Structured reporting not significantly associated with receiving proper incidental lung nodule follow-up
Structured reporting is not a powerful predictor of whether providers will close the follow-up loop for incidental lung nodules, according to research published Wednesday in JACR.
Such findings show up on about 24% of all chest CT scans, with thoracic radiology experts at the Fleischner Society recommending specific steps for follow through. However, incorporating the group’s guidelines into rad reporting has produced modest improvements, according to previous research.
NYU Langone Health experts sought to fill this care gap using an informatics-based incidental lung nodule program that standardizes reporting. The New York City institution’s intervention helps track nodules rads deem high-risk, with electronic requests for facilitators to make sure communication occurs with the ordering provider to close the loop.
Radiologist Stella Kang, MD, and colleagues said the switch has shown promise, but still requires further refinement.
“Although structured recommendations are important facilitators for tracking [incidental lung nodules] and clearer communication to providers and patients, there were persistently high rates of loss to follow-up for ILNs in reports with recommendations for follow-up,” Kang, with NYU Grossman’s departments of radiology and population health, and co-authors concluded. “More consistent and timely alert for inpatients or [emergency department] patients in particular is a key area of need for improved systems approaches to follow-up.”
For their study, NYU researchers retrospectively analyzed the four-hospital system’s records, pinpointing patients who were over age 35 and had a chest CT with a newly identified incidental nodule. Individuals were excluded, among several factors, if they had a known primary cancer, and a clinical indication of lung cancer screening, which require a different report structure. About 1,300 patients met the criteria, with researchers separating them into groups before NYU implemented a department-wide system of smart texts for reporting Fleischner Society recommendations (255) and after the changes (1,046).
Comparing the two groups, about 40% of the pre-intervention group had no follow-up imaging, despite meeting the guidelines, compared to nearly 30% in the structured reporting group. And almost 57% received timely follow-up prior to the changes, with delays more frequent, versus 75% after the reporting recalibration. Kang and colleagues found that differences between the two cohorts were mostly accounted for by nodules of less than 8 millimeters in the outpatient setting. Younger age, white race, outpatient care delivery and larger nodule size showed significant association with appropriate follow-up imaging, while structured recommendations had no impact.
“Appropriate follow-up completion and loss to follow-up improved when the structured recommendation system was in place, but further efforts to reach patients for missed follow-up may be best focused upon inpatient and ED discharge processes and care coordination,” the authors advised. “Follow-up among outpatients may be much higher due to the ordering provider being more likely to be the provider who would follow the nodules than for inpatients or ED patients, auto-release of results through patient portals and lower likelihood of competing, acute health issues.”
You can read more about their work in the Journal of the American College of Radiology here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.