Abstract
Advances in diagnostic imaging have helped revolutionize the practice of medicine. These advances have enhanced physicians’ understanding of diseases, improved diagnostic accuracy, and contributed tremendously to patient care. However, heterogeneity and on warranted variation in practice of radiology exists locally, regionally, nationally, and globally. Variations in diagnostic radiology practices are well-documented numerous. Even in a single radiology practice substantial unexplained variation exists in how imaging tests are requested, scheduled, performed, reported, communicated, and how frequently appropriate follow-up diagnostic and therapeutic tests and procedures are performed. Such unexplained words and variations in practice of diagnostic radiology can lead to some optimal quality of care, waste, and a diminished patient experience of care. Initiatives to close such performance gaps enhance the value of radiologists and diagnostic imaging to individual patients and to the healthcare system.
To improve quality, initiatives to define, measure, improve and monitor quality are critical. In this chapter, we define quality, describe the importance of measuring quality and characteristics of good quality metrics in radiology. We well describe examples of diagnostic radiology quality metrics in safety, timeliness, effectiveness, and patient centered domains. We will briefly describe the process for creation, presentation, and distribution of quality metrics to enable managing and leading the changes needed to improve the care of individual patients and the performance of the healthcare system.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American College of Radiology (2017) ACR Appropriateness Criteria® [Internet]. [cited 2017 Aug 24]. https://www.acr.org/Quality-Safety/Appropriateness-Criteria
Andriole KP, Prevedello LM, Dufault A, Pezeshk P, Bransfield R, Hanson R et al (2010) Augmenting the impact of technology adoption with financial incentive to improve radiology report signature times. J Am Coll Radiol 7(3):198–204
Andruchow JE, Raja AS, Prevedello LM, Zane RD, Khorasani R (2012) Variation in head computed tomography use for emergency department trauma patients and physician risk tolerance. Arch Intern Med 172(8):660–661
Bobbin MD, Ip IK, Sahni VA, Shinagare AB, Khorasani R (2017) Focal cystic pancreatic lesion follow-up recommendations after publication of ACR White Paper on managing incidental findings. J Am Coll Radiol 14(6):757–764
Boland GW, Glenn L, Goldberg-Stein S, Jha S, Mangano M, Patel S et al (2017) Report of the ACR’s economics committee on value-based payment models. J Am Coll Radiol 14(1):6–14
Choosing Wisely - An Initiative of the ABIM Foundation [Internet] (2015) [cited 2017 Aug 25]. http://choosingwisely.org/
Gee A (2012) Radiation Concerns Rise with Patients’ Exposure. The New York Times [Internet]. http://www.nytimes.com/2012/06/13/health/as-medical-imaging-rises-radiation-concerns-follow.html?_r=0
Gupta A, Ip IK, Raja AS, Andruchow JE, Sodickson A, Khorasani R (2014) Effect of clinical decision support on documented guideline adherence for head CT in emergency department patients with mild traumatic brain injury. J Am Med Inform Assoc 21(e2):e347–e351
Hillman BJ, Amis ES, Neiman HL, FORUM Participants (2004) The future quality and safety of medical imaging: proceedings of the third annual ACR FORUM. J Am Coll Radiol 1(1):33–39
Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. National Academy Press, Washington, DC
Ip IK, Mortele KJ, Prevedello LM, Khorasani R (2011) Focal cystic pancreatic lesions: assessing variation in radiologists’ management recommendations. Radiology 259(1):136–141
Ip IK, Gershanik EF, Schneider LI, Raja AS, Mar W, Seltzer S et al (2014) Impact of IT-enabled intervention on MRI use for back pain. Am J Med 127(6):512–518.e1
Ip IK, Raja AS, Seltzer SE, Gawande AA, Joynt KE, Khorasani R (2015) Use of public data to target variation in providers’ use of CT and MR imaging among Medicare beneficiaries. Radiology 275(3):718–724
