ACR accreditation has largely positive impact on rad-onc practices

Analyzing patterns of change in deficiencies common to radiation-oncology practices, researchers have found that earning accreditation from the American College of Radiology (ACR) equips these practices with a reliable, peer-reviewed means of assessing their adherence to national standards.

At the same time, it’s less clear that the accreditation reflects—or spurs—topnotch performance on the ground in patient safety, patient outcomes and/or the selection and reporting of quality metrics.

Shannon Fogh, MD, of UC-San Francisco and colleagues arrived at these conclusions after querying the ACR database for deficiencies picked up by the organization’s Radiation Oncology Practice Accreditation (ROPA) program between 2012 and 2014.

To see how patterns of common deficiencies have changed over time, the team ranked and compared this recent data with parallel data on the top 10 items as captured from 2000 to 2005 and analyzed in 2006.

Their report is running in the September-October edition of Practical Radiation Oncology.

In introducing their findings, the authors note that, since 2006, the ROPA program has accredited more than 600 academic, freestanding and hospital-based sites. In the 2012-14 window alone, ROPA received 272 new applications and 306 renewals.

The comparison showed notable improvements in the 2012-14 window over that of 2000-05 in timely verification of port films, documentation of physician peer review, inclusion of essential elements of a treatment prescription, evidence of a final physicist chart review, documentation of weekly treatment visits and inclusion of key elements of brachytherapy documentation.

Change patterns moving in the wrong direction—that is, those reflecting higher deficiency rates in 2012-14 than in 2000-05—included documentation of a robust quality assurance program, missing elements from the history and physical documentation, and documentation of follow-up visits.

Commenting on opportunities for improvement suggested by these latter findings, Fogh et al. state that future directions “should include gathering evidence regarding whether accreditation provides for safer and better quality care by analyzing patient outcomes, and a conclusion on whether or not it is justifiable to mandate that all radiation oncology practices undergo some form of peer review through accreditation.”

They note that, currently, only a few states have this as a requirement.

“Comparison of patterns of deficiencies noted in states where accreditation is mandatory versus states where accreditation remains voluntary,” they add, “could provide insights into the possible impact of mandatory accreditation on practices.”

The authors further conclude that changes in patterns of deficiencies across ROPA practices reflect various changes in the field, not least its growing reliance on imaging and electronic medical records.

They also point out that some benefits of accreditation may be intangible and difficult to quantitate—but may yet drive meaningful improvement.

“The very act of preparing for an accreditation survey involves review and improvement of departmental policies and procedures with quality and safety concerns in mind,” they write.