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To support economically sustainable, affordable diagnostic and interventional imaging services that promote health and provide cost effective diagnostic and treatment procedures, including identification and advancement of policies, technologies and practices, to meet growing demand and the health requirements of an ageing population.
This project was tasked to:
1. Review Australian and International evidence of implementations and outcomes of accreditation programs in related industries such as:
- Australian: ACHS, Pathology, GP Programs;
- US: American Institute of Ultrasound Medicine, American College Radiology, Intercollegiate Accreditation Program for Vascular Laboratories
2. Complete a post implementation review of RANZCR phase III pilots and any accredited sites to include: accreditation implementation processes, issues, costs, benefits and consumer outcomes. Include consultations with a representative range of radiology practice types and NATA
3. Review options to provide systematic support to all aspects of the accreditation process. Evaluation of the MedAudit Accreditation Software may be included.
4. Provide recommendations on RANZCR, industry and individual practice implementation to contribute to the ongoing development and continuous improvement of the Practice Accreditation Program workplan.
The project had a primary purpose of identifying issues associated with the voluntary practice accreditation and a secondary purpose of informing the development of the proposed mandatory accreditation programme.
Literature and related industry review; Evaluate Med Audit software; Post implementation review of accreditation; Interviews and questionnaires.
Radiology Planning Consultants Pty Ltd
The phasing-in approach by RANZCR to accreditation had advantages, particularly in Stage 2, allowing sites time to prepare manuals and standardise policy and procedure. Given this phased approach it was somewhat surprising that over twelve months into the RANZCR/NATA program only a handful of practices had completed Stage 3 requirements. However, it appeared that many sites were working toward Stage 3 accreditation in the background as applications increased in the voluntary program even during the course of the review. The report provided a number of recommendations to RANZCR to assist in the development of the accreditation program.
Final report
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Using acute low back pain as the representative condition, this project explored the reasons for inappropriate use of diagnostic imaging, with particular emphasis on the role of consumer demand. It reviewed the interventions that have been used, and recommends further strategies, to reduce inappropriate consumer demand for diagnostic imaging.
The ultimate aim of this project is to identify optimal strategies to reduce the demand for unnecessary imaging procedures (see Project ES02.ii below). While acute low back pain was used as the context for this project, it is hoped that the recommended strategies will be more widely applicable. .
Environmental scan; Literature review; Draft report of Opinion leaders; Gap analysis; focus groups; interviews; barrier analysis and identify intervention model.
National Institute of Clinical Studies
The inappropriate use of diagnostic imaging in a representative condition, acute low back pain, is driven by both health care professionals and their patients. The availability of evidence-based guidelines and interventions to implement guidelines in clinical practice has typically failed to overcome the problem. A mass media campaign successfully changed beliefs about back pain in the community and changed the stated management practices of general practitioners. However whether these changes in beliefs and stated practices translated to changes in behaviour and subsequent outcomes, such as a reduction in unwarranted x-rays, remains unknown.
Final report
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This project examines the effectiveness of a multifaceted intervention to reduce inappropriate diagnostic imaging referrals for primary care patients with low back pain. The intervention will incorporate community education through mass media, GP education and audit and feedback to GPs on referral rates. The intervention will be applied in an additive manner to enable assessment of the relative advantage of adding audit and feedback to the intervention.
This second stage is to design a model, using low back pain as a model, that addresses the requirements of a public awareness campaign, including:
- How to identify the current consumer perception, understanding and behaviour towards diagnostic imaging for the specific condition
- How to identify the desired consumer behaviour
- How to identify the most appropriate strategy to influence the consumers’ behavioural change
- How to implement the campaign
- How to evaluate the effectiveness and capacity for cost recovery of the public awareness campaign.
The aim of this project is to test the effectiveness of GP education, feedback on imaging referral rates to GPs and community education to reduce unnecessary referrals for low back pain imaging.
A multiple baseline design with communities as the unit of analysis is being used. This will be followed by detailed statistical analysis including ARIMA modelling, t tests and MANOVA.
University of Newcastle
This research has the potential to reduce an important and costly evidence-practice gap. It uses a design that will enable the differential effectiveness of educational strategies and performance feedback to be determined. This will enable examination of whether all components of the intervention are necessary to achieve the desired level of change. The interventions to be tested are cost-effective and could potentially be implemented broadly if successful. This represents an innovative use of routinely collected Medicare data to improve health care services. Furthermore, the use of Medicare data enables the intervention strategy to be replicated across Australia in a cost-effective manner. If the target reduction of 10% is achieved, this will translate into a reduction of significant numbers of imaging referrals Australia wide.
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This project includes a comparative review of the system currently employed in the Australian context, including the performance of MSAC and a review of models used in other countries.
The review pays particular attention to:
- The basis of each model, with attention to advantages and disadvantages
- The ability of the model to produce timely data
- The role of the model in horizon scanning and the selection of new technologies for early assessment
The project also considers funding mechanisms for the various possible evaluation models.
To identify the most effective strategies to support the identification, assessment and appropriate take up of new imaging diagnostic procedures or technologies in the Australian health system.
Literature review and comparative analysis; targeted consultation with key stakeholders; preliminary workshop; issues and scoping paper; report on progress; review of paper by QUDI and Economic Committee; final report
MacIsaac Informatics Pty Ltd
The major issues identified in this review are as follows:
- The major issue for the Diagnostic Imaging profession is the length of time taken for a technology to pass through the assessment and funding approval pipne.
- A broader range of HTA evaluation strategies are required in order to achieve the pragmatic outcome of an informative assessment, at an appropriate time in the technology implementation cycle, and within the constraints of available evidence, and resources for collecting further evidence.
- Diagnostic Imaging (DI) is an essential aspect of the healthcare process, yet rarely can an identifiable major outcome be attributable to the DI process alone.
- The rapid development in DI technology challenges the ability of controlled studies to keep pace, particularly where there are limited resources for research and academic study. Some DI technology is undergoing “generational change” within a 3-5 year timeframe.
- More needs to be done to broaden the range of acceptable research methods and HTA evidence gathering used in the evaluation of Diagnostic Imaging tecology.
- Improved communication between Government and the DI profession is needed to support information exchange on new technology developments and innovation in clinical practice, and to align professional practice with Medicare requirements.
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