Intersocietal Accreditation Commission (IAC) QI Self-Assessment Tool Utilization and Improved Accreditation Outcome

Introduction: Accreditation is often viewed as a benchmark of quality. The Intersocietal Accreditation Commission (IAC) has been evaluating and accrediting nuclear medicine and PET labs since 1997. As part of the accreditation process, the quality of staff credentials, equipment, protocols, study appropriateness, imaging, interpretation, reporting, and the quality improvement (QI) program are evaluated. Historically, deficiencies have been identified for approximately 70% of labs applying for IAC nuclear/PET accreditation. In 2016, to assist labs in self-evaluating and improving the quality of their diagnostic imaging studies, the IAC created a QI Self-Assessment Tool. The QI Self-Assessment Tool concentrates on four quality areas: test appropriateness, image quality/safety, interpretive quality, and report timeliness/completeness. The results of the self-assessment can be used to fulfill the annual QI accreditation requirements. The ability of IAC QI Tool to improve diagnostic imaging study quality is known. Using the IAC accreditation decision with its inherent identification of quality issues as an outcome variable, the aim of this study is to evaluate the effect of IAC QI Self-Assessment Tool utilization on subsequent accreditation decision by labs applying for IAC nuclear/PET accreditation.

Methods: All facilities applying for IAC nuclear/PET accreditation from October 2016 through November 2017 were evaluated. Variables measured included: application date, accreditation area (myocardial perfusion imaging (MPI), equilibrium radionuclide angiography (ERNA), general nuclear medicine (GNM), and PET), accreditation decision (delay = issues identified, grant = no significant issues identified), date of first QI self-assessment, self-assessment completed before submission of application (yes/no), number of assessments per lab, cases per assessment, and reviewers per assessment. The number and percentage was reported for categorical variables, and the median and interquartile range was reported for continuous variables. Comparisons were made using Chi-square tests (X²) and logistic regression analysis with a p-value of <.05 significant.

Results: Between October 2016 and November 2017, 784 labs applied for IAC nuclear/PET accreditation. Of those labs, 161 (20.5%) completed a QI self-assessment and 55 (7.0%) completed a self-assessment prior to submitting an accreditation application. The median number of assessments per lab was 2 (Q1=1, Q3=4). The median cases per assessment was 6.7 (Q1=2.6, Q3=13.1), and the median reviewers per assessment was 1.0 (Q1=1, Q3=2). Overall, quality issues (delayed accreditation), that must be corrected before accreditation is granted, were identified at 559 (71.3%) applicant labs. A smaller number of labs that utilized the QI Self-Assessment Tool had quality issues identified at the time of accreditation than those that did not use the tool (49.1% vs. 73.0, p<.0001). Controlling for the number of assessments, average cases per assessment, average reviewers per assessment, volume of studies, and type of lab, nuclear/PET labs that utilize the IAC QI Self-Assessment Tool are 3.46 times more likely to be granted accreditation.

Conclusions: The IAC QI Self-Assessment Tool demonstrates a positive effect in identifying and correcting quality issues leading to positive accreditation outcomes.

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