United States' experience in nuchal translucency measurement: variation according to provider characteristics in over five million ultrasound examinations.

Autor: Thornburg LL; Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA., Bromley B; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA., Dugoff L; Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA., Platt LD; David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA.; Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA, USA., Fuchs KM; Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA., Norton ME; Department of Obstetrics and Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA., McIntosh J; Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA., Toland GJ; Perinatal Quality Foundation, Oklahoma City, OK, USA., Cuckle H; Tel Aviv University, Faculty of Medicine, Ramat Aviv, Israel.
Jazyk: angličtina
Zdroj: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Ultrasound Obstet Gynecol] 2021 Nov; Vol. 58 (5), pp. 732-737.
DOI: 10.1002/uog.23621
Abstrakt: Objective: The Nuchal Translucency Quality Review (NTQR) program has provided standardized education, credentialing and epidemiological monitoring of nuchal translucency (NT) measurements since 2005. Our aim was to review the effect on NT measurement of provider characteristics since the program's inception.
Methods: We evaluated the distribution of NT measurements performed between January 2005 and December 2019, for each of the three primary performance indicators of NT measurement (NT median multiples of the median (MoM), SD of log 10 NT MoM and slope of NT with respect to crown-rump length (CRL)) for all providers within the NTQR program with more than 30 paired NT/CRL results. Provider characteristics explored as potential sources of variability included: number of NT ultrasound examinations performed annually (annual scan volume of the provider), duration of participation in the NTQR program, initial credentialing by an alternative pathway, provider type (physician vs sonographer) and number of NT-credentialed providers within the practice (size of practice). Each of these provider characteristics was evaluated for its effect on NT median MoM and geometric mean of the NT median MoM weighted for the number of ultrasound scans, and multiple regression was performed across all variables to control for potential confounders.
Results: Of 5 216 663 NT measurements from 9340 providers at 3319 sites, the majority (75%) of providers had an NT median MoM within the acceptable range of 0.9-1.1 and 85.5% had NT median MoM not statistically significantly outside this range. Provider characteristics associated with measurement within the expected range of performance included higher volume of NT scans performed annually, practice at a site with larger numbers of other NT-credentialed providers, longer duration of participation in the NTQR program and alternative initial credentialing pathway.
Conclusions: Annual scan volume, duration of participation in the NTQR program, alternative initial credentialing pathway and number of other NT-credentialed providers within the practice are all associated with outcome metrics indicating quality of performance. It is critical that providers participate in ongoing quality assessment of NT measurement to maintain consistency and precision. Ongoing assessment programs with continuous feedback and education are necessary to maintain quality care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
(© 2021 International Society of Ultrasound in Obstetrics and Gynecology.)
Databáze: MEDLINE
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