The Quality Improvement Summit is focused on improving patient safety, ensuring appropriate use of advanced imaging, and reducing associated costs. The day included didactic presentations, panel discussions, and question and answer sessions.
Saturday, October 21, 2017
1000 Corporate Blvd
Linthicum, MD 21090
Phone: (410) 689 – 3700
The 2017 AUA Quality Improvement Summit is presented in conjunction with the American College of Radiology (ACR) and the American College of Emergency Physicians (ACEP).
Call 410-689-3925 or e-mail Quality@AUAnet.org.
The 2017 Quality Improvement Summit focused on improving patient safety, ensuring appropriate use of advanced imaging, and reducing associated costs. The agenda included didactic presentations, panel discussions, and question and answer sessions.
The Summit welcomed urologists, radiologists, and emergency department physicians, in addition to researchers, policy makers and others. Their discussions throughout the day focused on four primary goals:
7:30 - 8 a.m.
Registration and Breakfast
8 - 8:10 a.m.
8:10 - 8:30 a.m.
Need for Physician-Led Stewardship of Imaging in Urology
8:30 - 9:00 a.m.
Urologist-Led Success Stories in Stewardship of Imaging for Prostate Cancer
9:00- 9:45 a.m.
Keynote: Imaging Wisely: Improving the Value of Medical Imaging
9:45 - 10 a.m.
10:00 - 10:30 a.m.
National Quality Initiatives in Renal Colic Imaging from the American College of Emergency Physicians (ACEP)
10:30 - 11 a.m.
The DOSE Initiative: Supporting Dissemination of Reduced-dose Renal Colic CT
11 - 11:30 a.m.
Multispecialty Collaboration on Best Imaging Practices in Renal Colic: ACEP/ACR/AUA E-QUAL Workgroup
11:30 a.m. - 12 p.m.
Practical Issues in CT Dose Optimization: Panel Discussion
12 - 12:15 p.m.
12:15 - 1:15 p.m.
Panel Discussion of Toolkit from AUA Imaging Stewardship Workgroup
1:15 - 1:50 p.m.
1:50 - 2:20 p.m.
Optimizing Implementation of Prostate MRI
2:20 - 2:50 p.m.
Cross-Cutting Measures: A Novel Vision for Quality Measurement
2:50 - 3:20 p.m.
Reflections from QI Summit Trainee Scholars and Attendees
3:20 - 3:30 p.m.
Opening Remarks - J. Stuart Wolf, Jr., MD, FACS (00:00)
Need for Physician-Led Stewardship of Imaging in Urology (02:36) - Matthew Nielsen, MD MS FACS
Urologist-Led Success Stories in Stewardship of Imaging for Prostate Cancer (19:39) - James Montie, MD
Keynote: Imaging Wisely: Improving the Value of Medical Imaging (00:00) - Rebecca Smith-Bindman, MD MPH
National Quality Initiatives in Renal Colic Imaging from the American College of Emergency Physicians (ACEP) (00:00) - Arjun Venkatesh, MD MBA MHS
The DOSE Initiative: Supporting Dissemination of Reduced-dose Renal Colic CT (34:39) - Christopher Moore, MD
Multispecialty Collaboration on Best Imaging Practices in Renal Colic: ACEP/ACR/AUA E-QUAL Workgroup
Practical Issues in CT Dose Optimization: Panel Discussion
Panel Discussion of Toolkit from AUA Imaging Stewardship Workgroup (00:00)
Resources from the American College of Radiology to Support Stewardship of Imaging
Optimizing Implementation of Prostate MRI (37:11)
Cross-Cutting Measures: A Novel Vision for Quality Measurement (00:00)
Reflections from QI Summit Trainee Scholars and Attendees (44:15)
Closing Remarks (56:15)
Dose Optimization for Stone Evaluation (DOSE)
The DOSE initiative is funded by the Agency for Healthcare Research and Quality to disseminate understanding and implementation of institutional practices that adhere to the “as low as reasonably achievable” (ALARA) principle when performing a CT for possible or known kidney stone. This initiative’s overall aim is to reduce radiation dose and dose variability for kidney stone CT and thereby improve quality and patient safety.
