Launched in 2008, the ACR® General Radiology Improvement Database (GRID) 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.
GRID comprises structure, process and outcome measures. Many of the approximately 20 process measures are related to TATs. 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.
There have been many changes in radiology since GRID was initiated, so the GRID Committee, chaired by Nadja Kadom, MD, is working to:
- Include more meaningful quality measures
- Collect more detailed exam- and patient-level data
- Make measures easier to report and be considered for CMS Quality Payment Programs (QPP)
New GRID Measures: Exam and Patient Level
GRID first began collecting exam- and patient-level data in 2014 and enabling report TAT measures to be included in CMS quality programs, such as the QPP. In July 2019, two new data elements were added to the report TAT by modality measures: “multiple readers” (i.e., attending and resident) and “place of service” (i.e., ambulatory, inpatient, emergency department or other). These new elements will allow greater specification and delineation of the TAT rates.
In the last quarter of 2019, GRID will have an additional seven exam-level measures developed by the ACR Quality Metrics Committee/Technical Expert Panel. Many of these focus on collecting data for recommended follow up of incidental findings and other detailed information in the radiology report.
Here are the new GRID exam-level measures:
- Interpretation of CT Pulmonary Angiography for Pulmonary Embolism
- Incidental Coronary Artery Calcification Reported on Chest CT
- Use of Structured Reporting in Prostate MRI
- Surveillance Imaging for Liver Nodules <10mm in Patients at Risk for Hepatocellular Carcinoma
- Use of Quantitative Criteria for Oncologic FDG PET Imaging
- Use of Low Dose Cranial CT or MRI Examinations for Patients with Ventricular Shunts
- Use of Low Dose CT Studies for Adults with Suspicion of Urolithiasis or Nephrolithiasis
In addition to the exam-level measures, here are some of the annual, process and outcome measures under consideration.
- Magnet Incidents
- Cases of NSF
- Non-NSF Gd Reactions
- Reactions for Patients with Implanted Devices
- Rate of Attended Falls
- Rate of Unattended Falls
- Rate of Deaths
- Rate of Code Blues
- Rate of Nosocomial Infections
- Rate of Wrong Exams
- Rate of Exams on Wrong Patient
- Rate of Exams on Wrong Site
- Patient Wait Time
- Time From Order to Exam
- Reacquisition Rate
- Report Turnaround Time
- Rate of Non-diagnostic Liver Biopsies
- Rate of Non-diagnostic Lung Biopsies
- Rate of Lung Biopsies Resulting in Pneumothorax Requiring Chest Tube
- Rate of CT HOCM Extravasation
- Rate of CT LOCM Extravasation
- Rate of Non-concordant Stereotactic Breast Biopsies
Finally, new measure concepts under consideration by the GRID committee include:
- Wait/Report TAT (indication specific)
- Processes (i.e., screening, protocoling, repeat imaging, critical results communication)
- Patient-centered (i.e., access to images, consultation services, measuring anxiety)
- Discrepancy (preliminary to final, trauma/stroke)
- Downstream imaging utilization
- Healthcare disparities
- Procedural complications
Across the board, the ACR is working continuously to ensure that radiologists have meaningful and achievable measures for ongoing quality improvement and to report to CMS under the QPP. Currently, CMS is evaluating approval of the new measures as QCDR measures for 2020.
To that end, the ACR is looking for volunteers to help evaluate the proposed GRID 2.0 quality measures. If your practice is interested in participating in the testing project, please complete an interest survey or contact Karen Orozco.
Under GRID 2.0, the committee is also considering how tools like ACR Assist® and structured reporting techniques can help radiologists provide more standardized characterizations of findings.
ACR Assist is a clinical decision support framework to automatically provide radiologists with structured clinical guidance, including classification and reporting taxonomies in the form of the ACR “RADS” such as BI-RADS®, LI-RADS® and PI-RADS® or based on the ACR incidental findings white papers. Using structured data and a reporting framework can significantly reduce the burden of reporting radiology measures.
Timeline for GRID 2.0
Testing of new measures will continue through the end of 2019, and ACR will begin implementing the new measures in GRID by early 2020. Coordination with software vendors to implement ACR Assist and structured reporting will also begin in 2020.
Watch this newsletter and the GRID web page for the announcement of new measures in GRID and for upcoming webinars to help you optimize your participation and quality reporting opportunities.