of medical
imaging in recent years, much of it
performed by nonradiologists, and
the resultant scrutiny by federal and
third-party payers, the issue of quality
assurance has moved to the forefront
among professional concerns.
As a profession, our quality agenda must
extend beyond effective care and
address unwarranted variation. We must
identify—and remedy—weaknesses in
the scientific basis for clinical decision
making in our everyday practice.
As Radiologists,
Quality Care is Not Our Goal.
It is Our Responsibility.
Successful Doctors
• Have the same pills and tools as others.
• Deal with frustrations proactively.
• Document/measure/monitor FAILURES.
• Identify and implement small changes that
make a difference.
• Try to understand complexity and
imperfection
“Increasingly, perceptive patients see radiologists and
radiologic examinations as the core of the diagnostic
process. Increasingly, it is critical that all of our
constituents, but especially our patients, perceive that
they receive great value and high quality when they come
to us for help.
Everyone should understand from the cleanliness of your
work place; from the sincerity, kindness, and technical
competence of each employee; and from your appropriate
communication with your patient that you hope to move
past quality service to your ultimate goal—excellence.”
John K. Crowe, MD
Value, Quality, Excellence: Our National Pastime
AJR, Nov 2000; 175: 1223–1224
The Dependent Variables
of Evidence-Based Medicine
•
•
•
•
•
•
•
•
•
Recruitment
Intelligence
Training
Retention
Reliability
Interest
Supervision
Leadership
Definition of Success
Knowledge is Power
Francis Bacon
Knowledge is Power
• POWER = Work / time
• TIME is MONEY ($)
• POWER = Work / $
• If KNOWLEDGE = POWER = Work / $
• Then K = W /$ or $ = W / K
• Therefore: For equal work and twice Knowlege
• W / K = 10 / 1 =$10 if 10 / 2 = $5
•
LEAST KNOWLEDGE = MOST MONEY!
Possible Futures
Rules & Triumphs
QA
“Works”
Fails
What are the metrics? How will we know?
Autopsy Rate
Was about 50%
Now less than 5%
Autopsies show diagnostic
errors
in 10-40% of cases
What is Evidence that the
ABR has improved?
Same Test Method since FDR was President
Apprenticeship-Guild
Length and Method of Training
Enculturation
M-O-C P-Q-I M-O-U-S-E