Kidney stones affect 10% of the US population over their lifetime leading to one million emergency department visits annually for stone evaluation. Nearly 80% of patients receive a CT scan when presenting to the ED with symptoms. Current recommendations of the American College of Radiology Appropriateness Criteria for Acute Onset Flank Pain states that “reduced-dose techniques are preferred” for kidney stone CT. Despite this, Weisenthal et al showed less than 8% of 2015-2016 kidney stone CT exams nationwide met the reduced dose criteria of DLP<200mGy*cm.
DOSE’s intervention allows institutions to create and implement reduced-dose CT for kidney stone. Joining is free and will provide you:
The AUA has been at the vanguard of efforts supporting stewardship of imaging, with the organization’s first Choosing Wisely recommendation stating that “A routine bone scan is unnecessary in men with low risk prostate cancer.”
Dr. Jim Montie presented the Michigan Urologic Surgery Improvement Collaborative (MUSIC) experience with reducing potentially avoidable staging imaging in prostate cancer to the QI Summit. The MUSIC Appropriateness Criteria are available as a downloadable PDF, and more information, including video links is available online.
The American College of Radiology’s Radiology Support, Communication and Alignment Network (R-SCAN) is a collaborative action plan that brings radiologists and referring clinicians together to improve imaging appropriateness based on a growing list of imaging Choosing Wisely topics. R-SCAN delivers immediate access to web-based tools and clinical decision support (CDS) technology that can help you optimize imaging care, reduce unnecessary imaging exams and lower the cost of care. There is no cost to participate, and R-SCAN participants may earn up to seven Improvement Activity credits under the CMS Quality Payment Program. R-SCAN is an easy (and free) way to try out CDS, which current legislation (the Protecting Access to Medicare Act of 2014) will require for most advanced imaging orders for Medicare patients. More information is available on the R-SCAN website or by emailing Nancy Fredericks at firstname.lastname@example.org.
Magnetic Resonance Imaging (MRI) is assuming an increasingly important role in prostate cancer care. The American College of Radiology (ACR) has taken an active role in the development of standards and educational resources to support the implementation of quality imaging programs. A foundation of these efforts is the Prostate Imaging and Reporting and Data System (PI-RADS), currently in version 2.0. In addition, the ACR offers educational courses to support the implementation of these standards.
In addition to the R-SCAN and PIRADS programs, the ACR provides a number of additional practical resources to support the stewardship of advanced imaging services. The ACR Appropriateness Criteria are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. The ACR has also published frequently asked questions related to the NEMA XR-29 (MITA Smart Dose) Standard to assist providers and facilities with compliance with requirements for CT dose optimization and management under the Protecting Access to Medicare Act.
Ultrasound Accreditation Program for Urology Practices
The AUA and the American Institute of Ultrasound in Medicine (AIUM) have collaborated to develop ultrasound accreditation program for urology practices
Urology practices now have a pathway for accreditation for the performance of ultrasound in the practice of urology. The accreditation program was developed by a joint task force consisting of members from the AUA and the AIUM. The accreditation program is offered by the AIUM. This is a voluntary program developed so that urology practices can demonstrate through an objective third party (AIUM) that high quality imaging is being performed in a safe environment by trained providers.
The AUA/AIUM Joint Ultrasound Task Force have created:
These documents provide the framework for the AIUM accreditation program for the performance of ultrasound in the practice of urology.
The AUA/AIUM Practice Guideline on the use of ultrasound in the practice of urology for accreditation purposes is separate and distinct from, and should not be confused with AUA's Clinical Practice Guidelines that involve a process of systematic review and analysis, ranking of evidence, development of guideline statements linked to strength of evidence, and thorough peer review.
In addition to the above-outlined resources, the Imaging Stewardship Workgroup of the AUA Quality Improvement and Patient Safety Committee has assembled a number of resources available for practices and urology residency programs to utilize as supporting material for local quality improvement activities.
