The American Board of Radiology Perspective on Maintenance of Certification Part IV—Practice Quality Improvement in Diagnostic Radiology

The American public expects safe, predictable, high-quality care and assumes that physicians work to remain current and competent. The American Board of Radiology (ABR) encourages each board-certified diagnostic radiologist to understand his or her professional responsibilities and to participate in continuous quality improvement and lifelong learning.

In the United States health care system, quality of care, medical error reduction, and patient safety represent continuing themes that dominate public concern ( ). Maintenance of Certification (MOC), the overarching program of the American Board of Medical Specialties (ABMS) and its member boards, is the response of U.S. physicians to address these concerns ( ). Although advances in medical science, technology, and biomedical research continue to accelerate, other barriers prevent rapid dissemination and adoption of evidence-based recommended care ( ). A RAND Corporation study has estimated that only 50%–54% of the care Americans receive is care that has been recommended on the basis of evidence-based medical literature ( ). Much of what radiologists do is not evidence based ( ). Outcomes and costs to diagnose and treat specific diseases vary widely among physicians, hospitals, health care providers, and regions of the country ( ).

To address challenges in the medical system and the public’s concerns, the ABMS, composed of 24 member boards representing all medical specialties in the United States, mandated in March 2000 that each board initiate specialty-specific MOC programs ( ). Diplomates are no longer granted lifetime certification but rather must demonstrate evidence of professionalism, continuing medical education and knowledge, as well as a commitment to practice improvement. The MOC program, including “Part IV: Practice Quality Improvement,” for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated in 2007.

The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. There are four component parts to the MOC process; “Part I: Professional Standing,” “Part II: Life Long Learning and Periodic Self-assessment,” “Part III: Cognitive Expertise,” and “Part IV: Evaluation of Practice Performance” ( ). The ABR program for self-evaluation of practice performance is linked to a process of continuing quality improvement and is entitled “Practice Quality Improvement” (PQI).

PQI projects

The key characteristics of PQI require each physician to demonstrate commitment to practice quality improvement and competence in clinical practice. How do we measure competence when practices are diverse and roles are unique? How can we improve quality in the system in which we provide care? The ABR guidelines state that every diplomate must select a project or projects that potentially can improve the quality of the diplomate’s practice and enhance quality of care. Key requirements for the ABR’s PQI program are that each project (a) be relevant to the diplomate’s practice, (b) be achievable in a practice setting, (c) produce measurable results that are suitable for repeated measurement over the course of the 10-year MOC cycle, and (d) be able to effect quality improvement. We anticipate that most PQI projects will include the majority or all of the six general competencies of medicine defined for training and practice: medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

A central element of PQI is to provide evidence of critical evaluation of an individual’s performance in practice. Clearly, the ultimate goals of each individual diplomate, as well as all diplomates collectively, must be to achieve ongoing improvement of practice and to demonstrate competency as a physician ( ).

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Table 1

PQI Timeline and Milestone Tracking for Diagnostic Radiology Diplomates

Year of Cycle What I Must Do Each Year of the 10-Year MOC Cycle 1

2 Collect baseline data 3 Analyze the data Work on improvement plan 4 Collect data, compare to initial data, summarize results 5 Modify improvement plan 6

8 Continue collecting data 9

PQI: Practice Quality Improvement; MOC: maintenance of certification.

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Patient safety

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Accuracy of interpretation

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Report turnaround time

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Practice guidelines and technical standards

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Communication project

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Practice guideline and technical standards project

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Referring physician surveys

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The ABR and MOC

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Transformation of the ABR infrastructure

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The role of subspecialty societies

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Summary

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References

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The American Board of Radiology Perspective on Maintenance of Certification Part IV—Practice Quality Improvement in Diagnostic Radiology

PQI projects

Patient safety

Accuracy of interpretation

Report turnaround time

Practice guidelines and technical standards

Communication project

Practice guideline and technical standards project

Referring physician surveys

The ABR and MOC

Transformation of the ABR infrastructure

The role of subspecialty societies

Summary

References

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