Tools for the Future
Quality and Safety initiatives help readiologists meet the demands of the new health care environment.
As health care in the United States moves toward new models for the provision of care, reimbursement, and valuebased purchasing, ACR members will be challenged to demonstrate the value of their service to patients, referring providers, administrators, and payers.
The Commission on Quality & Safety provides myriad tools members can take advantage of, including ACR Appropriateness Criteria®, accreditation, Image Wisely®, Image Gently®, practice guidelines and technical standards, RADPEER™, metric development, registries, lexicons, and quality control manuals. However, it would likely take a full issue of the Bulletin to adequately describe all of these programs. So this article will focus on two important initiatives, the Diagnostic Imaging Center of Excellence™ (DICOE) program and the National Radiology Data Registry (NRDR™).
DICOE goes beyond the normal modality accreditation. It is a comprehensive assessment of the entire medical imaging system, including the professional staff, technology, policies and procedures, and ultimately the quality of patient care. In order to qualify, facilities must first be accredited by the ACR in all modalities that they offer. They must also participate in the Dose Index Registry® and the General Radiology Improvement Database. As DICOE participants, they receive registration in these registries free of charge. The ACR encourages practices to do a thorough self-assessment before they apply, based on this criteria.
The DICOE survey team includes a radiologist, a medical physicist, and a radiologic technologist. They meet with the facility’s team members, tour the facility, and then do a detailed assessment, which includes governance and management, personnel, equipment and environment, radiation and general safety, quality management, policies and procedures, patient rights, infection control, communications, and outcomes. Read about the first practices to receive this recognition.
In my view, the DICOE recognition is synonymous with exceptional performance and commitment to the most rigorous standards in all phases of the medical imaging enterprise. Receiving this prestigious designation sets one’s practice apart. It shows that a radiology group has gone beyond the steps for a good-quality radiology practice in pursuit of excellence in patient care.
While the DICOE program rewards quality patient care, the NRDR brings together quality improvement databases developed and hosted by the ACR to promote practice quality in imaging. They are also critical to show the value of high quality radiology. The CT Colonography Registry, the General Radiology Improvement Database, and the IV Contrast Extravasation Registry were launched in 2008; the National Mammography Database was launched in 2009; and the Dose Index Registry was launched in 2011. At the end of October 2013, there were 794 registered facilities participating in the NRDR. The facilities are broadly representative of practice in the US, with 44 percent of active facilities at community hospitals and an additional 33 percent at free-standing facilities. Twelve percent of current facilities are rural.
The goal of the NRDR registries is to empower facilities and physicians to implement a cyclical quality improvement process. Facilities transmit data to the NRDR, receive semi-annual national benchmarking reports, compare and analyze their institution’s results, and develop and implement an improvement plan. Participants receive comparisons of their own performance to that of peers using standardized metrics. The American Board of Radiology has endorsed participation in all five of the NRDR registries as approved Practice Quality Improvement projects for Maintenance of Certification Part 4. Participation is highest in the more automated registries: the Dose Index Registry (which currently has over 6 million exams) and the National Mammography Database (which has over 5 million exams). We are working to make each registry as automated as possible. To help facilities learn from each other, NRDR staff and committee chairs host semi-annual webinars for participants. There is also an annual in-person data registries meeting for participants to present their experiences and discuss successses and challenges.
If radiologists are to maintain a leadership role in diagnosis, we need our patients, colleagues, and payers to know that we provide quality services that can be measured. These national registries help define practices across the country and can lead to nationwide improvements in patient care. Support of the NRDR will help ensure that we can demonstrate the quality and value of what we do.
For almost thirty years, the Commission on Quality and Safety has developed programs and tools to help guide ACR members in providing high-quality care. We have almost 900 volunteer members who participate in the committees that oversee these activities, and I am grateful for the energy, dedication, and expertise they bring to the commission. All of these programs contribute to the “value added” of radiologists as part of the ACR Imaging 3.0™ program. We look forward to continuing to serve the ACR membership by helping all of us meet the new demands of value-based purchasing and the new health care landscape.
By Debra L. Monticciolo, MD, FACR, Chair, ACR Commission on Quality and Safety