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Society-Based Practice Quality Improvement Projects for Maintenance of Certification

Michael Taylor, MS Northwest Permanente

Portland, OR 2009 AAPM Annual Meeting

Objectives

•  Understand PQI requirements

•  Individual vs. society based PQI projects

•  Review TG 127 PQI project

•  Project Development

M. Taylor 2009 AAPM Annual Meeting

AAPM ABR Diplomates

TG 127

ABR Trustees

M. Taylor 2009 AAPM Annual Meeting

ABR MOC version 1.0

M. Taylor 2009 AAPM Annual Meeting Slide adapted from P. Halverson 2006

ABR MOC version 2.0

M. Taylor 2009 AAPM Annual Meeting Slide adapted from P. Halverson 2006

ABR MOC version 3.x

M. Taylor 2009 AAPM Annual Meeting Slide adapted from P. Halverson 2006

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Definition of PQI? All Radiologic Physics diplomates must be trained in the process and procedures of quality improvement as they affect an individual's practice of Radiologic Physics.

http://theabr.org/moc/moc_rp/moc_rp_comp4.html

M. Taylor 2009 AAPM Annual Meeting

PQI Reading Resources

http://theabr.org/moc/moc_rp/moc_rp_pqiread.html http://www.amazon.com

M. Taylor 2009 AAPM Annual Meeting

PQI Summer Book Club Reading

http://www.amazon.com http://www.amazon.com

M. Taylor 2009 AAPM Annual Meeting

Definition of PQI? The key components of Part IV require a physicist-based response to demonstrate commitment to practice quality improvement (PQI) and progress in continuing individual competence in practice.

A central element of PQI projects (Part IV) is to provide evidence of critical evaluation of the individual’s performance in practice.

M. Taylor 2009 AAPM Annual Meeting

PQI Definition?

A metric based investigation that critically assesses, evaluates, and ‘improves’ a Diplomate’s performance in practice

M. Taylor 2009 AAPM Annual Meeting

Components of PQI

•  Relevance to patient care and/or individual practice

•  Identifiable metrics

•  Results

•  Assessment

•  Improvement Plan

•  Reassessment

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PQI timeline

1.  Collect baseline data.

2.  Review and analyze baseline data.

3.  Implement improvement plan.

4.  Collect data.

5.  Gauge ‘improvement’

6.  Report participation to the ABR.

M. Taylor 2009 AAPM Annual Meeting

Med. Phys. Volume 34, Issue 11, pp. 4158-4163 (November 2007)

MOC database

M. Taylor 2009 AAPM Annual Meeting

Type II project

•  Society or organization-based initiative

• Meets fundamental PQI elements

•  Aggregated data maintained, reported*, and benchmarked by organization

* Under development M. Taylor 2009 AAPM Annual Meeting

Type I vs. Type II

Type I Type II

Development Self Approval

Approval Self* ABR

Maintenance Self Organization

Reporting Self Self*

Benchmarking Possible Organization

M. Taylor 2009 AAPM Annual Meeting

http://theabr.org/moc/moc_rp/moc_rp_pqi_projects.html

TG127 PQI Template

M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi

TG127 PQI Template

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http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

AAPM PQI source

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

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http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

http://moc.aapm.org/pqi M. Taylor 2009 AAPM Annual Meeting

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Metrics?

M. Taylor 2009 AAPM Annual Meeting

PQI Possibilities

M. Taylor 2009 AAPM Annual Meeting

PQI Possibilities

M. Taylor 2009 AAPM Annual Meeting

Failure Mode and Effects Analysis

M. Taylor 2009 AAPM Annual Meeting

Process Tree Int. J. Radiation Oncology Biol. Phys., Vol. 71, No. 1, Supplement, pp. S170–S173, 2008

Risk Probability

M. Taylor 2009 AAPM Annual Meeting

Int. J. Radiation Oncology Biol. Phys., Vol. 74, No. 3, pp. 852–858, 2009

Severity Score Occurrence Detectability

1

2

3

4

5

6

7

8

9

10

No effect < every 5 years

Dose ∆ 5% Every 2-5 years Very easy to detect

Once per year

Minimal delay in care Several times a year Easy to detect

Once a month

Moderate delay in care

Several times a month Mildly difficult to

detect

Once a week

Dose ∆ 20%, reportable

Several times a week

Once a day

Patient dies several times a day Impossible to detect

Acknowledgements

•  Tammy Conquest (AAPM web development)

•  Tyler Lembcke (Extensive template input)

•  David Laszakovits (Division Chair, Maintenance of Certification, ABR)

•  Geoff Ibbot (Trustee, Therapeutic Radiologic Physics, ABR)

•  AAPM

•  Task Group 127

•  Matthew Meineke

M. Taylor 2009 AAPM Annual Meeting