national mammography database margarita zuley, md associate professor of radiology university of...
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NationalMammography
DatabaseMargarita Zuley, MD
Associate Professor of RadiologyUniversity of Pittsburgh
Medical Director Breast ImagingMagee Womens Hosp of UPMC
Credit and thanks to Mythreyi Bhargavan Chatfield, PhD Director, Data Registries for sample report slides
NMD
American College of Radiology (ACR) Initiative
Part of the NRDR ( National Radiology Data Registry)
Collects MQSA required data Provides comparative information back
to participating sites every 6 months Allows sites to do national and regional
benchmarking
What is NRDR?
Information system Provides objective measures of practice
processes and outcomes Designed by radiologists Includes
National Oncologic PET Registry (NOPR) CT Colonography Registry General Radiology Improvement Database
(GRID) IV Contrast Extravasation Registry (ICE) National Mammography Database Registry Quality Improvement Registry for CT scans in
Children (QuIRCC) Dose Index Registry
Benchmark Data
National benchmark data provided by Breast Cancer Surveillance Consortium (BCSC) are used for comparisons with facility data in the semi-annual reports provided to NMD participants
Also uses NMD results of all participating facilities as benchmarks
Facilities receive facility level and provider level data
Benefits
ABR has qualified the NMD for practice quality improvement (PQI) for ABR Maintenance of Certification (MOC) Program
3 PQI projects are required every 10 years for all radiologists who have not been given a lifetime certificate by the ABR
Joining
Any radiology facility can participate
A participation agreement and a business associate’s agreement between ACR and the facility must be signed first
Upload from facility to NMD
Obtained through input of data elements into facility RIS/ HIS
The RIS/HIS vendor must support the NMD platform (HL-7) fields
Vendor software must be approved by NMD
Facility requests upgrade to NMD version Assign one person to upload data Upload is one click
Data Security
PHI, NPI is uploaded Encryption of all incoming traffic to NRDR Firewalls to secure data Has third party safety monitoring Data on individual patients stay property of
facility Aggregate, anonomyzed data from registry
are property of ACR
Data Elements
Patient Identifiers Patient name, SSN, facility MRN, zip code
Race, ethnicity Gender LMP, height, weight Family and personal h/o breast cancer Biopsy and surgical history
Data Elements
Mmg date Radiologist NPI number Reason for exam Clinical symptoms Prior mmg date, was it compared at
read Breast density
Data Elements
BI-RADS category (7 point) Mmg only Combined assessment
Recommendations Classification of most significant
finding S/F or digital Use of CAD or double read
Data Elements
Biopsy results Modality used Biopsy result ( benign, HR, malignant) If cancer
Type ( invasive or DCIS) Size Nodal status Stage at diagnosis
Goals
PPV1 5-10% PPV2 25-40% Tumors found- stage 0 or 1 >50% Tumors found- minimal >30%
(1cm or less invasive or DCIS) Node positive rate <25%
From Linver et al AJR;1995;165:19-25
Goals
CDR (Ca/1000) 2-10 Prevalent 6-10 Incident 2-4
Recall rate 10% or less
Sensitivity >85% Specificity >90%
From Linver et al AJR;1995;165:19-25
Data Presented
Initial upload can be last 6 months or year Can elect to upload prior data if you like Initial older data can be incomplete First report back will only give data
results that you upload Will get 2 reports going forward, data
with at least 1 year follow up and preliminary data that does not yet have 1 year follow up