Transcript No Slide Title

Practice Quality Improvement (PQI)
Summit
Harvey L. Neiman, M.D., FACR
Executive Director
August 18, 2007
American College of Radiology
Quality Timeline
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Quality and Safety
– Voluntary Mammography Accreditation
– Radiation Oncology Accreditation
– Standards and guidelines
– MQSA
– Appropriateness Criteria
– CT, MR and other accreditation
• Ultrasound
• MR
• Nuclear Medicine
• CT, PET
– RADPEER™
• RADPEER™
• eRADPEER™
– NRDR
– MR Safety White Paper (Kanal)
– Radiation Dose White Paper (Amis)
Year Began
1987
1987
1990
1994
1995
1995
1996
1999
2002
2002
2005
2006
2007
2007
The ACR Approach to PQI
Quality Practice
Goal
The Tools
RADPEER
(Process)
Underlying
Concepts
(Structure)
GRID
Standards and
Guidelines
Targeted
Education
Dose Index Other
RadKat
Registry Registries
Accreditation
Appropriateness
Criteria
RADPEER™
RADPEER™ is an easy to use tool
developed to allow radiologists to do peer
review during the course of a day’s work.
When a new study is interpreted with a
prior study for comparison, a peer review
of the accuracy of the interpretation of the
previous examination occurs
RadPeer™ – What is it?
• RADPEER™ is part of a department’s quality program. After
submission of practice data to the ACR, the radiology chair or
medical director can access the reports online at any time.
The reports provide:
• Summary statistics and comparisons for each participating
radiologist by modality
• Summary data for the group by modality
• Data summed across all RADPEER™ participants by modality
RADPEER™
• RADPEER™ is a tool for PQI. It is not a project.
RADPEER™
Four point scoring system:
1 Concur with interpretation
2 Difficult diagnosis, not ordinarily expected to be made
3 Diagnosis should be made most of the time
4 Diagnosis should be made almost every
time/misinterpretation of findings
Score of 3 or 4 should be reviewed through the facility’s internal QA
process prior to submission to ACR
All data collected by ACR are considered to be privileged
and confidential peer review records of ACR and are thus
subject to legal protection of the Medical Malpractice Act
of Virginia, Section 8.01-581.17 of Code of Virginia 8/10/01
e RADPEER™
RADPEER™ - Issues
• Positive Aspects
– Available in variety of formats – paper, PDA, Web
– Easy to use
– Wide acceptance (as of July 2007)
• 514 active sites (practices)
– 223 paper
– 291 eRADPEER
• 7525 Radiologists
– Part of an overall program
RADPEER™ - Issues (2)
• Deficiencies
– No external validation of an institution’s reviews
– No normalization of one practice to another
– The number of cases entered varies significantly
– Only compartmentalizes by modality
– No obligatory remediation
RADPEER™ - Addressing of Deficiencies
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Validation and normalization of data – Ideas
– Web based blinded review from other practices
– Site reviews for accreditation to include RADPEER reviews
– Normalized to “exemplary sites”
– Benchmarking using GRID
Plans underway to evaluate by organ/body part and possibly disease
process
Systems available to “force” compliance
Correlation with RadKat (Radiology Knowledge Assessment Test)
RADPEER™ Committee
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Kenneth Chin, MD, Chair
David Dixon, MD
Charles Grimes, MD
David Linkous, MD
Albert Nemcek, MD
Robert Pyatt, MD
Richard Redvanly, MD
Trudie Cushing
The ACR Approach to PQI
Quality Practice
Goal
The Tools
RADPEER
(Process)
Underlying
Concepts
(Structure)
GRID
Standards and
Guidelines
Targeted
Education
Dose Index Other
RadKat
Registry Registries
Accreditation
Appropriateness
Criteria
National Radiology Data Registry, Chair: Jeff Weinreb, MD, FACR
NOPR
GRID, Interim Chair: Harvey Neiman, MD, FACR
ACR-NCR, Chair: R Nick Bryan, MD, PhD
Dose Index Registry, Chair: Richard Morin, PhD, FACR
CTC Registry, Chair: Dan Johnson, MD
CCTA Registry, Chair: Art Stillman, MD, PhD
NMD, Chair: Edward Sickles, MD, FACR
Technical Advisory Group, Chair: David Channin, MD
NRDR Overview
• Purpose of NRDR is to enhance your practice, the specialty of
radiology, and the care patients receive by providing accurate
and objective measures of practice processes and outcomes.
