How Do Noninvasive Imaging Facilities Perceive the Accreditation Process? Results of an Intersocietal Accreditation Commission Survey

Variation in additional testing and patient outcomes after stress echocardiography or myocardial perfusion imaging, according to accreditation status of testing site

BACKGROUND

The purpose of the present study was to determine whether patients receiving a stress echocardiogram or myocardial perfusion imaging (MPI) test have differences in subsequent testing and outcomes according to accreditation status of the original testing facility.

METHODS AND RESULTS

An all-payer claims dataset from Maine Health Data Organization from 2012 to 2014 was utilized to define two cohorts defined by an initial stress echocardiogram or MPI test. The accreditation status (Intersocietal Accreditation Commission (IAC), American College of Radiology (ACR) or none) of the facility performing the index test was known. Descriptive statistics and multivariate regression were used to examine differences in subsequent diagnostic testing and cardiac outcomes. We observed 4603 index stress echocardiograms and 8449 MPI tests. Multivariate models showed higher odds of subsequent MPI testing and hospitalization for angina if the index test was performed at a non-accredited facility in both the stress echocardiogram cohort and the MPI cohort. We also observed higher odds of percutaneous coronary interventions (PCI) performed (OR 1.68, 95% CI 1.13-2.50), if the initial MPI test was done in a non-accredited facility.

CONCLUSION

Cardiac testing completed in non-accredited facilities were associated with higher odds of subsequent MPI testing, hospitalization for angina, and PCI.

Accreditation, Credentialing, and Quality Improvement in Diagnostic Medical Sonography: A Literature Review

There are few regulations regarding facility accreditation and individual credentialing in diagnostic medical sonography (DMS), although it is known that the quality of examinations in the field can vary based by the operator. This literature review summarizes the findings from 19 research studies on accreditation, credentialing, and quality improvement and includes illustrative quotes from 23 position papers and 42 editorials. The review uncovered large differences in facility accreditation status based on sonography specialty and geographical area. The findings included many examples of positive correlations between accreditation and improved quality and also a positive correlation between credentialing and improved image quality. The survey studies revealed overwhelming support for accreditation and credentialing. Many articles raised concerns about the unknown quality of sonograms performed in nonaccredited facilities or by uncredentialed sonographers. If facility accreditation and/or individual credentialing could be implemented nationwide in DMS, it may lead to increased quality within the field.

Day of Week, Site of Service, and Patient Complexity Differences in Venous Ultrasound Interpreted by Radiologists Versus Nonradiologists

OBJECTIVE

Nationally, nonradiologists interpret an increasing proportion of lower extremity venous duplex ultrasound (LEVDU) examinations. We aimed to study day of week, site of service, and patient complexity differences in LEVDU services interpreted by radiologists versus nonradiologists.

MATERIALS AND METHODS

Using carrier claims files for a 5% national sample of Medicare beneficiaries from 2012 to 2015, we retrospectively classified all LEVDU examinations by physician specialty (radiologist versus nonradiologist), day of week (weekday versus weekend), site of service, and patient Charlson Comorbidity Index (CCI) scores. Pearson's χ² was used to test statistical significance.

RESULTS

Of 760,433 LEVDU examinations for which provider specialty could be determined, 439,964 (58%) were interpreted by radiologists and 320,469 (42%) by nonradiologists. On weekends, radiologists interpreted 75% (66,094 of 88,244) and nonradiologists 25% (22,150 of 88,244) (P < .0001). Of LEVDU examinations interpreted by radiologists, 57% were performed in the inpatient or emergency department settings, and 70% of LEVDU examinations interpreted by nonradiologists were performed in the private office or outpatient hospital setting. Radiologists interpreted a slightly larger proportion (17%) of their examinations on patients with more comorbidities (CCI of ≥3) than nonradiologists (15%) (P < .0001).

CONCLUSION

Compared with nonradiologists, radiologists interpret a disproportionately larger share of weekend (versus weekday) LEVDU examinations and a considerably larger proportion in higher acuity settings. Additionally, the patients on whom they render services have more comorbidities. To optimize around-the-clock patient access to necessary imaging, emerging quality payment programs should consider the timing and sites of service, as well as patient complexity.

Accreditation Is Perceived to Improve Echocardiography Laboratory Quality: Results of an Intersocietal Accreditation Commission Survey

The Intersocietal Accreditation Commission (IAC) began accrediting echocardiography laboratories in 1996 to improve quality in diagnostic imaging facilities. With no existing data linking accreditation to improved outcomes, the aim of this study was to examine the perceived value of accreditation among individuals who have successfully achieved IAC echocardiography accreditation. An electronic survey was sent to accredited facilities soliciting demographic data along with questions regarding the perceived value of accreditation related to 15 quality indicators; 10.455 emails were sent with 999 responses (9.6%), and 63% of respondents reported improvement in results due to accreditation. Of the 15 quality indicators, the process was perceived as leading to improvement by a majority for 10 of the quality indicators. Nonphysicians tended to report more improvement compared with physicians (64% vs. 54%, P = .056). The perceptions from hospital-based respondents were more favorable than nonhospital-based respondents (67% vs. 59%, P < .001). More than 90% of respondents reported that maintaining accreditation was important for improved quality and better reimbursement. The study showed that IAC echocardiography facility accreditation is perceived by most facilities to improve operations for most quality indicators, particularly regarding study quality and reporting.