The United States' experience in nuchal translucency: variation by provider characteristics in over 5 million ultrasound measurements.

OBJECTIVE The Nuchal Translucency Quality Review (NTQR) program has provided standardized education, credentialing, and epidemiologic monitoring of nuchal translucency (NT) measurements since 2005. We reviewed the effect of provider characteristics on the median NT measurement (NT median MoM) since the program's inception. METHODS Distributions were derived for all NT measurements performed between 01/2005 and 12/2019 for each of the three primary performance indicators of NT (median MoM, SD of log10 MoM and slope of NT on CRL). Provider characteristics explored as potential sources of variability included number of NT ultrasounds performed annually (volume), duration of participation in NTQR, prior credentialing with another organization, provider type (physician vs. sonographer), and number NT credentialed providers within the practice (size). Characteristics were evaluated for their effect on NT median MoM and geometric mean of the NT median MoM weighted for the number of ultrasounds. Wilcoxon Rank Sum Tests and ANOVA used for comparisons between groups and multiple regression to control for potential confounders. RESULTS Of 5,216,660 NT measurements from 7422 providers at 3319 sites, the majority (75%) had an NT median MoM within the acceptable range of 0.9-1.1 and 85% had NT median MoM not statistically significantly outside this range. Provider characteristics associated with measurement within expected range of performance included practice in a high volume center, longer duration of participation in the NTQR program, and prior credentialing. CONCLUSIONS Annual volume, duration of participation in NTQR, prior credentialing and size of practice are all associated with outcome metrics indicating quality performance. It is critical that providers participate in ongoing quality assessment to maintain consistency and precision within NT measurement. Ongoing assessment programs with continuous feedback and education are necessary to maintain quality care. This article is protected by copyright. All rights reserved.