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)