Radiology Patient Outcome Measures: Impact of a Departmental Pay-for-Performance Initiative on Key Quality and Safety Measures

Sheila S Enamandram; Kristine S Burk; Pragya A Dang; Wenhong W Mar; Cynthia Centerbar; Giles W Boland; Ramin Khorasani

doi:10.1016/j.jacr.2020.12.032

Radiology Patient Outcome Measures: Impact of a Departmental Pay-for-Performance Initiative on Key Quality and Safety Measures

J Am Coll Radiol. 2021 Jul;18(7):969-981. doi: 10.1016/j.jacr.2020.12.032. Epub 2021 Jan 28.

Authors

Sheila S Enamandram¹, Kristine S Burk², Pragya A Dang³, Wenhong W Mar¹, Cynthia Centerbar¹, Giles W Boland⁴, Ramin Khorasani⁵

Affiliations

¹ Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
² Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Radiology Department Quality and Safety Officer; Director of Quality and Safety for the Abdominal Imaging and Intervention Division, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
³ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁴ Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Chair of the Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
⁵ Director of the Center for Evidence Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts; Vice Chair of Quality and Safety, Department of Radiology Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

PMID: 33516768
DOI: 10.1016/j.jacr.2020.12.032

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.

Keywords: Pay-for-performance; peer learning; process improvement; quality; timeliness.

MeSH terms

Humans
Prospective Studies
Radiography
Radiologists
Radiology*
Reimbursement, Incentive*