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INTRODUCTION

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Analyzing and reporting quality processes are an integral component of today's world, regardless of the area of application, be it medical, manufacturing, customer service, or other areas. In order to allow an exploration of quality in nuclear cardiology, this chapter will provide definitions of quality today and examine five common cycles that have been used to promote quality improvement, each with their own unique characteristics that make them particularly well suited for specific applications. Utilization of quality-driven processes and their impact on cost and value will also be addressed. In this context, the importance of quality and its integration into global accreditation and certification processes, including the similarities and differences among the various bodies providing accreditation will be discussed. Clinical application of quality improvement methodologies regarding patient and test selection, performance, interpretation, reporting, and the development of a quality improvement program for each of these areas will be the next area of focus. Finally, the chapter will provide information regarding reporting of quality performance initiatives and the use of registries and benchmarks in clinical nuclear cardiology today.

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QUALITY DEFINITIONS

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Components of Quality

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Quality in nuclear cardiology today has much broader implications than just producing high-quality images. With the advent of appropriate use criteria, the availability of multiple imaging modalities and protocols, multiple settings in which nuclear cardiology imaging can be delivered, interpretation of nuclear cardiology tests by multiple specialties, pay-for-performance initiatives including accreditation and certification and the regulatory requirements for reporting, "quality" has become a much larger topic in everything we do in nuclear cardiology.1 This chapter will address the many facets of quality today.

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The current definition of quality can vary greatly depending upon the perspective of an individual or organization. It is clearly a perception that is supported by data depending upon the metrics utilized. Quality can range from the daily quality control testing performed to insure optimal camera performance to the ability of a nuclear cardiology study to reduce downstream healthcare expense. Given this broad range of quality in current practice it is important to understand some basic definitions. The traditional quality assurance activities that have been used in nuclear cardiology have focused on insuring high-quality imaging. These have been focused around quality control and quality assurance whose definitions imply maintaining performance of a process, for example, image acquisition, over a period of time and within specified parameters. The performance of this type of testing is addressed in Chapter 6 of this book. A well-functioning nuclear cardiology laboratory today has an established protocol for maintenance and assurance of quality control. More recently, quality improvement has become a focus of processes within the nuclear cardiology laboratory, in large part to maintain accreditation. Quality improvement initiatives were initially focused on process-driven measures of performance, such as report turnaround times or availability of the next appointment. More recently quality improvement has expanded to more outcome-driven measures such ...

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