Timothy D. Averch, MD FACS
Dr. Timothy Averch graduated from the University of Pittsburgh School of Medicine and went on to complete his Urology training at New York Medical College. Following his residency, he completed a fellowship in Endourology at Johns Hopkins Hospitals. Dr. Averch is currently Vice Chair for Quality and Professor of Urology at the University of Pittsburgh Medical Center and is the Director of Endourology. He is currently Chair for the AUA Quality Improvement and Patient Safety committee.
Thomas Chi, MD
Dr. Thomas Chi graduated as a President's Scholar from Stanford University with a Bachelor of Arts in Human Biology as well as Masters degrees in both Sociology and Music. He went on to earn his medical degree from the University of California, San Francisco School of Medicine. After graduating, he completed two years of general surgery residency training and then a urology residency at UCSF. After completing his Chief Resident year in the Department of Urology, he continued on to finish a fellowship in Endourology and Laparoscopy under the mentorship of Dr. Marshall L. Stoller. During his fellowship, Dr. Chi was awarded grant funding from the National Institutes of Health and the American Urological Association Urology Care Foundation to research the fundamental mechanisms underlying the formation of urinary stones. During that time he developed a novel model for the study of kidney stones utilizing the common fruit fly, Drosophila melanogaster. He joined the UCSF faculty of the Department of Urology in 2013. In addition to his clinical interests, his research focuses on understanding the genetic and microbial environment of the kidney related to how kidney stones form and developing new medical preventative interventions.
Nancy Fredericks, MBA
Nancy Fredericks has been on staff at the American College of Radiology for 15 years where she supported the ACR's medical imaging clinical trials research program for over ten years. She transferred to the College's Quality and Safety division to work with a team on the development and deployment of the Radiology Support, Communications and Alignment Network, or R-SCAN, where she is the program director. R-SCAN is supported by a grant under the CMS Innovation Center's Transforming Clinical Practice Initiative.
George Shiu-Kai Fung, PhD
Dr. George Fung is a Staff Scientist and CT Collaboration Manager at Siemens Healthineers. His main role is to facilitate academic-industrial partnership in CT research topics for various clinical applications. He is responsible for managing CT collaboration projects with the radiologists, physicians and scientists at Johns Hopkins University, Hospital of University of Pennsylvania, Emory University, and University of Utah. He is also an Adjunct Assistant Professor of Radiology at Johns Hopkins University. Before joining Siemens Healthineers, Dr. Fung has been affiliated with Johns Hopkins University for 10 years and worked on many NIH and industrial research projects.
David Kurth, MPH MA
David Kurth is the Director of Guidelines and Appropriateness Criteria at the American College of Radiology where he oversees the ACR's guidance development and revision processes in the Quality & Safety department as well as improving the Appropriateness Criteria methodology. Previously, David worked at RAND Corporation and Westat on research studies. He has worked at the corporate level in managed care, directing quality improvement projects and measures. He has also worked on health and education projects in the Gambia, Indonesia, Nepal, India, Malaysia and Qatar.
Christopher L. Moore, MD
Dr. Chris Moore is an Associate Professor in the Department of Emergency Medicine at Yale University School of Medicine where he has worked for the last 15 years. Dr. Moore is fellowship trained in point-of-care ultrasound, and is Chief of the Section of Emergency Ultrasound, and has a research interest in appropriate imaging. He derived and validated the STONE and STONE PLUS scores which are clinical prediction rules for patients presenting with suspected acute renal colic that can be used to determine likelihood of disease and need for imaging. He is currently funded by the AHRQ under an R18 mechanism entitled "Minimizing Unnecessary Irradiation from Renal Colic CT Scans in the United States", which has led to the Dose Optimization in Stone Evaluation (DOSE) initiative. He is currently leading a multi-specialty initiative involving the AUA, ACEP, and ACR in developing a "best practice guideline" that will produce an expert consensus and systematic review of the literature under the CMS funded eQual initiative to "reduce avoidable imaging."
