Radiology Patient Outcome Measures: Impact of a Departmental Pay-for-Performance Initiative on Key Quality and Safety Measures.

OBJECTIVE: Assess impact of a multifaceted pay-for-performance (PFP) initiative on radiologists' behavior regarding key quality and safety measures. METHODS: This institutional review board-approved prospective study was performed at a large, 12-division urban academic radiology department. Radiology patient outcome measures were implemented October 1, 2017, measuring report signature timeliness, critical results communication, and generation of peer-learning communications between radiologists. Subspecialty division-wide and individual radiologist targets were specified, performance was transparently communicated on an intranet dashboard updated daily, and performance was financially incentivized (5% of salary) quarterly. We compared outcomes 12 months pre- versus 12 months post-PFP implementation. Primary outcome was monthly 90th percentile time from scan completion to final report signature (CtoF). Secondary outcomes were percentage timely closed-loop communication of critical results and number of division-wide peer-learning communications. Statistical process control analysis and parallel coordinates charts were used to assess for temporal trends. RESULTS: In all, 144 radiologists generated 1,255,771 reports (613,273 pre-PFP) during the study period. Monthly 90th percentile CtoF exhibited an absolute decrease of 4.4 hours (from 21.1 to 16.7 hours) and a 20.9% relative decrease post-PFP. Statistical process control analysis demonstrated significant decreases in 90th percentile CtoF post-PFP, sustained throughout the study period (P < .003). Between 95% (119 of 125, July 1, 2018, to September 30, 2018) and 98.4% (126 of 128, October 1, 2017, to December 31, 2017) of radiologists achieved >90% timely closure of critical alerts; all divisions exceeded the target of 90 peer-learning communications each quarter (range: 97-472) after January 1, 2018. DISCUSSION: Implementation of a multifaceted PFP initiative using well-defined radiology patient outcome measures correlated with measurable improvements in radiologist behavior regarding key quality and safety parameters.

Impact of IT-enabled intervention on MRI use for back pain.

BACKGROUND: The purpose of this study was to examine the impact of a multifaceted, clinical decision support (CDS)-enabled intervention on magnetic resonance imaging (MRI) use in adult primary care patients with low back pain. METHODS: After a baseline observation period, we implemented a CDS targeting lumbar-spine MRI use in primary care patients with low back pain through our computerized physician order entry, as well as 2 accountability tools: mandatory peer-to-peer consultation when test utility was uncertain and quarterly practice pattern variation reports to providers. Our primary outcome measure was rate of lumbar-spine MRI use. Secondary measures included utilization of MRI of any body part, comparing it with that of a concurrent national comparison, as well as proportion of lumbar-spine MRI performed in the study cohort that was adherent to evidence-based guideline. Chi-squared, t-tests, and logistic regression were used to assess pre- and postintervention differences. RESULTS: In the study cohort preintervention, 5.3% of low back pain-related primary care visits resulted in lumbar-spine MRI, compared with 3.7% of visits postintervention (P <.0001, adjusted odds ratio 0.68). There was a 30.8% relative decrease (6.5% vs 4.5%, P <.0001, adjusted odds ratio 0.67) in the use of MRI of any body part by the primary care providers in the study cohort. This difference was not detected in the control cohort (5.6% vs 5.3%, P = .712). In the study cohort, adherence to evidence-based guideline in the use of lumbar-spine MRI increased from 78% to 96% (P = .0002). CONCLUSIONS: CDS and associated accountability tools may reduce potentially inappropriate imaging in patients with low back pain.

High-throughput generation of P. falciparum functional molecules by recombinational cloning.

Large-scale functional genomics studies for malaria vaccine and drug development will depend on the generation of molecular tools to study protein expression. We examined the feasibility of a high-throughput cloning approach using the Gateway system to create a large set of expression clones encoding Plasmodium falciparum single-exon genes. Master clones and their ORFs were transferred en masse to multiple expression vectors. Target genes (n = 303) were selected using specific sets of criteria, including stage expression and secondary structure. Upon screening four colonies per capture reaction, we achieved 84% cloning efficiency. The genes were subcloned in parallel into three expression vectors: a DNA vaccine vector and two protein expression vectors. These transfers yielded a 100% success rate without any observed recombination based on single colony screening. The functional expression of 95 genes was evaluated in mice with DNA vaccine constructs to generate antibody against various stages of the parasite. From these, 19 induced antibody titers against the erythrocytic stages and three against sporozoite stages. We have overcome the potential limitation of producing large P. falciparum clone sets in multiple expression vectors. This approach represents a powerful technique for the production of molecular reagents for genome-wide functional analysis of the P. falciparum genome and will provide for a resource for the malaria resource community distributed through public repositories.

The Pseudomonas aeruginosa PA01 gene collection.

Pseudomonas aeruginosa, a common inhabitant of soil and water, is an opportunistic pathogen of growing clinical relevance. Its genome, one of the largest among bacteria [5570 open reading frames (ORFs)] approaches that of simple eukaryotes. We have constructed a comprehensive gene collection for this organism utilizing the annotated genome of P. aeruginosa PA01 and a highly automated and laboratory information management system (LIMS)-supported production line. All the individual ORFs have been successfully PCR-amplified and cloned into a recombination-based cloning system. We have isolated and archived four independent isolates of each individual ORF. Full sequence analysis of the first isolate for one-third of the ORFs in the collection has been completed. We used two sets of genes from this repository for high-throughput expression and purification of recombinant proteins in different systems. The purified proteins have been used to set up biochemical and immunological assays directed towards characterization of histidine kinases and identification of bacterial proteins involved in the immune response of cystic fibrosis patients. This gene repository provides a powerful tool for proteome- and genome-scale research of this organism, and the strategies adopted to generate this repository serve as a model for building clone sets for other bacteria.