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1 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Collaboration is Strength
WHO / IRQN Referral Guidelines Pilot Exercise
Highlight of Preliminary Results
Michael Kawooya1, Lawrence Lau1, Miriam Mikhail2, María del Rosario Pérez2, Martin Reed1
1 International Radiology Quality Network (IRQN) and 2 World Health Organization (WHO)
2 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Members of Guidelines Development Group (GDG) & Special Interest Groups (SIGs)
Dr. Narayan Pendse (Radiology Consultant, Technical Editor)
Participants in WHO Consultancy on Referral Guidelines for Appropriate Use of Radiation
Imaging
Project participants: individual experts, collaborating & observer organizations
Pilot participants: sites, facilities, imaging & other practitioners
Acknowledgement
3 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Collaborators: International Paediatric Association
African Society of Radiology International Radiology Quality Network
American College of Radiology International Society of Radiology
Asian Oceanian Society of Radiology International Society of Radiographers and Radiological Technologists
Argentine Society of Radiology Israeli Centre for Technology Assessment in Health Care, Ministry of Health
Autorité de Sûreté Nucléaire Médecins Sans Frontières
Canadian Association of Radiologists Pan Arab Association of Radiological Societies
Centre National de Radioprotection, Tunisia National Centre for Child Health and Development, Japan
Chinese Society of Radiology National Centre of Radiobiology and Radiation Protection, Bulgaria
European Commission Pan American Health Organization
Federal Office for Radiation Protection, Germany Radiological Society of North America
Hong Kong College of Radiologists Royal and Australian New Zealand College of Radiologists
Inter-American College of Radiology World Federation of Nuclear Medicine and Biology
Image Gently Campaign World Federation of Ultrasound in Medicine and Biology
Institute of Tropical Medicine, Nagasaki University World Health Organization
International Atomic Energy Agency World Organization of National Colleges, Academies and Academic
Associations of General Practitioners and Family Physicians International Commission on Radiological Protection
Observers: French Society of Radiology
European Society of Radiology Royal College of Radiologists
Project Participants
4 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Section I: basic principles including radiation protection
Section II: 44 guidelines – based on consensus between ACR,
DIP & RCR guidelines
Participation from & collaboration with: RP agencies, health
authorities, professional organizations, healthcare organizations,
hospitals, general practitioners etc., including:
All 6 WHO regions (AFRO, AMRO / PAHO, EMRO, EURO, SEARO, WPRO)
16 countries
40 facilities, differing settings
Methodology
155 practitioners: 80 imaging practitioners (IP); 75 other practitioners (OP)
5 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Feedback by questionnaires
Identify RG availability, awareness & use
Review internet access
Identify preferred presentation: tabulated or algorithms;
preferred media & implementation strategy: print, CD,
mobile devices, CPOE, web-based etc.
Receive comments on 1) draft guidelines for Sections I & II
& 2) content appropriateness & usefulness
Identify gaps & future topics
Identify performance indicators to measure outcome
Scope
t
6 Pilot Site Location (N = 16)
Chile
Argentina
Venezuela
Uganda Nigeria
Netherlands
Italy Bulgaria
Malaysia
Philippines
China
India
Japan Israel
UAE South Korea
7 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Pilot Site Health Expenditure (N = 16)
REGION COUNTRY GNI 1 Health Ex2 Health Ex / GNI3
AFR Uganda 1,220 42 3.44%
AFR Nigeria 2,290 80 3.49%
AMR Argentina 17,250 892 5.17%
AMR Chile 19,820 1,075 5.42%
AMR Venezuela 12,250 555 4.53%
EMR United Arab Emirates 41,550 1,640 3.95%
EUR Bulgaria 14,790 522 3.53%
EUR Israel 28,070 2,426 8.64%
EUR Italy 32,490 3,436 10.58%
EUR Netherlands 42,710 5,995 14.04%
SEAR India 3,640 59 1.62%
WPR China 8,240 278 3.37%
WPR Japan 34,890 3,958 11.34%
WPR South Korea 29,860 1,616 5.41%
WPR Malaysia 15,610 346 2.22%
WPR Philippines 4,070 97 2.38%
