Getting it Done: An ACR Value Based Radiology PQI Testimonial * Jennifer Broder, MD Assistant Professor Tufts Medical School Lahey Hospital and Medical Center Burlington, MA * This presentation is a condensed version of the talk Dr. Broder presented at ACR 2015 Crossroads of Radiology®

The Practice Quality Improvement (PQI) Challenge Time – You are busy – Your colleagues in radiology are busy – Your referring providers are busy QI Ideas – Your colleagues who are “into” QI have a ton of ideas…. – But you are having a hard time finding an idea

The PQI Challenge QI Skills – Even if you have an idea, you don’t feel like you know which QI tools to use to get it done. – Operations management tools? Programming spreadsheets? Running meetings? QI Project Management? – Now that you have an idea, how do you get your colleagues to participate? – How do you get this done in a reasonable amount of time?

Meet the Challenge: ACR Value-Based Radiology PQI Time. – Registration is fast. – Data collection is efficient. – Results calculated for you.

Meet the Challenge: ACR Value-Based Radiology PQI Ideas. – Multiple topics, many of which are based on the Choosing Wisely national campaign to improve patient care – Likely one is relevant to your practice

ACR Value-Based Radiology PQI: Topics 10 different topics to choose from:

ACR Value-Based Radiology PQI: Topics SpecialtyTopicSocieties ChestAvoid admission/pre-op CXR for ambulatory patients with unremarkable exam ACR, ACP, ACS ChestDo not perform CTPA in patients with low clinical suspicion and negative D-dimer ACP, ACCP, ATS, ACR CV/EDDo not perform coronary CT angiogram in high risk patients presenting in the ER with acute chest pain SCCT EDAvoid the routine use of whole body diagnostic CT scanning in patients with minor/single-system trauma ACS GUDo not recommend follow-up for patients with clinically inconsequential cysts ACR GU/NMDon’t perform PET, CT and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis ASCO Choose one or more of the ten topics

ACR Value-Based Radiology PQI: Topics SpecialtyTopicSocieties MSK/NeuroDon’t perform advanced imaging of the spine within the first 6 weeks in patients with nonspecific low back pain in the absence of red flags. NASS, ACP, AAFP NeuroDon’t order sinus CT or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis. AAAAI, AAO Pedi/EDCT scans are not necessary in the immediate evaluation of minor head injuries AAP Pedi/NeuroNeuroimaging (CT/MRI) is not necessary in a child with a simple febrile seizure AAP

Meet the Challenge: ACR Value-Based Radiology PQI Skills. – Straight-forward data collection tools ready for your use – Collections of educational tools for your group to use in its intervention

What you will need to do: Project Management Decide: Which project is right for your group? – Which topic is most relevant to your practice? – Is there actually a problem? Near impossible to motivate participation if not – Is it a priority for the department administration/section head? Who will back you up if you run into trouble? – Is it a priority for the referring clinicians?

ACR Value-Based Radiology PQI We chose… SpecialtyTopicSocieties GUDo not recommend follow-up for patients with clinically inconsequential cysts ACR

Lahey’s Topic Why this topic? – Massachusetts utilization data suggests very high usage of pelvic ultrasound – Large hospital system; RIS search by ICD-9 codes demonstrated over 600 pelvic ultrasounds per year reporting ovarian cysts – Recommendations from the Society of Radiologists in Ultrasound now available regarding management of adnexal cysts Follow up is not recommended for simple cysts up to 5 cm in premenopausal females SpecialtyTopicSocieties GUDo not recommend follow-up for patients with clinically inconsequential cysts ACR

Lahey’s Topic Note: – This topic is a little different from the others – Evaluates radiologists recommendations rather than provider’s orders SpecialtyTopicSocieties GUDo not recommend follow-up for patients with clinically inconsequential cysts ACR

What you will need to do: Project Management Become familiar with ACR’s PQI processes and resources – Available on the ACR website:

Project Management: Get to Know ACR’s PQI Process

Project Management: Get to Know ACR’s PQI Tools Log in to your dashboard with your ACR login

Project Management: Get to Know ACR’s PQI Tools Dashboard = Step-by-step guidance Allows you to register for any and all topics

Project Management: The ACR PQI Dashboard Connect directly to ACR Select from the dashboard to score your cases

Project Management: ACR Select Scoring the cases in ACR Select automatically generates reports. This site has a lot of opportunity for reducing the ordering of pre-op chest x-rays!

Project Management: Online Data Collection Forms Submission of “Project Completion Form” triggers notification to the ABR

Project Management: Resources for Your Intervention

Project Management: Your Team Develop your team wisely Think through each member’s role before you start. – Which radiologists will you work with? Who needs to participate in planning? Who will review cases? Will these individuals participate fully and in a timely fashion? If they don’t, do you have department leadership (section head/chairperson) support to back you up?

Project Management: Your Team Which referring clinicians should be included in the project? – Do you need to contact the leadership of your referring clinicians? – Should the referring clinicians be involved in planning the project? Or be involved only as targets of the intervention? – How are you going to communicate with them?

Project Management: Your Team What administrative support will you need? – Never underestimate the value of talking to your RIS/IT folks before you start – Understand what your options are for how to find the cases relevant to your project

Project Management: Making Your Plan ABR PQI 3-meeting format is useful here. Meeting 1: Plan details » Member roles » Scope of project » Timeline » Intervention Data entry Meeting 2: Review results, plan intervention in detail Intervention Data entry Meeting 3: Review results, discuss outcomes and next steps

Project Management: Be explicit NameResponsibilities Radiologist AProject lead, manage timeline and updates, coordinate with RIS review cases* Radiologist BReview cases, identify/develop educational resources for referring clinicians Radiologist CReview cases, conduct outreach to referring clinicians RIS ManagerData mine cases x2, pre and post intervention Referring Clinician AOrganizes access to XYZ referring group for intervention

Project Management: Be explicit ActivityPerson responsibleExpected Date of Completion Completed? Meeting #1All participantsFeb 1, 2015 Data Mine #1RIS ManagerFeb 7, 2015 Case Review #1Radiologist A Radiologist B Radiologist C Feb 14, 2015 Meeting #2All participantsFeb 16, 2015 Organize Intervention Radiologist B Referring Clinician A February 26, 2015 Perform Intervention Radiologist CMarch 30, 2015

Project Management: Be explicit ActivityPerson responsibleExpected Date of Completion Completed? Meeting #1All participantsFeb 1, 2015 Data Mine #1RIS ManagerFeb 7, 2015 Case Review #1Radiologist A Radiologist B Radiologist C Feb 14, 2015 Meeting #2All participantsFeb 16, 2015 Organize Intervention Radiologist B Referring Clinician A February 26, 2015 * Perform Intervention Radiologist CMarch 30, 2015

Project Management: Be explicit ActivityPerson responsibleExpected Date of Completion Completed? Data Mine #2RIS ManagerMay 1, 2015 Case Review #2Radiologist A Radiologist B Radiologist C May 7, 2015 Meeting #3All participantsMay 14, 2015

Project Management: The Timeline Timeline and deadlines – Mutually agreed upon explicit dates – In writing Giving people less time to accomplish a task usually increases the likelihood it will get done

Project Management: The Timeline Group should meet weekly, even if virtually. – Weekly updates including Timeline What’s completed What’s pending What’s delinquent – May be just bulleted s – Helps hold people accountable

Summary ACR Value Based PQI = PQI made easy ACR takes care of the idea, QI tools, and resources for intervention Bulk of your time is spent – Building relationships with your referring providers – Demonstrating how you add value to patient care Proactive project management is the key to successful completion

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