Khorasani R (2004) Leading your organization through a successful software implementation has little to do with the technology. J Am Coll Radiol 1(6):430–431
Khorasani R (2009) Optimizing communication of critical test results. J Am Coll Radiol 6(10):721–723
Khorasani R, Bates DW, Teeger S, Rothschild JM, Adams DF, Seltzer SE (2003) Is terminology used effectively to convey diagnostic certainty in radiology reports? Acad Radiol 10(6):685–688
Kotter J (1995) Leading change: why transformation efforts fail. Harv Bus Rev
Lacson R, O’Connor SD, Andriole KP, Prevedello LM, Khorasani R (2014a) Automated critical test result notification system: architecture, design, and assessment of provider satisfaction. AJR Am J Roentgenol 203(5):W491–W496
Lacson R, Prevedello LM, Andriole KP, O’Connor SD, Roy C, Gandhi T et al (2014b) Four-year impact of an alert notification system on closed-loop communication of critical test results. AJR Am J Roentgenol 203(5):933–938
Lacson R, O’Connor SD, Sahni VA, Roy C, Dalal A, Desai S et al (2016) Impact of an electronic alert notification system embedded in radiologists’ workflow on closed-loop communication of critical results: a time series analysis. BMJ Qual Saf 25(7):518–524
Lu MT, Rosman DA, Wu CC, Gilman MD, Harvey HB, Gervais DA et al (2016) Radiologist point-of-care clinical decision support and adherence to guidelines for incidental lung nodules. J Am Coll Radiol 13(2):156–162
Maehara CK, Silverman SG, Lacson R, Khorasani R (2014) JOURNAL CLUB: renal masses detected at abdominal CT: radiologists’ adherence to guidelines regarding management recommendations and communication of critical results. AJR Am J Roentgenol 203(4):828–834
Manary MP, Boulding W, Staelin R, Glickman SW (2013) The patient experience and health outcomes. N Engl J Med 368(3):201–203
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) [Internet] (2015) [cited 2017 Aug 25]. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
Mitchell AM, Jones AE, Tumlin JA, Kline JA (2012) Prospective study of the incidence of contrast-induced nephropathy among patients evaluated for pulmonary embolism by contrast-enhanced computed tomography. Acad Emerg Med 19(6):618–625
O’Connor SD, Dalal AK, Sahni VA, Lacson R, Khorasani R (2016) Does integrating nonurgent, clinically significant radiology alerts within the electronic health record impact closed-loop communication and follow-up? J Am Med Inform Assoc 23(2):333–338
Prevedello LM, Andriole KP, Khorasani R (2008) Business intelligence tools and performance improvement in your practice. J Am Coll Radiol 5(12):1210–1211
Prevedello LM, Andriole KP, Hanson R, Kelly P, Khorasani R (2010) Business intelligence tools for radiology: creating a prototype model using open-source tools. J Digit Imaging 23(2):133–141
Protecting Access to Medicare Act of (2014) Public Law 113-93 Apr 1, 2014 p. Congressional Record Vol 160
Raja AS, Gupta A, Ip IK, Mills AM, Khorasani R (2014) The use of decision support to measure documented adherence to a national imaging quality measure. Acad Radiol 21(3):378–383
Sahni VA, Silveira PC, Sainani NI, Khorasani R (2015) Impact of a structured report template on the quality of MRI reports for rectal cancer staging. Am J Roentgenol 205(3):584–588
Silveira PC, Dunne R, Sainani NI, Lacson R, Silverman SG, Tempany CM et al (2015) Impact of an information technology-enabled initiative on the quality of prostate multiparametric MRI reports. Acad Radiol 22(7):827–833
Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R et al (2009) Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 251(1):175–184
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Laroya, R., Khorasani, R. (2018). Quality Metrics: Definition, Creation, Presentation, and Use. In: Donoso-Bach, L., Boland, G. (eds) Quality and Safety in Imaging. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_163
Download citation
DOI: https://doi.org/10.1007/174_2017_163
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-42576-4
Online ISBN: 978-3-319-42578-8
eBook Packages: MedicineMedicine (R0)