Quality Evaluation in Non-Invasive Cardiovascular Imaging

Transcription

1 Quality Evaluation in Non-Invasive Cardiovascular Imaging

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3 Peter L. Tilkemeier Robert C. Hendel Gary V. Heller James A. Case Editors Quality Evaluation in Non- Invasive Cardiovascular Imaging

4 Editors Peter L. Tilkemeier Department of Medicine Greenville Health System Greenville South Carolina USA Robert C. Hendel Miller School of Medicine University of Miami Miami Florida USA Gary V. Heller Department of Cardiovascular Medicine Atlantic Healthcare System Morristown New Jersey USA James A. Case Cardiovascular Imaging Technologies Kansas City Missouri USA ISBN DOI / ISBN (ebook) Library of Congress Control Number: Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland

5 Foreword Quality: A Degree of Excellence Quality. What does that word even mean? The standard of something as measured against other things of a similar kind; the degree of excellence of something. Oxford Dictionaries. In diagnostic testing, we can define quality as high value that leads to better outcomes for the patient tested. But this does not happen by chance. We have all seen those images, and perhaps more frequently, those reports of images, which are of low quality. They do not accurately represent the true state of the cardiac anatomy or physiology of the patient and cannot trustworthily guide further testing or management. The experienced referring physician may become less trusting of results, and may learn to adapt by layering tests, changing test referral patterns, or perhaps moving to more invasive testing strategies which they believe to be more definitive. The latter may increase costs and risks but also removes the potential diagnostic and prognostic benefit of non-invasive imaging. In the USA, there is a move from volume-based to value-based purchasing of healthcare services. This transformation will dictate that 90 % of payments from Medicare will be related to quality measures within a few years of this printing. This includes mandatory laboratory accreditation for non-invasive imaging (as of 2012) and implementation of appropriate use criteria in decision support prior to ordering advanced cardiac imaging (as of 2017) in order to receive payments under the Medicare physician fee schedule. This book is dedicated to increasing the level of quality in imaging by equipping the adaptable reader with the specific tools needed to navigate this sea change. Each area of non-invasive imaging has its own deep dive into how to improve quality. Whether motivated by our Hippocratic duty, medical liability concerns, or garnering fair payment for imaging services rendered, we all must strive for the highest level v

6 vi Foreword of quality in imaging. We must set and maintain quality as that degree of excellence, communicating it and even perseverating on it until it is uniform, commonplace, and widespread. Chicago, IL, USA Kim Allan Williams, MD

7 Preface Quality management is a journey, not a destination. ~Thomas H. Berry, leader in quality management development A common theme among multiple international societies and organizations involved in cardiac imaging has become apparent in recent years: quality, due to its impact on all phases of cardiac imaging. Quality in imaging clearly has importance in clinical practice, is essential for accreditation, and signifies a laboratory that places patient care first. Quality in cardiac imaging impacts directly on patient care and may affect outcomes in a variety of ways. How quality initiatives are implemented in hospitals, clinics, and imaging centers is unclear and guidance is needed for laboratory s medical and technical directors and hospital administrators with regard to the development of quality improvement programs. This book is designed to serve as an important resource describing the importance of quality in cardiovascular imaging and how best to optimize an imaging laboratory. Quality Evaluation in Non-Invasive Cardiovascular Imaging is designed to help physicians, technologists/technicians, and administrators develop their own quality programs. Discussions of each of the major cardiac imaging modalities (including computed tomography, cardiac magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography, and echocardiography) are provided in a structured format. The first section addresses important global perspectives of the importance of quality, its relationship to value in the evolving role of non-invasive cardiac imaging, and the important role that accreditation plays in assuring quality. The final section presents tools for the reader to develop a meaningful quality improvement program, assists in preparing for accreditation, and suggests benchmarks for reporting quality. The overarching emphasis on quality in this book is of vital importance as part of the quest to advance the role of non- invasive cardiovascular imaging as gatekeeper to more expensive testing procedures and interventions. As editors, we felt it important to assemble a group of authors that shared our vision as well as clinical expertise in each of the imaging modalities. With the group of experts contributing to this handbook, we believe that this book will be a valuable vii

8 viii Preface resource for all individuals interested in establishing high quality cardiac imaging services. Each modality-specific section is constructed of chapters addressing clinical applications of the imaging modality, appropriate patient and protocol selection and important elements for meaningful quality control and improvement programs addressing the needs for physician and technologist certification as well as laboratory accreditation. We anticipate that this book will serve as an important resource for the quality improvement activities in cardiac imaging laboratories and provide a day-to-day reference addressing quality issues as they may arise. We invite you to begin on your quality improvement project for non-invasive cardiac imaging services and that Quality Imaging: A Handbook for Non-Invasive Cardiology will serve as a valuable resource in guiding you through that journey. Greenville, SC, USA Morristown, NJ, USA Miami, FL, USA Kansas City, MO, USA Peter L. Tilkemeier Gary V. Heller Robert C. Hendel James A. Case

