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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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Chung CY, Min TL, De Macedo Filho R, Weinberg BD, Mullins ME, Fioramonte AL. Establishing a Departmental Symposium for Resident Scholarly Activity: How We Did It. Acad Radiol 2023; 30:125-131. [PMID: 35644756 DOI: 10.1016/j.acra.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 11/26/2022]
Abstract
Many radiology departments have successfully increased trainee research involvement by providing protected academic time for research, offering travel funding for conferences, and developing research-focused curriculum via resident research tracks and other mechanisms. A departmental platform for trainees to share their scholarly projects can foster intradepartmental awareness and collaborations, supplement the existing resident research curriculum, encourage peer learning amongst trainees, and allow departmental celebration of their trainees' accomplishments. The authors describe the development of a departmental symposium for resident scholarly activity at their institution and detail a practical framework for implementation and lessons learned, which may serve as a guide for other radiology departments interested in establishing a similar event.
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Affiliation(s)
- Charlotte Y Chung
- Department of Radiology, New York University Langone Health, 660 First Ave 2nd floor, New York, NY 10016.
| | - Taejin L Min
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Robson De Macedo Filho
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Amy L Fioramonte
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Kvam KA, Bernier E, Gold CA. Quality Improvement Metrics and Methods for Neurohospitalists. Neurol Clin 2021; 40:211-230. [PMID: 34798971 DOI: 10.1016/j.ncl.2021.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Measurement of clinical performance is largely driven by the requirements of the Centers for Medicare and Medicaid Services and accrediting bodies like The Joint Commission. Performance measures include length of stay, readmission rate, mortality rate, hospital-acquired complications, and stroke core measures. Hospital rankings also depend heavily on quality and patient safety indicators. Becoming facile with these measures can aid neurohospitalists in understanding their value and garnering resources to support improvement projects. Neurohospitalists can apply a structured A3-based method to define a clinical problem, perform systematic analysis, then design and test solutions to drive improved outcomes for patients with neurologic disease.
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Affiliation(s)
- Kathryn A Kvam
- Neurohospitalist Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA 94305-5235, USA.
| | - Eric Bernier
- Stanford Health Care, 300 Pasteur Drive, MC 5255, Stanford, CA 94305, USA
| | - Carl A Gold
- Neurohospitalist Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, 453 Quarry Road, Stanford, CA 94305-5235, USA
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Sibley C, Ayers C, King B, Browning T, Kwon JK. Decreasing Patient Dwell Times for Outpatient Cardiac Nuclear Medicine Studies: The Benefits of SMART Goals, Scope Limitations, and Society Guidelines in Quality Improvement. Curr Probl Diagn Radiol 2020; 49:333-336. [PMID: 32321661 DOI: 10.1067/j.cpradiol.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND We describe a quality improvement project to improve patient dwell times for outpatient cardiac nuclear medicine exams. Preliminary data indicated that the mean patient dwell time was about 270 minutes. Our specific, measurable, achievable, relevant, and time-bound goal was to reduce patient dwell times for outpatient pharmacologically stressed cardiac nuclear medicine exams by 60 minutes over the course of 2 months. METHODS An interdisciplinary team was formed which used staff interviews and workflow observation to create a cause and effect diagram as well as a process map. Review of the national guidelines for cardiac nuclear medicine exams identified rest and stress intervals as intervention targets. A new protocol was designed and implemented. RESULTS The mean patient dwell time was improved from 270 to 184 minutes. CONCLUSIONS Overall, we found that a clear specific, measurable, achievable, relevant, and time-bound goal, limited scope, and national guideline review allowed for a successful quality improvement project.
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Affiliation(s)
- Carson Sibley
- UT Southwestern Department of Radiology, Dallas, TX; Parkland Health and Hospital System, Dallas, TX.
