Developing Process-based Quality Indicators for Interventional Radiology: A Feasible Standardized Evidence-based Approach to Assessing the Quality of Care of Patients Undergoing Interventional Radiology Procedures

Tuesday, April 1, 2025

3:00 PM – 3:09 PM CT

Location: Music City Center, 205 A

Presenting Author(s)

VL

Victor Lee (he/him/his)

Medical Student
University of British Columbia, Canada

Author/Co-author(s)

HB

Helena Bentley, MD

Radiology Resident
University of British Columbia, Canada
JB

Jaspreet Bajwa, MD

Clinical Associate Professor
University of British Columbia, Canada
VC

Véronique Caty, MD

Professeure adjointe de clinique
Université de Montréal, Canada
SD

Surinder Dhaliwal, MD

Assistant professor
University of Manitoba, Canada
AH

Anastasia Hadjivassiliou, MBBS, FRCR, FRCPC

Interventional Radiologist
UBC Hospital, Canada
AM

Anirudh Mirakhur, MD

Clinical Associate Professor
University of Calgary, Canada
Nicolette Sinclair, MD (she/her/hers)

Interventional Radiologist
St. Paul's Hospital, Saskatoon, Saskatchewan, Canada, Canada
Alanna Joyce Supersad, MD (she/her/hers)

Interventional Radiology Fellow
University of Toronto - University Health Network (UHN), Canada
Jason Wong, MD, FSIR (he/him/his)

Interventional Radiologist
University of Calgary, Foothills Medical Centre, Canada
ED

Erin Davidson, RN

Head of Nursing, Interventional Radiology
Vancouver Coastal Health, Canada
TB

Tamara Bollinger, None

Clinical Services Manager, Interventional Radiology
Vancouver Coastal Health, Canada
Nd

Nevin de Korompay, MD

Clinical Instructor
University of British Columbia, Canada
GL

Gerald Legiehn, MD

Clinical Associate Professor
University of British Columbia, Canada

Purpose: As modern healthcare systems become increasingly reliant on interventional radiology (IR) procedures ensuring appropriate quality of care is of utmost importance. There remains no feasible standardized evidence-based approach to assessing the quality of care of patients undergoing IR procedures. We sought to develop process-based quality indicators (QIs) for patients undergoing IR procedures.

Materials and Methods: Process-based QIs were developed using a modified Delphi technique based on RAND-UCLA Appropriateness Methodology. A structured review of published literature, including clinical guidelines, and semi-structured interviews with nationally recognized leaders in IR was performed to identify candidate process-based QIs and to determine the level of evidence supporting the validity of their use. A national expert panel comprising 12 members, including interventional radiologists and multi-disciplinary members of the healthcare team, was then convened, which rated candidate process-based QIs on their validity and feasibility during two rounds of independent ratings. After the initial round of independent ratings, a synchronous meeting of the expert panel was held, during which collated ratings were discussed with particular emphasis on candidate process-based QIs that were found to yield notable disagreement, as measured through a disagreement index. Process-based QIs shall be selected by the median ratings of validity and feasibility and the level of agreement among the expert panel during the final round of independent ratings.

Results: Fifty candidate process-based QIs were identified, encompassing 4 domains: departmental processes, pre-procedural, peri-procedural, and post-procedural patient care. In the initial round of independent ratings, the expert panel determined 36 of the 50 candidate process-based QIs to be both valid and feasible, with only 3 candidate process-based QIs reaching the threshold for disagreement. Some candidate process-based QIs were determined by the expert panel to be invalid, infeasible, or both. In the synchronous meeting, the expert panel discussed each of the candidate process-based QIs and informed several modifications to improve their comprehensibility and generalizability. The final round of independent ratings is ongoing.

Conclusion: This ongoing landmark study employs a validated methodology to identify a comprehensive set of process-based QIs for patients undergoing IR procedures. Process-based measures of quality of care identify a priori steps for subsequent quality improvement initiatives.