Assessing and Improving the Interpretation of Breast Images: Workshop Summary by Sharyl J. Nass

Author:Sharyl J. Nass
Language: eng
Format: epub
Publisher: The National Academies Press
Published: 2015-11-14T00:00:00+00:00

Implementing Performance Criteria

Once performance criteria are established, implementation should involve a clear plan of action for those radiologists identified as having inadequate performance metrics, several participants said. Such a pathway will make the criteria more acceptable to radiologists, especially those found to be in the low performance range, Smetherman noted. Carney suggested coaching or mentoring individuals who don’t meet performance criteria. Pisano responded that such coaching tends to occur in large academic practices. For example, at her own institution, a radiologist’s recommendation for a 6-month follow-up of diagnostic mammography has to be agreed upon by consultation with other radiologists in the practice. “We review every pathology report. Every biopsy you do, you review as a group and you learn from that. There are enough of us that we coach each other,” she said.

Wallis pointed out that in the United Kingdom, inadequate performance is remedied with mentoring, and there is a clear procedure and government funding for that mentoring, which is described more fully in the section “Mammography Regulation and Quality Assurance in Other Countries.” Nationally funded mentoring is also linked to audits in the Netherlands, said Mireille Broeders, assistant professor of clinical epidemiology at the Dutch Reference Center for Screening, and Ruud Pijnappel, radiologist at University Medical Center Utrecht. They said at least one radiologist from the team that is audited meets with a pair of expert radiologists as part of the audit session to discuss the audit results. At that session, 40 cases with interval cancers are reviewed and they discuss whether the cases should have been recalled. “It’s good to have this conversation with peers in order to see if you can improve and do better next time,” Pijnappel said. Other members of the radiology team also often attend these discussions because they appreciate the opportunity to learn more, Broeders added.

Buist reported that Group Health Cooperative in Washington state voluntarily used the criteria developed by Miglioretti and her colleagues, and they restructured their mammography program to improve performance “which speaks to its relevance,” she said, adding that implementing criteria might vary from organization to organization unless there is a regulatory requirement for it.

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