Radiology Partners is making measured progress addressing asymptomatic abdominal aortic aneurysms through standardized reporting and other changes, leaders detailed Monday in the Journal of the American College of Radiology.
Such an enlargement of the body’s main blood vessel requires careful surveillance, with rupture mortality rates clocking as high as 90%. But sometimes communication can break down between referrer and radiologist, derailing follow-up imaging and increasing the chances rates of rupture or death.
To address this concern, Rad Partners launched a performance improvement initiative, increasing the use of best practices in reporting. Prior to implementation, only about 2% of rad reports for dangerous aneurysms included recommendations for follow-up, but that number leapt to 58% with the changes.
“After the implementation of the [quality improvement] initiative and a training period, compliance tracking and monthly actionable scorecard reporting are powerful drivers for performance improvement,” corresponding author Upma Rawal, MD, with the Rad Partners Research Institute, and co-authors from Johns Hopkins explained May 10 in JACR. “As with any successful change management program, constant and consistent feedback is vital to maintain performance.”
Rawal and colleagues developed their best practice recommendations through an “extensive” literature review in collaboration with vascular imaging experts across the organization. Asymptomatic aneurysms with a maximum diameter greater than 5.5 centimeters or rapid expansion are one indication signaling the need for intervention, reducing mortality by upward of tenfold compared to emergency repair after a rupture, the authors noted.
With best practices in hand, Rad Partners integrated a structured reporting template into its dictation software. Following a training period, scientists monitored across 345 facilities in the practice and used monthly scorecards to track progress.
Prior to the initiative, out of more than 64,000 consecutive reports reviewed during a six-month period, 855 included incidental abdominal aortic aneurysms (1.3%). Of those, 783 measured between 2.6 to 5.4 centimeters, requiring imaging surveillance, yet only 2.1% of rad reports included follow-up recommendations. After the changes, 2,641 studies showed AAAs meeting the measurement threshold, but the follow-up number leapt to 58%. And roughly 97% of those cases adhered to Rad Partners’ best-practice recommendations.
“Factors that differentiated between high- and low-performing practices and radiologists included commitment of the local radiology leadership to adhere to the [quality improvement] initiative, discussion of performance and strategies to improve adherence at department meetings and with individual radiologists, and incorporation of the provided macro in radiology reports,” Rawal and colleagues advised. “Investment in tools and strategies to support these QI initiatives are crucial for change management and successful implementation,” they added later.
You can read much more about the effort in JACR here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.