PPA Info

OCC – Diagnostic Radiology Practice Performance & Assessment (PPA)

Each AOBR certified physician is required to successfully complete a qualified OCC practice performance assessment every three year CME cycle or a total of three projects per 10-year OCC cycle. There are several different options for completing this requirement.

Complete an Attestation Form:

The simplest way to fulfill this requirement for most of our AOBR certified physicians is to attest to participating in a quality improvement activity.  Physicians can visit https://physicianportal.osteopathic.org/PPA to attest.  Please, note you will be required to sign into the site using your osteopathic.org login information. The AOBR will audit a percentage of attestation forms to ensure participation in the project.

Or Complete a Practice Performance Assessment (PPA):

To avoid the potential of an audit, AOBR certified physicians can also submit a full practice performance assessment (PPA) project using the physician’s own patient data. Physicians will be required to demonstrate that they can assess the quality of radiological care they provide compared to peers and national benchmarks and then apply the best evidence or consensus recommendations to improve that radiological care using follow-up assessments.

Detailed information and helpful links pertaining to each of the categories are listed below in order to assist diplomates in choosing what project type best suits their practice.

A diplomate must select a project from one of the following categories:

Patient Safety
In order to ensure high standards for patient care, physicians will participate in a project that will measure potential gaps within their practice and give the physician a chance to reflect upon why those gaps are occurring. Improvement plans will, in turn, be implemented into their daily practice in order to raise the standards for patient care.

A wide range of projects could be completed under the patient safety category. Projects would review areas such as:

    • Critical results reporting time frame
    • Correctly identifying patients
    • Staff communication improvement
    • “Safe practices” in imaging children

Accuracy of Interpretation
Accuracy of Interpretation is key to the field of radiology. In order to help maintain high standards, physicians may participate in a project that will measure potential gaps within their reading procedures, provide additional physician input, resulting in the reduction in the amount of physician errors.

Examples of projects could include, but are not limited to:

    • Double reading
    • Radiology pathology correlation or correlation with surgical findings
    • Participation in the ACR program RADPEERTM

Practice Guidelines & Technical Standards
Each diplomate or group planning the project is required to use the Communications Guidelines and select one other elective guideline relevant to their practice. The most important aspect of the Communications Guidelines is the communication of urgent, critical, or unexpected findings. The points to be evaluated by answering yes or no to each are:

    1. Is there a list of the findings that the group agrees are urgent to communicate with the referring physician?
    2. Is such a list communicated to the members of the group?
    3. Is there a process to determine documentation of communication of urgent, critical findings?

For each answer of “no” to the above, a solution(s) should be incorporated into the written improvement plan.

For the second, elective guideline, the diplomate or group must select at least one aspect of that guideline (e.g., technique for performing examination) and audit one percent of annual cases. The benchmark for acceptable performance is (1) the guideline is being followed, or (2) valid documentation of reason for variance, in 100 percent of cases. 

Referring Physician Surveys
Timely insight from referring physicians becomes increasingly more critical. While patient satisfaction is extremely important, referring physicians are the principal customers of a radiologist’s practice. Radiologists need to know how referring physicians feel about their systems, services and performance. The benefits of diagnostic imaging are not realized until the referring physician acts upon the results of the study in most cases. Radiologists must be active in taking an introspective look at various feedback, assess its strengths and weaknesses and help define areas of opportunity along with measurable and attainable goals.

The survey must be administered at least two times. A minimum of 20 responses at each administration is recommended to detect improvement. After tabulating the results, an improvement action plan must be developed and implemented. The second survey should be administered after the action plan has been in place for at least 6 months. All survey results and improvement plans are to be kept by the participant(s). The survey materials, either paper or electronic, must be retained by the participants throughout the 10-year OCC cycle. 

Report Timeliness
Projects in this area are expected to impact patient safety and improve outcomes; to reduce errors, morbidity, and complications; to improve patient satisfaction; to increase compliance with standards; and to improve practice efficiency and communication.

Objectives in a Report Timeliness Process include:

    • Measure and document the timely communication of results of imaging examination
    • Measure and document direct communication of critical values

Report timeliness generally requires data collection at a practice or department level but is also permissible at the individual level. There should be an existing departmental or individual process for measuring and reporting time from examination completion to approval of final report, or a plan for implementing such a process.

The minimum data to be collected for a report timeliness project include:

    • Measure of time from examination completion to posting of results in the medical record
    • Number of cases in the audit
    • Mean and/or median time from exam completion to availability of report to actionable person

The project should include the following comparison to benchmarks for report timeliness:

    • Departmental mean
    • Individual performance/prior audits

The minimum data to be collected for a critical value reporting project include:

    • Measure of time from identification of critical or unexpected finding to notification of actionable person
    • Number of cases in the audit
    • Mean and/or median time from exam completion to availability of report to actionable person
    • Compliance with departmental/institutional policy regarding notification of critical values

The project should include the following comparison to benchmarks for critical value reporting:

    • Requirements of departmental critical value reporting policy

Choose a project that presents a challenge or perceived gap in your practice. Projects may be selected from a variety of existing projects sponsored by national organizations and societies or self-directed by the diplomate. Lists of projects are available on the websites of many organizations including RSNA, ACR, Image Gently Campaign and other national subspecialty societies.

Sponsored projects, including registries, are preferred for use in OCC by either individuals or groups. They have standardized formats for use by the diplomate and offer project specific templates to be followed throughout their completion.

The AOBR will randomly audit OCC participants. It is incumbent upon the physician to retain the source data of each of his/her projects in the event of an audit.

Please keep in mind that examples given are not required projects by the AOBR, each is merely a resource to assist diplomates in researching the types of projects they may or may not like to participate.