1Gross National Income Per Capita (USD); 2Health Expenditure (USD) (World Bank 2011 data); 3Health Expenditure / GNI derived (%)
8 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Guideline Availability
Country-specific question: participation from 16 countries, all 16 responded (N = 16)
Are RG available in your country? “Yes” 8 out of 16 Easy to obtain updates? “Yes” 4 out of 8
8 8
Yes No
4 4
Yes No
9 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Awareness of Availability
Radiologists Referrers
Hospital managers Patients
8
13
7
3
0 5 10 15
No
Few
Many
Most
14
12
3
2
0 5 10 15
No
Few
Many
Most
13
13
4
1
0 5 10 15
No
Few
Many
Most
26
2
3
0
0 10 20 30
No
Few
Many
Most
Facility-specific question: 40 facilities participated, 31 responded to this question (N = 31)
10 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
By radiologists By referrers
Is based on For
Use of Guidelines
12
14
3
2
0 5 10 15
No
Few
Many
Most
15
12
2
2
0 5 10 15 20
No
Few
Many
Most
22
2
1
6
0 5 10 15 20 25
Not mandated
Radiologist policy
Facility policy
Hospital policy
13
5
6
6
1
0 5 10 15
None
Rare cond
Difficult cond
Most cond
All cond
Facility-specific question: 40 facilities participated, 31 responded to this question (N = 31)
11 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Fast Internet Access
12
11
10
3
3
1
25
26
29
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Referrer
Facility
General
Mixed No Yes
Facility-specific question: 40 facilities participated, all 40 responded to this question (N = 40)
12 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Preferred Format
Individual-specific question: 155 practitioners participated, all 155 responded: IP = 80; OP = 75
Responded by either “Yes” or “No” to: ACR = 118/155; DIP = 93/155; RCR / CAR = 100/155
Each practitioner can select one or more preferred format
41%
29%
50%
-10%
-25%
-6%
27%
31%
29%
-22%
-15%
-15%
-30% -20% -10% 0% 10% 20% 30% 40% 50% 60%
RC
R, C
AR
DIP
AC
R
OP No
OPYesIP No
IP Yes
ACR
DIP
RCR / CAR
13 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Preferred Media
1
62
26
51
29
60
49
21
37
10
34
0 20 40 60 80 100 120
Others
Web-based
CPOE
Mobile devices
CD-ROM
Hard copy
IP
OP
Individual-specific question: 155 practitioners participated, all 155 responded to this question
(N = 155: IP = 80; OP = 75)
Each practitioner can select one or more preferred media
14 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Section I: basic principles including radiation protection
Section II: 44 clinical imaging guidelines
Content appropriateness & usefulness
Gaps & future topics
Performance indicators
Following collation & comprehensive analysis, data will be presented in a future forum
Specific Comments
15 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Synergy
RG projects support implementation of BSS & Bonn call-for-
action priorities
WHO – IRQN RG Project adds value to other RP & RG actions
End-users’ feedback to the pilot exercise informs future actions &
supports adoption / adaptation of RG
Need to share methodology for, evidence & experience in RG
development, update & use
16 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Quality improvement is a continuum, i.e. persisting & on-going efforts are needed
Need to strengthen communication, share experience & improve collaboration via a common platform
to minimize duplication, maximize value & facilitate improvement
WHO – IRQN RG project team is ready to join others in related projects by sharing pilot data &
collaborating in RG / justification actions to improve the availability & use of RG worldwide
Conclusion
An inclusive global platform will facilitate stakeholder engagement, regional & local adoption /
adaptation & implementation of RG, i.e. value of a “globally-supported & locally-championed”
implementation framework
Such actions support “Do the RIGHT procedure & do the procedure RIGHT” approach for RP, enhance
patient care & improve system sustainability
17 IAEA Technical Meeting on Justification of Medical Exposure | Vienna | 11-13 March 2014 WHO – IRQN RG Pilot Highlight of Preliminary Results
Collaboration is Strength
Thank you very much for your kind attention!
Michael Kawooya1, Lawrence Lau1, Miriam Mikhail2, María del Rosario Pérez2, Martin Reed1
1 International Radiology Quality Network (IRQN) and 2 World Health Organization (WHO)
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