9 Contents Part I Overview 1 The Importance of Quality Peter L. Tilkemeier 2 The Quality Cycle Peter L. Tilkemeier 3 The Quality/Cost/Value Relationship Peter L. Tilkemeier 4 The Complexity of the Non-invasive Cardiac Imaging Process Peter L. Tilkemeier 5 Accreditation and International Perspectives Peter L. Tilkemeier Part II CT 6 Clinical Applications of Cardiac CT Amgad N. Makaryus and Seth Uretsky 7 CT: Patient Selection Steve W. Leung and Marcus Y. Chen 8 Computed Tomography: Quality Control James A. Case 9 Reporting and Accreditation of Cardiac CT Amgad N. Makaryus and Seth Uretsky ix

10 x Contents Part III MRI 10 MRI: Clinical Applications Ibrahim M. Saeed and Ryan Longmore 11 MRI Patient Selection Ibrahim M. Saeed and Ryan Longmore 12 Cardiac MR Protocol Selection Joseph Soltys 13 Cardiac MR Quality Control Joseph Soltys 14 MRI Report Ibrahim M. Saeed 15 MRI: Laboratory Accreditation and Quality Improvement Program Ibrahim M. Saeed Part IV PET 16 Cardiac PET Imaging: Clinical Applications and Patient Selection Gary V. Heller, James A. Case, and Abhijit Ghatak 17 Cardiac PET Quality Control for Imaging, Patient Preparation and Reporting James A. Case and Gary V. Heller 18 Cardiac PET Quality Improvement James A. Case and Gary V. Heller Part V SPECT 19 SPECT: Clinical Applications Cesia Gallegos and Robert C. Hendel 20 SPECT: Patient Selection Robert C. Hendel and Cesia Gallegos 21 SPECT: Quality Control Patty Reames, Cesia Gallegos, and Robert C. Hendel 22 SPECT: Reporting Robert C. Hendel and Cesia Gallegos 23 SPECT: Quality Improvement Program Cesia Gallegos, Patty Reames, and Robert C. Hendel

11 Contents xi 24 SPECT: Accreditation and Certification Cesia Gallegos and Robert C. Hendel Part VI ECHO 25 Elements of the Echocardiographic Exam Linda D. Gillam and Sofia Shames 26 Patient Selection Linda D. Gillam and Sofia Shames 27 Quality Control: Personnel Linda D. Gillam and Sofia Shames 28 Quality Control: Equipment and Laboratory Structure; Image Acquisition, Review and Analysis; Study Reporting Linda D. Gillam and Sofia Shames 29 Quality Control: Laboratory Accreditation Linda D. Gillam and Sofia Shames 30 Exploring the Dimensions of Quality and Future Directions Linda D. Gillam and Sofia Shames Part VII Laboratory Perspectives 31 Developing a Quality Improvement Program Peter Tilkemeier 32 Preparation for Accreditation or Reaccreditation Peter Tilkemeier 33 Reporting Quality and Determining Benchmarks Peter Tilkemeier 34 Additional Quality Activities and the Future Peter Tilkemeier Index

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13 Contributors James A. Case, PhD Technical Director, Cardiovascular Imaging Technologies, Kansas City, MO, USA Marcus Y. Chen, MD Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA Cesia Gallegos, MD Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA Abhijit Ghatak, MD, MRCP Southwest Heart PC, Las Cruces, NM, USA Linda D. Gillam, MD, MPH Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, NJ, USA Gary V. Heller, MD, PhD Department of Cardiovascular Medicine, Morristown Medical Center, Atlantic Healthcare System, Gagnon Cardiovascular Institute, Morristown, NJ, USA Research Section, Intersocietal Accreditation Commission, Ellicott City, MD, USA Robert C. Hendel, MD, FACC, FAHA, FASNC Cardiovascular Division Chief (Interim), University of Miami Miller School of Medicine, Miami, FL, USA Steve W. Leung, MD Division of Cardiovascular Medicine, Departments of Medicine and Radiology, University of Kentucky, Lexington, KY, USA Ryan Longmore, DO Department of Cardiology, Saint Luke s Hospital, Kansas City, MO, USA Amgad N. Makaryus, MD, FACC, FACP, FASE, FSCCT Department of Cardiology, NuHealth, Nassau University Medical Center, East Meadow, NY, USA xiii

14 xiv Contributors Patty Reames, ARRT, CNMT, NCT, FASNC Practice Manager, Ohio State University Heart and Vascular Center, Bellefontaine, OH, USA Ibrahim M. Saeed, MD, FACC, FAAP Saint Luke s Mid America Heart Institute Cardiovascular, University of Missouri, Kansas City, MO, USA Sofi a Shames, MD Department of Cardiology, Columbia University Medical Center, New York, NY, USA Joseph Soltys, PhD MR Physics, Cardiovascular Imaging Technologies, LLC, Kansas City, MO, USA Peter L. Tilkemeier, MD, MMM. Department of Medicine, Greenville Health System, Greenville, SC, USA Seth Uretsky, MD, FACC Cardiovascular Fellowship Program, Atlantic Health System, Gagnon Cardiovascular Center, Morristown, NJ, USA