《mammography benchmarks angoff process乳腺x线筛查标准 angoff方法课件》由会员分享，可在线阅读，更多相关《mammography benchmarks angoff process乳腺x线筛查标准 angoff方法课件（16页珍藏版）》请在金锄头文库上搜索。
1、Screening Mammography Benchmarks Modified Angoff: Screening Performance and Guidelines for Practice,Robert D Rosenberg and Patricia Carney for Breast Cancer Surveillance Consortium,Overview - Performance Benchmarks,Mammography Audit and Practice Recommendations before the BCSC BCSC Early Efforts - M
2、ethods BCSC Screening Audit results BCSC and the Modified Angoff Process,Mammography Audit - History in the US,Single Practice Frankl 1983/Wolfe 1987 (3,000/Yr) Spring-Kimbrel/Sickles 1987-1990 (6,000/Yr) Community Practice Sienko 1993 and Rosenberg 1996 (42,000/yr) Multi-community Practice Yankaska
3、s 2005 (240,000/yr),BiRads Committee & Audit - 1991 to Present,Collaborative work ACR, ACS, NIH Specific Discrete Results! Importance of the Audit! Specified Audit Measurements Preliminary Definitions Recommendations and Assessments Screening and Diagnostic,BCSC and the Audit,Methods: Standardized O
4、perational Definitions Computerized methods Applicable across practices Assessment vs. RecommendationExtended Types of Practices with AuditsFrom Selected Individual Practices to Regionally selected Practices,BCSC and the Audit II,Creation of Methods/Definitions for Research that are also Clinically
5、Applicable Consultation with ACR and Members of BiRads Committee Consultation with Community Radiologists Extensive Validation of Methods How to ask Questions, and specific answers,Screening Benchmarks Distribution of Performance by Radiologists,2,500,000 Screening Studies 300 Radiologists Audit Mea
6、sures: Recall Rate, PPV 1,2,3, Sensitivity, Specificity, Cancer detection rate, Cancer Size and Stage,Radiology: Volume 241: Number 1October 2006,Cancer Detection Rate,Specificity,Sensitivity,PPV of Biopsy Rec,Great Job Dad Now What?,Weve Created performance measures for the Community, what do we do
7、 with them? What should they be/could they be?,Existing Guidelines: Expert Opinion,1994 - AHCPR Clinical Practice Guideline #13: “Desirable Goals Achieved by Highly Skilled Experts” i.e. - Expert Radiologists at Dedicated Facilities Three Goals for Mammography Defined High Sensitivity Reasonable Rat
8、es of Recall and PPV2 Cancers detected are small and Localized,Modified - Angoff Meeting,Meeting funded and assisted by American Cancer Society Moderated and Organized by Patricia Carney Assemble group of 10 “Expert” mammographers Mix of academic and private practice radiologists Mix of regions of t
9、he country,Angoff Method,Process Approach for Setting Cut-Point Criteria for Low Performers Developed in the 1970s and applied in International and National Medical Student Assessment for USMLE-CPX Purpose is to Increase “Accountability” for Meeting a Standard of Proficiency. Most Commonly Used Meth
10、od to Set Educational Performance Standards Today,Modified - Angoff Process,Question to Expert Panel: Beyond what range of performance would you recommend consideration for additional training? Anonymous answers given and displayed Experts view responses, discuss, repeat goals Experts then given act
11、ual performance ranges in clinical practice - and repeat the process Repeat for each performance measurement,AHCPR Expert performance 1994 vs. Angoff Minimally acceptable expectations,Radiology: Volume 255: Number 2May 2010,Angoff - Implications for Care,The selected cut - points could recommend 18%
12、 to 49% of physicians for remediation for one or more measures. If all physicians fell within the boundaries, there would be 14 more cancers/100,000 women screened and 880 fewer false positive studies.,Summary,It is a complex process to create valid benchmarks for community Radiology These Benchmarks inform experts on realistic recommendations for community performance,
