The American board of radiology perspective on maintenance of certification: part IV--practice quality improvement for diagnostic radiology.

1All authors: The American Board of Radiology, 5441 E Williams Blvd., Tucson, AZ 85711. Address correspondence to J. L. Strife. he American public expects safe, predictable, high-quality care and assumes that physicians work to remain current and competent. The American Board of Radiology (ABR) encourages each board-certified diagnostic radiologist to understand his or her professional responsibilities and to participate in continuous quality improvement and lifelong learning. In the United States health care system, quality of care, medical error reduction, and patient safety represent continuing themes that dominate public concern [1–3]. Maintenance of Certification (MOC), the overarching program of the American Board of Medical Specialties (ABMS) and its member boards, is the response of U.S. physicians to address these concerns [4–8]. Although advances in medical science, technology, and biomedical research continue to accelerate, other barriers prevent rapid dissemination and adoption of evidence-based, recommended care [9]. A RAND Corporation study has estimated that only 50–54% of the care Americans receive is care that has been recommended on the basis of evidence-based medical literature [3]. Much of what radiologists do is not evidence based [10]. Outcomes and costs to diagnose and treat specific diseases vary widely among physicians, hospitals, health care providers, and regions of the country [10]. To address challenges in the medical system and the public’s concerns, the ABMS, composed of 24 member boards representing all medical subspecialties in the United States, mandated in March 2000 that each board initiate specialty-specific MOC programs [4–8]. Diplomates are no longer granted lifetime certification but rather must demonstrate evidence of professionalism, continuing medical education and knowledge, as well as a commitment to practice improvement. The MOC program, including “Part IV: Practice Quality Improvement,” for diagnostic radiology, radiation oncology, and radiologic physics has been developed, approved by the ABMS, and initiated in 2007. The overriding objective of MOC is to improve the quality of health care through diplomate-initiated learning and quality improvement. There are four component parts to the MOC process: “Part I: Professional Standing,” “Part II: Lifelong Learning and Periodic Self-Assessment,” “Part III, Cognitive Expertise,” and “Part IV: Evaluation of Practice Performance” [11–15]. The ABR program for self-evaluation of practice performance is linked to a process of continuing quality improvement and is titled “Practice Quality Improvement” (PQI).