| | - Camara Ayers
- UT Southwestern Department of Radiology, Dallas, TX
| | - Brent King
- UT Southwestern Department of Radiology, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - Travis Browning
- UT Southwestern Department of Radiology, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
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Cheung YY, Riblet NBV, Osunkoya TO. Use of Iterative Cycles in Quality Improvement Projects in Imaging: A Systematic Review. J Am Coll Radiol 2018; 15:1587-1602. [PMID: 30181090 DOI: 10.1016/j.jacr.2018.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Studies suggest that quality improvement (QI) projects in health care lack scientific rigor, but the actual frequency of use of proven scientific QI methodology is unknown. The purposes of this study are to (1) conduct a systematic review of QI projects in radiology journals on the frequency of use of iterative cycles, a marker of proven QI methodology, and (2) assess association of the use of iterative cycles with characteristics of these projects. MATERIALS AND METHODS We searched English-language radiology journals on MEDLINE between 2008 and 2015 for published QI studies. Three reviewers appraised studies and extracted data. Use of iterative cycles was identified, and results were summarized qualitatively. χ2 Analysis evaluated associations of iterative cycles with other data elements. RESULTS Of 3,134 potentially eligible citations, 44 studies met inclusion criteria. Only 46% of these used iterative cycles to refine intervention. Use of iterative cycles were associated with projects designed to improve process, QI expert support, reporting of unintended effect of intervention, and explicitly stated use of iterative cycles. General lack of scientific rigor was represented by failure to report baseline data (9%), describe unintended effects (66%), and discuss limitations (36%). CONCLUSIONS Our systematic review found fewer than half of the QI projects in radiology journals used iterative cycles to refine intervention, a scientific strategy central to many proven improvement methodologies. Use of iterative approach was associated with projects designed to improve processes, QI expert support, report of unintended effect, and explicitly stated use of iterative cycles.
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Affiliation(s)
- Yvonne Y Cheung
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Natalie B V Riblet
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Tomiwa O Osunkoya
- Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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Golder WA. Interpretation and Diplomacy Aspects of Authority and Care in Imaging Reports. J Digit Imaging 2017; 31:5-8. [PMID: 28808802 DOI: 10.1007/s10278-017-0014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Whereas the creativity and intellectual power of the radiologist are measured against his/her written report, the value of the message will not only be judged by the precision of the medical statement. The same result can be attributed to different words. Numerous common and accidental factors exert influence on the decision on what is said and what is not said, how it is assessed and what is ignored. The less certain a diagnosis is and the less favourable its possible consequences are, the more subtleties and periphrases are to be expected within the report. The decision on the nature and the volume of the written report will not only be taken by the time of recording, but is likewise prepared by the knowledge of the patient's history and symptoms, the personal relationship to him/her as well as by a set of conditions throughout the inspection of the images. The intuition that accompanies the information transfer in imaging diagnostics does not only explain the differences in volume and depth of diagnosis and differential diagnosis, but also the range of diagnostic and therapeutic recommendations.
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Affiliation(s)
- Werner A Golder
- Association d'Imagerie Médicale, Avignon, 23, rue de l'Oriflamme, 84000, Avignon, France.
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Itri JN, Bakow E, Probyn L, Kadom N, Duong PAT, Gettle LM, Mendiratta-Lala M, Scali EP, Winokur RS, Zygmont ME, Kung JW, Rosenkrantz AB. The Science of Quality Improvement. Acad Radiol 2017; 24:253-262. [PMID: 28193375 DOI: 10.1016/j.acra.2016.05.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 02/04/2023]
Abstract
Scientific rigor should be consistently applied to quality improvement (QI) research to ensure that healthcare interventions improve quality and patient safety before widespread implementation. This article provides an overview of the various study designs that can be used for QI research depending on the stage of investigation, scope of the QI intervention, constraints on the researchers and intervention being studied, and evidence needed to support widespread implementation. The most commonly used designs in QI studies are quasi-experimental designs. Randomized controlled trials and cluster randomized trials are typically reserved for large-scale research projects evaluating the effectiveness of QI interventions that may be implemented broadly, have more than a minimal impact on patients, or are costly. Systematic reviews of QI studies will play an important role in providing overviews of evidence supporting particular QI interventions or methods of achieving change. We also review the general requirements for developing quality measures for reimbursement, public reporting, and pay-for-performance initiatives. A critical part of the testing process for quality measures includes assessment of feasibility, reliability, validity, and unintended consequences. Finally, publication and critical appraisal of QI work is discussed as an essential component to generating evidence supporting QI initiatives in radiology.
