In this Physician Spotlight, we talk with Nadja Kadom, MD, the new Chair of the General Radiology Improvement Database (GRID) Committee, about the role radiologists play in ensuring more patient-focused quality and safety and how participating in the GRID Registry can help.
Q. Tell us about your journey to become a quality and safety champion.
A. I became interested in quality and safety in 2013, when I first heard about quality improvement as a career for radiologists. A mentor at Boston Medical Center coached me through my first quality improvement project, and then I was hooked. My first project was trying to reduce errors in my own radiology reports. My next project was designing a quality improvement curriculum for radiology residents at Boston Medical Center. After I joined Emory Healthcare, we also implemented a fellowship quality improvement program in the neuroradiology section. In recent years, I have been focusing my quality improvement efforts on implementation science, by helping physicians adopt new evidence into practice. My goal is to answer two key questions: How do we shift behaviors in the healthcare community towards appropriate imaging utilization? What is appropriate imaging utilization? And how can we make sure that it results in improved patient care?
Q. How are you using implementation science in your organization?
A. As Director of Pediatric Neuroradiology, I initiated a project on pediatric headache imaging to educate physicians on when children with headaches should have imaging. First, we looked at the evidence, then we visualized the criteria for pediatric headache imaging into flow diagrams or algorithms, which we shared with pediatricians and pediatric specialists via a webinar. We now have a quality improvement project in our community where we're tracking whether this intervention (creating the algorithms and educating referring physicians on them) has any bearing on improving the appropriateness of imaging orders. Down the line, we have a few more ideas to improve physician behaviors, including the design and distribution of patient decision aids for various types of headaches. Access a PDF or a PowerPoint file with the algorithms (click to download directly to your computer).
Q. What other quality improvement programs have you initiated?
A. In 2018, I developed a project we call Info-RADS. The idea is to add to a highly technical radiology report language that patients can more easily understand. It's difficult to just translate the whole report into lay language, because it might not convey what we want or be as helpful as we think for patients. My hypothesis is that a better approach is to give patients a brief message to indicate whether their findings are normal (and no other steps need to be taken) or whether there was an incidental finding that requires follow up. Working with patient and family advocates at our institution, we developed two short messages to that effect that the radiologists can add into their imaging reports. We are continuing to refine the message about incidental findings to be more meaningful to patients and relieve anxiety, in response to patient feedback we had solicited.
Q. How are you bringing your commitment to patient-centered quality to your role as chair of the GRID Committee?
A. The GRID Registry helps facilities establish benchmarks for quality improvement by collecting general practice radiology measures and comparing them to similar facilities. There have been many changes in radiology since GRID was initiated, so the GRID Committee is working to include more meaningful quality measures, collect more detailed exam- and patient-level data and make measures easier to report and be considered for CMS quality programs. When I joined the GRID Committee, we began brainstorming about new patient-centered measures, including those related to diversity, biologic sex vs. gender, ethnic and cultural differences, interpretive services, multi-faith prayer rooms, time to patient portal, pain management during and after invasive procedures, and population health issues.
Q. Why is it important for the radiology community to focus on patient-centered measures in efforts to improve quality?
A. From a population health perspective, we have realized there is better follow through and adherence to treatment by patients when they are partners in care. Many patients want more information; and, in many cases, patients now get information on the internet first, and then go to the doctor — almost like for a second opinion. That sounds like a joke, but it's becoming real, so we have to be ready. Improving patient outcomes is one of the Quadruple Aims of healthcare, and I see GRID registries as a driver for meeting the needs of our patients in radiology.
Q. What steps should radiologists take to get more engaged quality and safety and patient-centered care?
A. All it takes is advocacy — if only one person in a practice becomes the champion or advocate for one issue that is near and dear to their heart, it can have great impact. I’ve seen that effective change has happened through people who really care about a single issue. Take, for example, Malala and what she has achieved for education for girls. People with passion can lead the whole team forward; that's what makes all the difference.