September 06, 2018

Q&A With Jason N. Itri, MD, PhD

In this Spotlight, we talk with Jason N. Itri, MD, PhD, Vice Chair of Quality and Patient Safety and Associate Professor, Wake Forest Baptist Health, about how the General Radiology Improvement Database (GRID) Committee is working to make quality measures more meaningful for radiologists.

What is the GRID Registry and how does it help improve quality and safety?
The General Radiology Improvement Database collects information about imaging facilities to establish benchmarks for performance and quality improvement. It allows facilities and physicians to compare turnaround times (TATs), patient wait times, incident rates and many other types of measures with other facilities and practices of similar size and type.

The GRID was formed in 2008 as the brain-child of the late Harvey L. Neiman, MD, FACR, who had considerable foresight about the importance of performance and quality measurement within the specialty. Currently, GRID comprises structure, process and outcome measures. Many of the approximately 20 process measures are related to turnaround time (TAT). The GRID outcome measures span several topics that cover a broad array of measures for quality and performance in the practice of radiology. GRID allows participants to benchmark themselves relative to other similarly sized practices and identify opportunities for improvement.

What is changing in GRID?
A lot has changed in radiology over the last 10 years since GRID was initiated. The GRID Committee is taking another look at the quality measures collected in the registry, especially as they relate to MACRA and the increasing impact of quality and safety on reimbursement. At the same time, GRID participation has increased dramatically over the last 10 years. The majority of the 150 participating practices are submitting process measures to the registry, primarily because TATs are reported to CMS as part of the Quality Payment Program. Fewer practices currently participate in the outcome measures, because it can be a burden to report those measures and they aren't always tied to reimbursement.

On the GRID Committee, we are working to include more meaningful quality measures, especially related to diagnostic accuracy. Another area we're interested in is access and capturing the intervals between the initial reporting of symptoms or screening results to diagnostic exam, and from diagnostic exam to image-guided biopsy. There is data that shows if you're waiting more than a few months with some types of cancers, the prognoses are worse. Equally important is the anxiety patients experience when they are waiting weeks or months to get a diagnosis and begin treatment.

We're also focusing on identifying and including measures related to patient-centered care (for example, radiology consultation clinics where you can measure patient satisfaction). In short, we’re working to make the GRID measures more contemporary and meaningful to radiologists and other stakeholders today. And if we can do that in a way that doesn't create too much of a burden to report, then we believe can get more practices to participate.

What steps are you taking to make GRID outcomes measures easier to report?
We’re looking at how tools like ACR Assist™ and structured reporting techniques can help. ACR Assist is a clinical decision support framework for radiologists to automatically provide structured clinical guidance, including classification and reporting taxonomies in the form of the ACR “RADS” such as BI-RADS®, LI-RADS® and PI-RADS®. Creating a structured reporting framework can significantly reduce the burden of reporting radiology measures.

Why should radiology practices participate in GRID?
Quality is often hard to measure, so practices end up competing on measures like turnaround time and cost. And that is a commodity-based practice. Unfortunately, it is difficult for stakeholders — payers, patients and government agencies — to separate radiology practices in terms of quality. So far, radiology practices are frequently differentiated in terms of turnaround time and cost of services. Unless we find better ways to measure our quality, we will be commoditized.

Participation in GRID will help us shift the focus to quality and value. And it will ultimately lead to quality improvement and better patient care. That’s the main goal: being able to compare yourself to other similar practices, to see how you're performing and to identify areas for improvement.

What is on the horizon for GRID?
We're going to look at the current measures to see where we can breathe new life into GRID and make it more relevant and more robust than it is today. Right now, there are 11 quality measures that have been proposed by the ACR Quality Metrics Technical Expert Panel that are going through feasibility testing. We hope GRID can serve as a proof of concept for those new measures to see how they're received and what kind of data we can get. We are also evaluating other measures in areas like diagnostic accuracy, access, patient-centered care and appropriateness. If your practice is interested in participating in our upcoming testing project, please fill out an interest survey or contact Karen Orozco at korozco@acr.org.

What are three actions you would recommend for fellow radiologists related to GRID and quality improvement?
One, for every radiologist, it’s important to understand where we're going with quality in the field. I'm not saying everyone needs to be a quality expert; but take some time to understand quality measurement and its importance to our specialty, so that we're not just judged solely on cost and turnaround times.

Two, if you have an interest in quality, there's no shortage of need for quality champions in radiology practices across the U.S. There are tons of resources available, people to talk to, workshops and opportunities to learn more about quality. So, if you have an interest, please get involved. Reach out to someone at the ACR, volunteer for a committee or apply for an Amis Fellowship, which is how I first got involved.

Three, be a willing participant in the quality measurement process. I can’t overstate how happy it would make me if people just randomly emailed me and said, "Hey, I have this idea for a quality measure." Or "What do you think about this?" Let’s harness everyone's interests and experiences. There are tens of thousands of radiologists out there, so if you have an idea about a quality measure, make your voice heard.

Meet the Physician

Jason N. Itri, MD, PhD 

Jason N. Itri, MD, PhD, recently joined the abdominal imaging section at Wake Forest Baptist Medical Center in Winston-Salem, NC, and serves as the vice chair of quality and patient safety. He previously served as the director of peer review and physician performance at the University of Virginia Department of Radiology, vice chair of operations at the University of Cincinnati Medical Center, and director of quality and safety at the University of Pittsburgh Medical Center.

His roles with the ACR include chair of the General Radiology Improvement Database and vice chair of the ACR Quality Metrics Technical Expert Panel. He is a passionate advocate for improving quality and safety in health care with academic interests including diagnostic error, quality measure development, comparative effectiveness research, patient-centered radiology and leadership development.

He previously received the Teacher of the Year award at UVA in radiology and has served on several Accreditation Council for Graduate Medical Education (ACGME) committees including Residency Review, Milestones and Clinical Learning Environmental Review.