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Affiliation(s)
- Jason N Itri
- Department of Radiology, University of Virginia, 1215 Lee Street, Box 800170, Charlottesville, CA 22908.
| | - Eric Bakow
- UPMC Health Plan, Pittsburgh, Pennsylvania
| | - Linda Probyn
- Sunnybrook Health Sciences Centre, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | | | - Lori Mankowski Gettle
- Division of Abdominal Imaging and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mishal Mendiratta-Lala
- Abdominal and Cross-sectional Interventional Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Elena P Scali
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald S Winokur
- Department of Radiology, Division of Interventional Radiology, Weill Cornell Medicine/New York Presbyterian Hospital, New York, New York
| | - Matthew E Zygmont
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Justin W Kung
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Reducing Variability in Orthogonal Reformatted Image Quality Associated With Axial Long-z-Axis CT Angiography. AJR Am J Roentgenol 2016; 207:1360-1365. [PMID: 27610698 DOI: 10.2214/ajr.16.16233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of our study was to reduce variation in image quality of orthogonal reformatted images generated from long-z-axis CT angiography (CTA) studies of the upper and lower extremities. SUBJECTS AND METHODS Upper and lower extremity CTA studies were targeted at a single health care system. A correctly performed CTA examination was defined as one that met the following three criteria: Sagittal and coronal reformats were obtained, a high-resolution matrix greater than 512 × 512 was used, and reformatted images were available in a distance-measurable format. Baseline data were collected from February 1, 2014, through September 30, 2014. Corrective actions were implemented during three consecutive plan-do-check-act (PDCA) cycles from October 1, 2014, through July 31, 2015, that addressed human, technical, and systematic variations. A 3-month maintenance period followed in which no intervention was performed. Longitudinal data were analyzed monthly using a statistical process control chart (p-chart). RESULTS The total number of long-z-axis extremity CTA studies analyzed was as follows: 351 CTA studies were analyzed at baseline, 94 at the first PDCA cycle, 92 at the second PDCA cycle, 114 at the third PDCA cycle, and 138 during the maintenance period. The monthly rate of correctly performed studies ranged from 7% to 51% (mean, 38% ± 13% [SD]) during the baseline period, 32-59% (mean, 46% ± 14%) during the first PDCA cycle, 40-81% (mean, 61% ± 21%) during the second PDCA cycle, and 80-82% (mean, 81% ± 0.9%) during the third PDCA cycle. The monthly rate improved to 90-91% (mean, 91% ± 0.5%) during the maintenance period. The upper and lower control limits of the p-chart were upshifted after the second and third PDCA cycles. Correcting systematic and technical variations led to the greatest improvements in reformat accuracy. CONCLUSION Obtaining consistently and correctly reformatted images from long-z-axis CTA studies is achievable using iterative PDCA cycles.
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Decker SJ, Grajo JR, Hazelton TR, Hoang KN, McDonald JS, Otero HJ, Patel MJ, Prober AS, Retrouvey M, Rosenkrantz AB, Roth CG, Ward RJ. Research Challenges and Opportunities for Clinically Oriented Academic Radiology Departments. Acad Radiol 2016; 23:43-52. [PMID: 26598485 DOI: 10.1016/j.acra.2015.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 12/26/2022]
Abstract
Between 2004 and 2012, US funding for the biomedical sciences decreased to historic lows. Health-related research was crippled by receiving only 1/20th of overall federal scientific funding. Despite the current funding climate, there is increased pressure on academic radiology programs to establish productive research programs. Whereas larger programs have resources that can be utilized at their institutions, small to medium-sized programs often struggle with lack of infrastructure and support. To address these concerns, the Association of University Radiologists' Radiology Research Alliance developed a task force to explore any untapped research productivity potential in these smaller radiology departments. We conducted an online survey of faculty at smaller clinically funded programs and found that while they were interested in doing research and felt it was important to the success of the field, barriers such as lack of resources and time were proving difficult to overcome. One potential solution proposed by this task force is a collaborative structured research model in which multiple participants from multiple institutions come together in well-defined roles that allow for an equitable distribution of research tasks and pooling of resources and expertise. Under this model, smaller programs will have an opportunity to share their unique perspective on how to address research topics and make a measureable impact on the field of radiology as a whole. Through a health services focus, projects are more likely to succeed in the context of limited funding and infrastructure while simultaneously providing value to the field.
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ALARA: Impact of Practice Quality Improvement Initiative on Dose Reduction in Pediatric Voiding Cystourethrogram. AJR Am J Roentgenol 2015; 205:886-93. [DOI: 10.2214/ajr.14.13492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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