title: Quality of nuchal translucency measurements correlates with broader aspects of program rigor and culture of excellence.
abstract: BACKGROUND
  To determine if nuchal translucency (NT) quality correlates with the extent to which clinics vary in rigor and quality control.
  
  
  METHODS
  We correlated NT performance quality (bias and precision) of 246,000 patients with two alternative measures of clinic culture - % of cases for whom nasal bone (NB) measurements were performed and % of requisitions correctly filled for race-ethnicity and weight.
  
  
  RESULTS
  When requisition errors occurred in <5% of cases, the average MoM (multiple of the median) was 0.97. When >5% (33%), the curve lowered to 0.93 MoM (p < 0.001) with both bias and precision of measurements impaired. Likewise, for centers with NB >90%, MoM was 0.99 compared to those <10% at 0.93 (p < 0.001). Precision and bias were highly correlated (p < 0.001).
  
  
  CONCLUSIONS
  Rigor in NT measurements has improved, but the discussion has been confined to individuals. Progressive educational and remediation strategies need to expand to a second dimension - clinics themselves. Cross-clinic variation in NT quality exists independent of individual variation in NT quality, and two divergent indices of program rigor are associated with NT quality. Quality control must be program wide, and to effect continued improvement in the quality of NT results across time, the cultures of clinics must become a target for intervention.
authors.affiliation: Comprehensive Genetics & Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, NY, USA. Evans@Compregen.com
authors.forename: Mark I
authors.initials: MI
authors.lastname: Evans
authors.forename: David A
authors.initials: DA
authors.lastname: Krantz
authors.forename: Terrence
authors.initials: T
authors.lastname: Hallahan
authors.forename: John
authors.initials: J
authors.lastname: Sherwin
authors.forename: David W
authors.initials: DW
authors.lastname: Britt
mesh_terms: D005260:Female; D006801:Humans; D050316:Medical Order Entry Systems; D048208:Nuchal Translucency Measurement / Q000706:statistics & numerical data; D015588:Observer Variation; D015279:Organizational Culture; D011247:Pregnancy; D011295:Prenatal Care; D011786:Quality Control; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies