Are outcomes too often left out of radiology quality metrics?

The healthcare industry is increasing its focus on outcome-based quality metrics, but radiology continues to rely on structural metrics, according to a recent study published in the Journal of the American College of Radiology.

Anand Narayan, MD, of Johns Hopkins Hospital in Baltimore, and colleagues performed an inventory of quality metrics currently being used in radiology by performing a systematic review of literature from the last 15 years and surveying current radiology benefit managers (RBMs).

Narayan et al. used the Donabedian framework to break the metrics into three categories: structural metrics (which examine fixed practice characteristics, such as equipment or accreditation), process metrics (which examine if provided services were appropriate), and outcome metrics (including patient and case outcomes).

The authors found that in radiology, 46 percent of quality metrics are structural, 27 percent are process-based and another 27 percent are outcome-based.

These results supported the authors’ hypothesis that “only a minority” of the metrics would be related to patient outcomes.

According to the authors, this shows that radiology may be out of touch when it comes to judging a physician or practice’s overall performance, and it’s necessary to adapt and rely more on outcome-based metrics.

“Relying solely on structure and process metrics is out of step with national trends and also represents a missed opportunity to draw attention to the significant impact high-quality imaging can have on patient populations,” the authors wrote. “By choosing from the robust assortment of outcome metrics reported and referenced here, radiologists can work to effectively decommoditize their own work by directly relating diagnostic performance to patient outcomes.”

A few specific details stood out from the authors’ statistics:

• At 37.1 percent, accreditation was the most commonly cited structural metric, followed by board certification (28.6 percent) and a quality dashboard (22.9 percent).
• At 85 percent, use of appropriateness criteria was the most commonly cited process-based metric, followed by report finalization time (60 percent) and patient wait time (50 percent).
• Peer review was by far the most commonly cited outcome-based metric (95 percent).
• Structural metrics made up a majority (77 percent) of all metrics currently used by RBMs. Process- and outcome-based metrics both came in at 11 percent.
• The American College of Radiology (ACR) proved to be popular among today’s radiologists. ACR accreditation, ACR Appropriateness Criteria, and the ACR’s RADPEER technology were the most commonly cited accreditation, appropriateness criteria and form of peer review, respectively.