The NRDR quality databases have been in existence since 2008 and provide comparison benchmarks, comparing facilities and physicians to the database as a whole, and to other similar facilities. Some of the measures included on our submission list have been in use since early 2008 (e.g. CTC True Positive Rate, and CTC Clinically Significant Extracolonic Findings Rate). To date, CMS has approved 22 QCDR measures for use in ACR's QCDR.
All our registry reports contain comparisons to all facilities in the registry. Most reports also contain comparisons to similar facilities, such as facilities of the same type, in similar locations, and in the same geographic region.
Registry data in the Dose Index Registry have been used to develop size-specific benchmarks, by CT exam, for radiation exposure and are published and available for use by all physician practices. These benchmarks are also being used in the definition of new registry measures, such as percent of CT chest exams without contrast that perform at or better than benchmark on Dose Length Product.
Risk Adjustment of Quality Measures
Currently the NRDR does not report risk-adjusted measures. We plan to start developing risk-adjustment models in the next year. However, we use a number of other strategies to help maintain comparability:
We specify the standards fairly narrowly to maintain comparability to peers. For example, for dose index measures, we map all exam names to a standard lexicon so that exams are compared to similar protocols at peer facilities. All measurements are standardized to the same phantom. Radiation dose indices may be justifiably different for patients of different sizes. For body exams, we report size-specific dose estimates that estimate doses to patients after adjusting the scanner output for patient size. This provides reasonable comparisons across facilities.
A number of our measures are screening measures, and screen asymptomatic patients. To a large extent, this mitigates the need for risk adjustment because screening populations tend to be similar across patients. In addition, NRDR feedback reports provide information to help facilities meaningfully compare themselves to peers most similar to them.
We provide demographic distributions of patients for mammography measures. The measures are for a screening mammography population that tends to be large, and screening populations (women age 40 and older) tend to not differ too much in distribution across facilities. NRDR feedback reports provide demographic comparisons so that facilities can examine whether patient characteristics may explain the facility’s deviation from registry averages.
For all registries, we compare facilities to other facilities with similar characteristics, such as same type (e.g. academic/community), similar location (e.g. metropolitan/rural/suburban), and same geographic region. Patient populations in similar locations may be more similar than patient populations nationwide, and comparisons to narrower peer groups provide better comparisons.
Examples of Comparison Benchmarks in Use in NRDR
Sample reports illustrating peer comparisons are posted on the NRDR website.
National Mammography Database (NMD) measures:
Dose Index Registry (DIR) measures for CT exams: At the request of CMS, we are modifying the DIR measures for CMS reporting. We have published a paper in Radiology on size-specific diagnostic reference levels (benchmarks) for radiation doses from common imaging exams. The new DIR measures will assess the percent of exams that are at or better than benchmark. Reports will contain comparisons of each facility’s score relative to other peer facilities. CMS reporting will be based on performance of the physician group across all locations at which they practice, and will be benchmarked against other groups.
MIPS/QPP Measures: Physicians and physician groups can view their performance on an interactive portal as they submit data. Prior year benchmark values from CMS are provided in a pdf document on the same page as the performance measures.