目的:我们部门的持续质量改进(QI)过程包括在膝关节X光片报告中插入Kellgren-Lawrence(KL)骨关节炎(OA)等级模板,以减少不必要的MR成像。然而,缺乏这种分级制度的统一采用。制定了全部门的财务激励措施,以提高对QI指标的遵守程度。这项研究的目的是评估财务激励对KL分级系统使用的影响,并比较肌肉骨骼(MSK)放射科医师与没有财务激励使用KL分级的普通放射科医师的依从率。
方法:在引入新的基于质量的经济激励措施之前和之后,通过查询我们的部门放射学数据库来确定包含KL分级和标准化随访建议的所有膝关节X线照片报告的百分比。将MSK和普通放射科医生的激励前依从率与采用期进行了比较,和两个独立的6个月后激励期。
结果:总计,回顾性分析了52,673例报告的KL分级使用情况(MSK放射科医师解释的41,670例报告和普通放射科医师解释的11,003例报告)。在激励采用期间,MSK放射科医师的报告中,依从性的增加最大(36.1%至53.2%)。这种改善在MSK放射科医师中持续存在,在最近研究的实施后期间平均为62.7%。在非激励的普通放射科医师报告中观察到依从性的改善程度较小(19.3%至27.5%);在实施后随访期间,他们的合规率降至26.5%。
结论:引入经济激励措施后,与未激励的普通放射科医师相比,激励的MSK放射科医师对QI实践的采用显着增加,并持续改善。
OBJECTIVE: Ongoing quality improvement (QI) processes in the authors\' department include the insertion of a Kellgren-Lawrence (KL) osteoarthritis grading template in knee radiography
reports to decrease unnecessary MRI. However, uniform adoption of this grading system is lacking. Department-wide financial incentives were instituted to improve compliance with QI metrics. The purpose of this study was to evaluate the effect of a financial incentive on KL grading system use and to compare compliance rates of musculoskeletal (MSK) radiologists with those of general radiologists who were not financially incentivized to use KL grading.
METHODS: Percentages of all knee radiography
reports containing KL grading with standardized follow-up recommendations were determined by querying the departmental radiology database before and after the introduction of the new quality-based financial incentive. Preincentive compliance rates for MSK and general radiologists were compared with an adoption period and two separate 6-month postincentive periods.
RESULTS: In total, 52,673
reports were retrospectively analyzed for KL grading use (41,670
reports interpreted by MSK radiologists and 11,003 interpreted by general radiologists). Increase in compliance was greatest among MSK radiologists\'
reports during the incentivized adoption period (from 36.1% to 53.2%). This improvement was sustained among MSK radiologists and averaged 62.7% during the most recently studied postimplementation period. A lesser degree of improvement in compliance was observed in nonincentivized general radiologists\' reports (from 19.3% to 27.5%); during the postimplementation follow-up period, their compliance decreased to 26.5%.
CONCLUSIONS: The introduction of a financial incentive resulted in significantly increased adoption of QI practices with sustained improvement among incentivized MSK radiologists compared with nonincentivized general radiologists.