DAP Spirometry Quality Control Program
Spirometry is a useful diagnostic test commonly performed in a variety of settings; however accurate results are dependent on careful technique, and proper equipment calibration and maintenance. The American Thoracic Society (ATS) and European Respiratory Society (ERS) have recommended a number of procedures to reduce variability including the weekly testing of flow volume measurements. Under the DAP Spirometry Quality Control Program, facility personnel at each site perform quality control procedures, and spirometry measurements on a Biologic Normal (BioQC) subject according to the DAP protocol. The results, submitted to the DAP twice each year, give an indication if any areas of concern exist with the spirometer or performance of the tests. An individual report with recommendations will be sent to the facility at the end of each reporting cycle.
Accreditation from the Diagnostic Accreditation Program (DAP) is a requirement for all sites that perform spirometry. Continuing accreditation is based on the satisfactory review of quality assurance and control data submitted to the DAP by the community based service. Level 1 and Level 2 (formerly known as Category IIA and IIB) facilities and private clinics performing spirometry require participation in the DAP Spirometry Quality Control Program as part of their accreditation.
Exemption: If the spirometer used exclusively is the COPD-6 Spirometer, as approved by the Medical Services Commission for case finding, DAP accreditation is not required for this test.
Steps in the Accreditation Process:
All new spirometry services to be provided by an accredited facility or credentialed physician must proceed through the Initial Assessment process PRIOR to service delivery and patient testing.
The 3 main steps required to start a new community based spirometry service are outlined in detail on the DAP webpage here. They include:
1. DAP application: Complete documentation and submit data to the DAP.
2. Credentialing: Physicians not previously credentialed by the DAP for spirometry must complete the required forms and submissions.
3. Authorization by the Ministry of Health: In order to be authorized by the Ministry of Health and to bill for this service, follow the procedures in this step.
Documentation: The DAP application starts with completing the Initial Assessment/Change in Service Form. This form provides the DAP with information regarding the type of equipment used, qualifications of the individual(s) performing and interpreting the test, how the testing is performed, and quality control activities.
Technical Component: The above form is sent to the DAP along with the Initial Assessment Data Submission for Community Based Spirometry Testing The facility/physician submits 5 spirometry tests performed on a biologic normal (BioQC) person. This is accompanied with calibration and linearity testing data, and forms the technical component of the DAP evaluation. For more information on calibration, linearity and BioQC testing, please see the Spirometry Quality Control Plan. Once this data has been reviewed and approved, the DAP will confer a provisional accreditation award.
Medical Review Component: In order to complete the medical review component, the facility will next submit their first 5 patient reports with interpretation, and calibration reports. Based upon a satisfactory review, the facility/physician will be provided with full accreditation for that site.
Accreditation is subject to the facility/physician’s satisfactory participation in continuing accreditation assessment activities. Accreditation awards are renewed every 4 years.
Continuing Accreditation Assessment Activities
The continuing accreditation activities assess 3 critical aspects of quality:
- Equipment performance – assurance that the spirometer is functioning appropriately to produce measurements that are within acceptable limits of accuracy and precision.
- Procedure performance – assurance that the patient procedure has been performed according to American Thoracic Society (ATS) standards and the test was performed correctly.
- Interpretation appropriateness – assurance that the tracings and data have been interpreted appropriately.
The DAP will provide feedback to the physician related to equipment performance; procedure performance; and interpretation appropriateness for the purposes of quality improvement. On-site surveys will not take place in this accreditation program. Accreditation is subject to the facility/physician’s satisfactory participation in these continuing accreditation assessment activities.
Assessment and Escalation of Unsatisfactory Results: The document describing the escalation criteria for technical and medical reporting issues relating to Spirometry testing may be found here. Escalation is to the DAP committee for recommendations up to, and including withdrawal of the accreditation award.