• Establishes benchmarks to allow comparison of facility or
physician data to that of the region and the nation.
• Gives unified mechanism for security, data storing, content
management, common data elements for future research
projects
• Provides users with a single front-end with ACR on-line services
and single sign-on
• Builds on the success of RADPEER™ and the National
Oncologic PET Registry
NRDR Overview (2)
• It is a data warehouse – a database of databases
– Each registry functions independently
– Leverages the Technology
– Allows information to be shared across registries
• ACR Registries can be and are a cooperative effort with other
societies
– NOPR: Academy for Molecular Imaging, SNM, ASCO, ACRIN
– ACR/NCR: SIR, ASNR, ASITN
– NRDR: RSNA
NRDR Overview (3)
• ACR/NCR introduced June 2007
• National Oncologic PET Registry
– Over 40,000 patients entered
– Over 1500 sites participating
General Radiology Improvement Database (GRID)
• GRID is a key tool for objectively measuring performance
indicators for the purpose of evaluating and improving facility
processes and outcomes.
• Simple, objective, numeric monitoring of data
• Standardized collection of measures allows for valid
comparisons across similar facility types
• Performance measures include volume, structural measures,
protocols, personnel training, safety, process measures,
outcomes and customer satisfaction
General Radiology Improvement Database
Sample GRID Data Elements
• General Facility Information
– Type of institution (academic, community, community –
teaching)
– Location (urban, suburban, rural)
– Annual volume
Sample GRID Data Elements
• Structural Measures
– Flouroscopy time reported
– Report access 24/7
• Protocols
– Pregnancy, allergies, infection control, etc.
• Personnel
– CME hours, certification
• Safety
– Personnel training, documentation of medications and
allergies
Sample GRID Data Elements
• Process Measures
– Patient wait time
– Time from order to exam
– Report turnaround time
• Outcomes
– % insufficient tissue for liver biopsy
– Pneumothorax rate on lung biopsy requiring intervention
– % negative head CT
– BIRAD code % (screening)
Sample GRID Data Elements
• Other GRID elements
– Patient satisfaction survey
– Referring physician satisfaction survey
GRID (General Radiology Improvement Database
• Goal is to have Version 1.0 available for pilot testing by January
1, 2008. Likely to be predominately manual
• Working to develop Version 2.0 as mainly electronic data entry
CME Weekend Course
ACR Approach
Do you Own it?
ACR RadKat*
RADPEER™*
ACR Education Center™
ACR Campus™
Benchmarking (NRDR)
Did you Do it?
Do you Know it?
SAM Credit
*Questions by Modality, Body Part and Disease Type
Radiology Knowledge Assessment Test (RadKat)
• Self administered, low stress
• Personalized assessment of skills
• Based on expertise with DIXIT and TIXIT as well as CPI
(Continuous Professional Improvement)
• 50 questions in each area of practice or areas that taker wants to
be assessed
• Results only to the taker of the exam
– Benchmarked to others with similar practice patterns
• Radiologist may correlate results of RadPeer and RadKAT
Practice Quality Improvement
Summary
• RADPEER™ is a tool that can be used for PQI
• RADPEER™ has many strengths
– We recognize and are addressing the deficiencies
• RADPEER™, GRID and RadKat are key elements in the ACR’s
approach to helping practices and individual radiologists
accomplish PQI;