Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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.
J Am Coll Radiol. 2021 Jul;18(7):969-981. doi: 10.1016/j.jacr.2020.12.032. Epub 2021 Jan 28.
Assess impact of a multifaceted pay-for-performance (PFP) initiative on radiologists' behavior regarding key quality and safety measures.
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.
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.
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.
评估多方面绩效薪酬（PFP）计划对放射科医生在关键质量和安全措施方面行为的影响。
本研究经机构审查委员会批准，在一家大型的 12 个分部的城市学术放射科进行。2017 年 10 月 1 日实施放射科患者结果测量，测量报告签名的及时性、关键结果的沟通以及放射科医生之间的同行学习交流的生成。指定了专业分部范围和个人放射科医生的目标，每日在内部网仪表板上透明地传达绩效，每季度（占工资的 5%）进行财务激励。我们比较了实施 PFP 前后 12 个月的结果。主要结果是从扫描完成到最终报告签名的每月第 90 个百分位数时间（CtoF）。次要结果是及时完成关键结果的闭环沟通的百分比和全部分部范围同行学习交流的数量。使用统计过程控制分析和并行坐标图评估时间趋势。
在整个研究期间，共有 144 名放射科医生生成了 1255771 份报告（613273 份在 PFP 之前）。每月第 90 个百分位数 CtoF 绝对减少了 4.4 小时（从 21.1 小时到 16.7 小时），相对减少了 20.9%。PFP 后，统计过程控制分析显示 90 个百分位数 CtoF 显著减少，整个研究期间持续（P <.003）。在 PFP 之后，有 95%（2018 年 7 月 1 日至 9 月 30 日的 119 名）和 98.4%（2017 年 10 月 1 日至 12 月 31 日的 126 名）的放射科医生实现了>90%的关键警报及时关闭；自 2018 年 1 月 1 日以来，所有分部都超过了每季度（范围：97-472）90 次同行学习交流的目标。
使用明确的放射科患者结果测量实施多方面的 PFP 计划与放射科医生在关键质量和安全参数方面行为的可衡量改进相关。
