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Gynecologic Consensus ConferenceWorking Group 3, Topic 6: General Quality June 4, 2011
• Joseph Tworek, MD (Senior Author)
• Lydia P. Howell, MD (Chair)
• Ritu Nayar, MD
• Sana O. Tabbara, MD
• Barbara Winkler, MD
• Lynnette Savaloja, SCT
• Nicole E. Thomas, MPH, CT(ASCP), (CAP Staff)
Working Group 6
© 2011 College of American Pathologists. All rights reserved. 2
• Historical data and national benchmarksoUseful for smaller labsoHistorical data will identify trends within
labo Published benchmarks may identify lab
drift− National benchmarks not always available
Available methods for monitoring quality data
© 2011 College of American Pathologists. All rights reserved.
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• Justification: Survey and website
• Monitoring laboratory-wide data against national benchmarks may provide a baseline to identify and stratify lab performanceo Not valuable for labs with small numbers of primary
screeners
o Taken in context with other factors (eg, high-risk population)
• Comparing individual data to laboratory-wide data may help identify outlierso Retain with other QA documents
Statement: Selected metrics should be monitored individually, as well as globally for the laboratory.
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A. Agree with entire statement 95.92%
B. Only individual quality data should be monitored; no global monitoring. 0%
C. Only global laboratory monitoring; no individual monitoring. 0%
D. Disagree with entire statement (ie, quality data should not be monitored at all). 2.04%
Vote#56: Selected metrics should be monitored individually, as well as globally for the laboratory.
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A. Agree with entire statement. 92.9%
B. Only cytotechnologist quality data should be monitored. 3.57%
C. Only pathologist quality data should be monitored. 1.79%
D. Disagree with entire statement (ie, individual quality data should not be monitored at all). 1.79%
Vote#57: Monitoring of selected metrics for individuals should include both CTs and Pathologists
© 2011 College of American Pathologists. All rights reserved. 6
• Justification: Survey
• Quality metrics should be shared with each CT and pathologist o From survey, 59% and 81% of labs facilitate comparison
of CT to other CTs and to laboratory data respectively
o 48% and 60% of labs facilitate comparison of pathologists to other pathologists and to laboratory data respectively
o Table 3 page 55
• Lab mean data and/or individual data could be shared openly or privately, identified or de-identified at the discretion of the lab
Statement: Results of quality metrics should be shared with individual CTs and pathologists.
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A. Agree with entire statement. 98.39%
B. Quality metrics should only be shared with CTs. 1.61%
C. Quality metrics should only be shared with Paths. 0%
D. Disagree with the entire statement (ie, quality metrics should not be shared at all). 0%
Vote#58: Results of quality metrics should be shared with individual CTs and pathologists.
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• Justification:o Survey
−Most common is monthly (62.3% prepare quality report monthly).
−Helpful in semi-annual evaluation of CT (eg, determining screening limits)
−Labs can decide whether to de-identify results when sharing: – Most labs (70% from survey) do not code CT and
pathologists results to maintain confidentiality.
Statement: Results of quality metrics should be shared at least twice a year with individuals.
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A. Agree with entire statement. 65.6%
B. Time frame is too frequent. 0%
C. Time frame is too infrequent. 9.4%
D. Time frame should be left to discretion of the lab. 25%
E. Disagree with entire statement (ie, quality metrics should not be shared with individuals at all). 0%
Vote#59: Results of quality metrics should be shared at least twice a year with individuals.
© 2011 College of American Pathologists. All rights reserved.
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• Justification: Survey
• Multi-head review of difficult cases ranked second most useful quality metric
• 60% of labs conduct in-house reviewo Share interesting caseso Review of educational program slideso Hone diagnostic criteriao Review cases identified from QAo Review laboratory generated study material
Statement: Reviewing selected cases for educational purposes is a useful quality tool.
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A. Strongly Agree 86.4%
B. Agree 13.6%
C. Disagree 0%
D. Strong disagree 0%
Vote#60: Reviewing selected cases for educational purposes is a useful quality tool.
© 2011 College of American Pathologists. All rights reserved. 12
Areas for future development
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• Justification: Survey
• Top 3 methods across (HPV, Cyto-histo cor., 5 yr look backs, and immediate re-screen)o Lab defined action limits/thresholds (46%-
66%)o Rate change (23% - 35%)o Lab defined action limits/thresholds from
literature (21% - 26%)
Insufficient data to determine best methods to identify variance in lab-wide quality metrics.
© 2011 College of American Pathologists. All rights reserved. 14
• Justification: Survey
• Varies by metric
• More commonly done for CTs than Pathso 54%, identify outlierso 47%, user defined action limits (arbitrary)o 37%, rate changeo 22%, compare S.D. with historical meano 18%, user defined action limits based on
literature
Insufficient data to specifically describe how to identify variance in individual quality metrics.
© 2011 College of American Pathologists. All rights reserved. 15
• 85%, identify root cause analysis, address the cause and continue to monitor
• 42%, conduct in-lab re-education
• 33%, increase real time re-screen of NILM prior to sign out
• 32%, decrease slide work load
• 21%,retrospective re-screen of a defined number of previous NILM cases.
Common actions from survey to address variance in lab-wide performance
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• 68% identify cause of variance and conduct focused review or education
• 53% increase real time re-screen of NILM prior to sign out
• 46% counseling and continued monitoring (warning shot)
• 45% decrease work load limits
• 37% conduct in-house tutorial
• 31% conduct an audit of previous cases
Common actions from survey to address variance in individual performance
© 2011 College of American Pathologists. All rights reserved. 17
Working Group 3
Topic 6
General Quality
Additional Voting Questions
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VotingWG3 - General Quality
68. Low-volume methodologies should have a higher-level of quality oversight/control.
A. Yes, screened by designated “experts” 11.11%
B. Yes, automatically re-screened 6.67%
C. Both A&B 20%
D. Yes, I agree with statement, but left to discretion of lab 53.33%
E. No, I do not agree with statement 8.89%
19© 2011 College of American Pathologists. All rights reserved.
• Justification: professional opinion and literature
• Need more data regarding practice patterns and their validity
• Consider use of slide set of unknowns to assess initial competency
• Rescreen percentage of cases for a period of timeo The percentage and time length depend upon
the laboratory’s resources and patient population (ie, abnormal rate)
o For labs with low volume or low abnormal rates, consider additional test of verified unknowns or if possible use “spiked” cases
WG3-Statement: Newly hired primary screeners should be monitored, but best method(s) is unclear.
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69. Newly hired primary screeners should be monitored, but best method(s) is unclear.
A. Strongly agree 37%B. Agree 46.3%C. Disagree 14.8%D. Strongly disagree 1.8%
VotingWG3 – General Quality
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