Peer Review in Radiology

Transcription

1 Department of Radiology Massachusetts General Hospital Harvard Medical School Peer Review in Radiology Hani Abujudeh MD, MBA Associate Professor of Radiology Harvard Medical School Massachusetts General Hospital

2 Disclosure None- no financial interest

3 Outline Why and why not -to do Peer review 3 ways to do Peer review Full review RADPEER Grapevine

4 Why not? To do peer review Cost- time value Risk of getting a bad evaluation Possible using the data in a legal court

5 Government pressure Why? Important Medicaid, Medicare, licensing of equipment Payer pressure Pay for performance Competition (defining who we are) pressure Showing self auditing Patient centered care: Self improvement

6 Things to consider Return on investment How much time do you spend, % of reviews (3 systems significant time investment variation between each of the systems) What value does it bring against competition Price on self improvement!

7 Deming Improvement Cycle

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9 Material and Methods: 90 abdominal/pelvic CT reported by 3 abdominal radiologists were randomly selected for the study Same radiologists were asked to blindly reinterpreted 60 exams (30 of their previous interpretations and 30 from others) 3 Investigators assessed all reports and gave impressions of discrepancy of the reports Inter-observer and intra-observer discrepancy rates were evaluated

10 Score Description Definition Examples 1 No disagreement No discrepancy found Absence vs. presence of incidental hepatic cyst, renal cyst, gallstone 2 Minor disagreement with no clinical significance 3 Major disagreement with clinical significance and potential change to patient treatment plan Material and Methods: Additional imaging recommended but with a different modality Potential vs. definitive malignancy No recommendation vs. recommendation for a test that would typically be required as a regular treatment plan Stable vs. more than minimal interval change of tumor Similar description of findings but one radiologist did not state potential metastasis but another did No recommendation vs. recommendation for potentially serious condition Typographical or dictation errors that would significantly change the meaning of the report Absence vs. presence of cirrhosis in a patient with known HCC Absence vs. presence of fatty liver Recommendation vs. no recommendation for incidental renal mass Normal liver vs. heteterogeneous liver with recommendation for MRI to evaluate for possible liver pathology Normal colon vs. abnormally thickened colon with a recommendation for further investigation of colitis

11 Results: Score Description Intra-observer Discrepancy (%) Inter-observer Discrepancy (%) 1 No disagreement Minor disagreement Major disagreement 32 26

12 Conclusions: There was a 26% to 32% rate of major discrepancy in the interpretation of abdominal and pelvic CT examination at our institution. The majority of major discrepancy were due to missed findings, different opinions regarding the interval change of substantial findings, and presence or absence of recommendations

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14 RADPEER RADPEER is a simple tool developed to allow physicians to do peer review during the course of a day s work. When a new study is interpreted with an prior study for comparison, a peer review of the accuracy of the interpretation of the previous examination occurs

15 RADPEER Piloted RADPEER in 2001 Offered to members in 2002 e RADPEER developed in 2005 Scoring changes implemented

16 Four point scoring system: 1. Concur with interpretation RADPEER 2. Discrepancy in Interpretation/not ordinarily expected to be made (understandable miss) a. unlikely to be clinically significant b. likely to be clinically significant 3. Discrepancy in Interpretation/ should be made most of the time a. unlikely to be clinically significant b. likely to be clinically significant 4. Discrepancy in Interpretation/ should be made almost every time - misinterpretation of finding a. unlikely to be clinically significant b. likely to be clinically significant 16

17 March 31, 2013 RADPEER Over 1,110 participating groups Over 16,400 physicians 17

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26 Conclusion: The why s and why not s Although lot of pressures Self improvement 3 Peer review processes Recreate a radiology report Individual comment on a prior report Group review

27 Thank you Massachusetts General Hospital Harvard Medical School