Best ways to provide feedback to radiologists on mammography performance

The Mammography Quality Standards Act of 1992 required a minimum performance audit of radiologists performing mammography. Since then, no studies have evaluated radiologists' perceptions of their audit reports, such as which performance measures are the most or least useful, or what the best formats are to present performance data.

We conducted a qualitative study with focus groups and interviews of 25 radiologists currently practicing mammography. All radiologists practiced at one of three sites in the Breast Cancer Surveillance Consortium (BCSC). The discussion guide included open-ended questions to elicit opinions on the following subjects: the most useful performance outcome measures, examples of reports and formats that are easiest to understand (e.g., graphs or tables), thoughts about comparisons between individual-level and aggregate data, and ideas about additional performance measures they would find useful. All discussions were tape-recorded and transcribed. We developed a set of themes and used ethnographic software to qualitatively analyze and extract quotes from transcripts.

Radiologists thought that almost all performance measures were useful. They particularly liked seeing individual data presented in graphic form with a national benchmark or guideline for each performance measure clearly marked on the graph. They appreciated comparisons between their individual data and their peers' data (within their facility or state) and requested comparisons with national data (such as the BCSC). Many thought customizable, Web-based reports would be useful.

Radiologists think that most audit statistics are useful; however, presenting performance data graphically with clear benchmarks may make them easier to understand.