Priyanka Prakash MD, Presenter: Nothing to Disclose

Sheela Agarwal MD, MS, Abstract Co-Author: Nothing to Disclose

Daniel Ira Rosenthal MD, Abstract Co-Author: Nothing to Disclose

Hani H. Abujudeh MD, MBA, Abstract Co-Author: Research grant, Bracco Group Consultant, RCG HealthCare Consulting

James H. Thrall MD, Abstract Co-Author: Stockholder, Apple Inc Stockholder, Achillion Pharmaceuticals, Inc Stockholder, RPC Inc

Sanjay Saini MD, Abstract Co-Author: Nothing to Disclose

Report turn around time (RTAT) is an important “quality” metric in radiology. Effect of pay for performance (P4P) incentive on RTAT has been studied in the past with favorable results. The purpose of our study was to assess the temporal relationship of P4P incentive to a decreasing RTAT trend.

Image acquisition time (C), preliminary report generation time (P) and report finalization time (F) are recorded in the Radiology information system (RIS) database of our institution which is an urban academic medical center with approximately 100 residents and fellows. Between Jan 2005 to Dec 2010, the C-P, P-F and C-F times were extracted from this database using commercial software (Web Universal v9.0.2: MicroStrategy). Data were stored and analyzed using Microsoft Excel worksheets. The RTAT for subspecialty 57 radiologists (15 abdominal, 6 Breast, 5 Emergency, 6 Bone, 9 Neuroimaging, 5 Nuclear medicine, 2 Pediatrics, 6 Thoracic and 3 Vascular IR) who were present during the entire study period were used for analysis. The P4P program was implemented from Jan07 to Dec08 and again from Jan- Dec10. The C-P, P-F and C-F times for each subspecialty were compared between Jan 05-Dec 06 (before the implementation of P4P), Jan 07- Dec 08 (during P4P), 2009 (withdrawal of P4P) and 2010 (reintroduction of P4P).

The average C-F time during the four study periods was 84±63, 36±22, 25±15 and 19±9hrs. The average C-F time (hrs) for the four time frames for different subspecialties was: 106±78, 38±25, 27±14 and 20±7 for Abdominal, 105±33, 42±15, 43±26 and 28±12 for Breast, 34±26, 13±7, 10±5 and 9±6 for Emergency, 51±33, 25±14, 19±10 and 17±7 for Bone, 229±250, 101±80, 58±34 and 46±22 for Neuroimaging, 37±34, 15±10, 12±5 and 8±3 for Nuclear medicine, 65±54, 28±22, 15±11 and 9±3 for Pediatric, 40±23, 23±11, 16± 12 and 13±7 for Thoracic and 92±33, 40±21, 21±12 and 17±10 for Vascular IR respectively (p<0.01).

The average C-P, P-F and C-F times showed a continuous downward trend since Jan 2005. This decrease in RTAT started before the implementation of P4P incentive and continued when P4P was withdrawn and reintroduced. Hence, factors other than financial incentives primarily leadership's focus on quality of care also contribute to the desired culture change.

Factors other than the financial incentives should be identified and exploited to the maximum to improve the quality of care.

Prakash, P, Agarwal, S, Rosenthal, D, Abujudeh, H, Thrall, J, Saini, S, Enhancing 'Quality and Safety' Culture in Radiology: P4P Incentive Is Not the Only Factor.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11012482.html