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Impact of nuchal translucency credentialing by the FMF, the NTQR or both on screening distributions and performance
Author(s) -
Evans M. I.,
Krantz D. A.,
Hallahan T. W.,
Sherwin J.
Publication year - 2012
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.9023
Subject(s) - credentialing , medicine , nuchal translucency , sonographer , nuchal translucency measurement , pregnancy , ultrasonography , medical education , first trimester , gestation , surgery , biology , genetics
Objective In the USA, both The Fetal Medicine Foundation (FMF) and the Nuchal Translucency Quality Review Program (NTQR) have operated education, review and credentialing for physicians and sonographers for the measurement of nuchal translucency (NT). We sought to assess differences in the distribution of NT measurements based upon the system from which the operator obtained their education, review and credentialing. Methods 398 311 NT measurements by 1541 sonographers who had performed ≥ 50 exams from July 2008 to June 2010 were grouped by organization. Differences between grouped measurements were assessed using analysis of variance of log 10 NT multiples of the median (MoM), with sonographer and organization as factors. Results MoM values were significantly lower ( P ⩽0.001) and SD was significantly higher ( P < 0.001) for the NTQR group compared with the FMF group or those sonographers credentialed by both. The percentage of individuals with negative bias ≥ 10% was greater for the NTQR group ( P < 0.001). The difference was less but still significant ( P = 0.009) when bias was adjusted for by the overall median for the organization. Conclusions Although NT MoM measurements were significantly lower and had a wider variance when obtained by the NTQR group, our data cannot distinguish between bias in training or the attributes of the participating sonographers in each program. With these large numbers, it is unlikely that patient characteristics could explain the discrepancy in distributions. Ongoing efforts to monitor sonographer performance with remediation for poor performers may reduce discrepancies between organizations. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.