James Montie, MD
James Montie is Professor Emeritus in the Department of Urology at the University of Michigan and was Chairman of the Department from 1997-2007. His urology residency was at the Cleveland Clinic and oncology fellowship at Memorial Sloan-Kettering Cancer Center. He has been on the faculty at the Cleveland Clinic and Wayne State University prior to joining the University of Michigan in 1995. Dr. Montie is a founding Co-Director of the Michigan Urological Surgery Improvement Collaborative (MUSIC), a quality improvement collaborative that now includes 90 percent of the urologists in the state of Michigan.
Matthew Nielsen, MD MS FACS
Dr. Matthew Nielsen, the 2017 Quality Improvement Summit Chair, is a urologic oncologist at the Lineberger Comprehensive Cancer Center at UNC Chapel Hill, where he is Director of Urologic Oncology, Associate Professor of Urology and Adjunct Assistant Professor of Epidemiology and Health Policy and Management. His research interests in clinical epidemiology, cancer care quality, and medical decision-making have been supported by strong interdisciplinary collaborations and continuous extramural funding from the National Institutes of Health, the Agency for Healthcare Research and Quality, the American Cancer Society and the Patient-Centered Outcomes Research Institute. Alongside his clinical and research activities, Dr. Nielsen is involved in quality improvement and patient safety activities as a member of the Quality Improvement and Patient Safety Committee of the AUA, the Physician Consortium for Performance Improvement, and as a consultant for the American College of Physicians' High Value Care Task Force. Dr. Nielsen earned his medical degree at Johns Hopkins, where he remained for residency training at the Brady Urological Institute prior to joining the faculty at UNC.
Andrei Purysko, MD
Dr. Andrei Purysko is an Associate Staff of the section of Abdominal Imaging and Nuclear Radiology Department at Cleveland Clinic, and a Clinical Assistant Professor of Radiology at Case Western Reserve University School of Medicine. Dr. Purysko graduated from the Faculdade de Medicina de Petrópolis in Rio de Janeiro and completed residency training in Internal Medicine and Radiology at the Hospital Beneficência Portuguesa in São Paulo, Brazil. He then joined Cleveland Clinic in 2009, where he completed fellowship training in Abdominal and Thoracic Imaging, and Nuclear Radiology. Dr. Purysko has led the prostate MRI program at Cleveland Clinic since 2014. He assisted in developing the MRI/US fusion guided biopsy service line at Cleveland Clinic's main campus and in several other facilities in northeast Ohio, Florida and Nevada. Dr. Purysko serves as a member of several working groups of the American College of Radiology, including the technical subcommittee of the Prostate Imaging Reporting and Data System committee, the prostate MRI accreditation working group, and the Appropriateness Criteria expert panel in Uroradiology.
Erick M Remer, MD
Dr. Erick M. Remer is Professor of Radiology in the Section of Abdominal Imaging in the Imaging Institute at the Cleveland Clinic. He completed his undergraduate and medical degrees at the University of Michigan, a transitional internship at Henry Ford Hospital, residency and was Chief Resident at Northwestern University, before returning to Ann Arbor for a fellowship in cross sectional imaging. Dr. Remer is actively involved in many of Radiological organizations and recently finished his term as Specialty Chair of the ACR Appropriateness Criteria expert panel on Urological Imaging. Dr. Remer is Director of Abdominal Imaging Research at the Cleveland Clinic and his interests lie predominantly in the area of Genitourinary Imaging, including CT dose reduction, imaging of urolithiasis, adrenal and renal tumor imaging, and percutaneous tumor ablation.
Rebecca Smith-Bindman, MD MPH
Dr. Rebecca Smith-Bindman is Professor of Radiology, Epidemiology and Biostatistics, Obstetrics, Gynecology and Reproductive Medicine, and Health Policy at the University of California, San Francisco School of Medicine. She is a clinical researcher with expertise in epidemiology, technology assessment, outcomes research, comparative effectiveness research, health services research, and dissemination and implementation sciences focused on imaging. Her research has focused on evaluating the quality, utilization, accuracy, predictive values and impact of diagnostic testing on patient health, and has quantified both the risks and benefits of medical imaging when used in different contexts and by different populations. She is leading several studies that assess and standardize the radiation dose used for CT scanning, in order to minimize doses, without loss of diagnostic accuracy. Additional current research is focused on putting systems-based solutions in place to standardize the interpretation and conduct of radiology to ensure maximum effectiveness and safety.
