Anand Narayan MD, PhD, Presenter: Nothing to Disclose

Christina McGraw Cinelli MD, Abstract Co-Author: Nothing to Disclose

John A. Carrino MD, MPH, Abstract Co-Author: Consultant, BioClinica, Inc Consultant, Pfizer Inc Advisory Board, General Electric Company

Paul G. Nagy PhD, Abstract Co-Author: Nothing to Disclose

Josef Coresh MD, PhD, Abstract Co-Author: Nothing to Disclose

Daniel Durand MD, Abstract Co-Author: Nothing to Disclose

As the US healthcare delivery system transitions from volume to value, numerous public, private and non-profit entities have developed quality metrics to evaluate health care providers. Radiology quality metrics currently in use by CMS programs (e.g., Physician Quality Reporting System) do not focus on true diagnostic outcomes. We present here an exhaustive inventory of all published radiology quality metrics and classify them according the hierarchical framework of Donabedian et al., which is used widely throughout the broader healthcare quality metric literature.

A systematic review was performed in which eligibility criteria included published primary research articles, commentaries, and review articles from 2000 onward. Multiple databases were searched (7/1/2013) as well as the reference lists of identified articles. Studies were double-read with discrepancies resolved by consensus. Outcome measures were organized based on standard Donabedian categories (structure, process, outcome). Results were reported according to PRISMA study guidelines for reporting systematic reviews.

Our initial search yielded 1816 unique citations (Figure 1). Our double-blind abstract screen identified 110 papers for detailed review, of which 16 were included in the final analysis. A total of 75 unique metrics were reported, which were further classified as follows: 28 (37%) structure metrics, 24 (32%) outcome metrics and 23 (31%) process metrics. The most commonly cited outcome metric was the ACR RADPEER score (50% of papers). The most commonly cited structural metric was whether or not a facility was accredited by the ACR (31% of papers). The most commonly cited process metric was whether ACR appropriateness criteria were followed (25%).  

Numerous radiology quality metrics have been described, which are evenly divided between structure, process and outcomes metrics. Additional research is needed to determine why there has been low uptake of radiology outcome metrics into existing value-based contracting (e.g., CMS PQRS).

Radiologists must work to develop quality metrics that evaluate patient centered outcomes of radiologic studies. 

Narayan, A, Cinelli, C, Carrino, J, Nagy, P, Coresh, J, Durand, D, Quality Measurements in Radiology: A Systematic Review of the Literature.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14003355.html