QUALITY ASSESSMENT AND IMPROVEMENT - WHAT RADIOLOGISTS DO AND THINK

OBJECTIVE. The main objectives of the study were as follows: first, to study the nature and extent of radiologists' involvement in and their attitudes toward quality assessment (QA) and continuous quality impro vement (CQI)/total quality management (TQM) in hospitals and in office s; and second, to ascertain whether differences in size, type, and loc ation among hospitals and nonhospital radiology offices affect the QA and CQI/TQM activities of radiologists. We analyzed data from a nation al survey conducted by the American College of Radiology (ACR) in 1993 . MATERIALS AND METHODS. Questionnaires about QA and CQI/TQM activitie s and attitudes were mailed to 216 hospital-affiliated diagnostic radi ology group practices using a sample selected from the ACR master list of radiology practices in the United States. The response rate was 90 %. A stratified random sample ensured representation of different geog raphic regions, various group sizes, and both academic and nonacademic groups. Responses were weighted so that our data show what answers ab out hospitals would have been if (i) the survey had been answered by a ll hospital radiology departments in the United States (except for tho se few staffed by solo practitioners or nonradiologists) and (ii) our questions about nonhospital offices had been answered by all radiology groups in the United States (except those few having no hospital acti vity). RESULTS. The majority (86%) of hospital radiology departments r eport having a program to monitor and evaluate physicians' performance s. Fifty-one percent collect incorrect diagnoses by specific radiologi st. Twenty-eight percent collect some of their QA data through compute rized information systems. We found some statistically significant dif ferences by hospital size and location, with larger hospitals and urba n hospitals being more likely to engage in some QA activities. Multiva riate analyses, once controlled for hospital size and location, found no significant differences in QA activity between university and commu nity hospitals or between hospitals with and without a residency progr am. QA and CQI programs were less common in offices than in hospitals. With the exception of mammographic interpretations, most practices di d not monitor and evaluate physicians' performances in the office sett ing. Respondents representing 58% of hospital radiology departments th ought that QA and CQI contributed to improvement in patient care. Only 19% of radiology practices answered that CQI has been of cost benefit to their organization. CONCLUSION. Most radiology practices engage in a variety of QA and CQI activities in hospitals. However, this is les s true in offices, in which radiologists have more discretion, and rad iologists remain skeptical about the usefulness of CQI.