Kevan Sternberg, MD
Dr. Kevan Sternberg is an assistant professor of urology at the University of Vermont. He is co-director of the multi-disciplinary kidney stone clinic and director of research for the division of urology. In addition to clinical endourologic care, his interests include clinical and quality improvement research. He is currently serving on the E-QUAL panel. Additional responsibilities include Vermont state representative to the New England section of the AUA and New England section representative to the board of the Journal of Urology. Dr. Sternberg received his medical degree from the State University of New York at Buffalo where he also completed urology residency. This was followed by an endourology fellowship at the University of Pittsburgh. His clinical interests focus on endourologic treatment and medical management of kidney stones.
Arjun Venkatesh, MD MBA MHS
Dr. Arjun Venkatesh is an Assistant Professor and Director of Quality and Safety Research and Strategy in the Department of Emergency Medicine at the Yale University School of Medicine and Scientist at the Yale New Haven Hospital-Center for Outcomes Research and Evaluation (CORE). Dr. Venkatesh is a nationally recognized health services researcher and expert in quality measurement. He is co-Principal Investigator of the Centers for Medicare and Medicaid Innovation funded Emergency Quality Network (E-QUAL) and has been funded by the NIH, Agency for Healthcare Research and Quality and Emergency Medicine Foundation to study emergency department, hospital and health system quality and efficiency. He has published over 50 peer-reviewed papers and is senior editor of The Evidence: Practice Changing Studies book series.
J. Stuart Wolf, Jr., MD FACS
J. Stuart Wolf, Jr., received his MD from Northwestern University and completed urology residency at UCSF followed by an Endourology / Laparoscopy Fellowship with Ralph Clayman. He joined the University of Michigan in 1996, and over the ensuing 20 years he served as the Director of the Division of Endourology, the Director of the Endourology / Laparoscopy Fellowship, and the Associate Urology Department Chair for Surgical Services. In 2016, he assumed his current role as Associate Chair for Clinical Integration and Operations in the Department of Surgery and Perioperative Care at Dell Medical School of the University of Texas at Austin. Dr. Wolf has served on the Board of Directors of the Michigan Urologic Society, the Society of Academic Urology, and the Endourological Society. He currently serves as the inaugural chair of the AUA Science & Quality Council. In 2018, he will start a 6-year term as Trustee of the American Board of Urology.
Justin Ziemba, MD
Dr. Justin B. Ziemba is currently an Assistant Professor of Urology in Surgery at the Perelman School of Medicine at the University of Pennsylvania, where he also earned his medical degree. He stayed at the University of Pennsylvania to complete his general surgery internship and urologic surgery residency. Following his residency, he spent two years as a clinical and research fellow in minimally invasive surgery and endourology at the James Buchanan Brady Urological Institute of the Johns Hopkins Hospital and Instructor of Urology at the Johns Hopkins School of Medicine. Dr. Ziemba's clinical focus is on the surgical treatment and medical management of kidney stone disease. This clinical focus is supported by his research interests in the metabolic causes of kidney stone formation, imaging support for the diagnosis and treatment of kidney stones, and the health-related quality of life for patients with kidney stone disease. He also remains committed to improving health care quality and patient safety. He has advanced training in quality improvement methodology and adverse event investigation through a graduate certificate from the Bloomberg School of Public Health at Johns Hopkins University.
