Enamandram SS, Burk KS, Dang PA, Mar WW, Centerbar C, Boland GW, Khorasani R. Radiology Patient Outcome Measures: Impact of a Departmental Pay-for-Performance Initiative on Key Quality and Safety Measures.
J Am Coll Radiol 2021;
18:969-981. [PMID:
33516768 DOI:
10.1016/j.jacr.2020.12.032]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE
Assess impact of a multifaceted pay-for-performance (PFP) initiative on radiologists' behavior regarding key quality and safety measures.
METHODS
This institutional review board-approved prospective study was performed at a large, 12-division urban academic radiology department. Radiology patient outcome measures were implemented October 1, 2017, measuring report signature timeliness, critical results communication, and generation of peer-learning communications between radiologists. Subspecialty division-wide and individual radiologist targets were specified, performance was transparently communicated on an intranet dashboard updated daily, and performance was financially incentivized (5% of salary) quarterly. We compared outcomes 12 months pre- versus 12 months post-PFP implementation. Primary outcome was monthly 90th percentile time from scan completion to final report signature (CtoF). Secondary outcomes were percentage timely closed-loop communication of critical results and number of division-wide peer-learning communications. Statistical process control analysis and parallel coordinates charts were used to assess for temporal trends.
RESULTS
In all, 144 radiologists generated 1,255,771 reports (613,273 pre-PFP) during the study period. Monthly 90th percentile CtoF exhibited an absolute decrease of 4.4 hours (from 21.1 to 16.7 hours) and a 20.9% relative decrease post-PFP. Statistical process control analysis demonstrated significant decreases in 90th percentile CtoF post-PFP, sustained throughout the study period (P < .003). Between 95% (119 of 125, July 1, 2018, to September 30, 2018) and 98.4% (126 of 128, October 1, 2017, to December 31, 2017) of radiologists achieved >90% timely closure of critical alerts; all divisions exceeded the target of 90 peer-learning communications each quarter (range: 97-472) after January 1, 2018.
DISCUSSION
Implementation of a multifaceted PFP initiative using well-defined radiology patient outcome measures correlated with measurable improvements in radiologist behavior regarding key quality and safety parameters.
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