|Matthew Nielsen, MD, MS, FACS||Need for Physician Led-Stewardship of Imaging in Urology|
|James Montie, MD||Urologist Led Success Stories in Stewardship of Imaging for Prostate Cancer|
|Rebecca Smith-Bindman, MD||Imaging Wisely: Improving the Value of Medical Imaging|
|Arjun K. Venkatesh, MD, MBA, MHS||National Quality Initiatives in Renal Colic Imaging from the American College of Emergency Physicians (ACEP)|
|Chris Moore, MD||Dose Optimization in Stone Evaluation: DOSE|
|Erick M. Remer, MD, FACR, FSAR||Urolithiasis: Radiology Perspective|
|Kevan Sternberg, MD||E-Qual - Urologist Perspective|
|Erick M. Remer, MD, FACR, FSAR||ACR Appropriateness Criteria®|
|Nancy Fredericks, MBA||R-SCAN: Engaging Clinicians in Value-based Care|
|Andrei S. Purysko, MD||Optimizing Implementation of Prostate MRI|
|Arjun K. Venkatesh, MD, MBA, MHS||Cross-Cutting Measures: A Novel Vision for Measurement|
The AUA recognizes the importance of including residents and fellows in events, especially those related to quality improvement and patient safety. Therefore, a new program has been established to promote resident and fellow involvement in the Quality Improvement Summit. The inaugural program awarded travel scholarships to five individuals who attended the 2017 Quality Improvement Summit. As part of the event’s concluding activities, these five participated in a panel and shared their reflections on the program and what lessons they learned.
Justin S. Ahn, MD
Dr. Ahn is a urology resident at the University of Washington, expected graduation in 2019. He plans to pursue a fellowship in laparoscopy/endourology. Dr. Ahn grew up in Los Angeles, received his BS at Emory University, followed by MD from University of Texas Southwestern, achieving Phi Beta Kappa and junior AOA status at respective institutions. During his research year, Dr. Ahn worked in the Applied Physics Lab at the University of Washington, studying new therapeutic ultrasound technologies for kidney stones in addition to national imaging patterns after kidney stone procedures. Also a commercial-rated pilot, Dr. Ahn has interest in applying aviation safety practices to medicine and is currently collaborating with Boeing and Alaska Airlines to develop quality improvement and safety initiatives at the University of Washington Medical Center.
Joshua Halpern, MD
Dr. Halpern is currently a chief resident in urology at Weill Cornell Medicine-New York Presbyterian Hospital. After receiving his BA in History at the University of Pennsylvania, he received his MD degree from Weill Cornell Medical College, where he subsequently received his Masters in Health Policy and Economics. His research interests broadly include health services research with a particular focus on prostate cancer screening and evaluation for microscopic hematuria. He currently serves as chair of the Housestaff Quality Council at New York Presbyterian Hospital. After expected graduation from residency, Dr. Halpern will serve as a Fellow in Andrology at Northwestern University beginning in July 2018.
Dima Raskolnikov, MD
Dr. Raskolnikov is a PGY-3 urology resident at the University of Washington in Seattle, Washington. He graduated from Cornell University with a Bachelor of Science in Biology & Society and attended SUNY Downstate College of Medicine. During medical school, he was selected to participate in the National Institutes of Health (NIH) Medical Research Scholars Program. His work at the National Cancer Institute focused on the ability of MRI/US fusion-guided prostate biopsy to improve cancer diagnosis and surveillance. Dr. Raskolnikov is currently involved in quality improvement programs that make urological care more effective and efficient within UW Medicine.
Jennifer Robles, MD
Dr. Robles completed a urologic surgery residency at Washington University in Saint Louis in 2016 and is currently an Endourology and Laparoscopic/Robotic Surgery Fellow at Vanderbilt University. She is also a VA Quality Scholar and is completing a fellowship in Quality Improvement, including a Masters in Public Health. Her interests are in surgical quality improvement, particularly using implementation science and clinical informatics to improve the efficiency and quality of surgical care delivery.
Emily Slopnick, MD
Dr. Slopnick is a urology chief resident at University Hospitals Cleveland Medical Center in Cleveland, OH. She graduated summa cum laude from the University Honors and Scholars Program at Miami University. She then received her MD from Mount Sinai School of Medicine, where she was awarded Distinction in Research upon graduation for publication of original research. Dr. Slopnick is involved with the University Hospitals Quality Institute in both educational and research capacities and is studying national quality and patient safety topics with national research databases. She will remain at University Hospitals next year for fellowship in Female Pelvic Medicine and Reconstructive Surgery.
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