RADAR: A Closed-Loop Quality Improvement Initiative Leveraging A Safety Net Model for Incidental Pulmonary Nodule...

Area of Science:

• Medical Informatics
• Radiology
• Quality Improvement in Healthcare

Background:

• Incidental pulmonary nodules (IPNs) require timely follow-up to ensure appropriate patient management.
• Variability in follow-up care for IPNs can lead to delayed diagnosis and treatment.
• A quality improvement (QI) initiative was implemented to address challenges in IPN follow-up.

Purpose of the Study:

• To evaluate the effectiveness of the RADAR (Radiology Result Alert and Development of Automated Resolution) QI initiative.
• To assess whether patients with IPNs received timely follow-up care post-QI implementation.
• To compare the rates of timely IPN follow-up before and after the QI intervention.

Main Methods:

• A QI study was conducted at an academic medical center, analyzing IPNs identified on chest imaging between February 2017 and March 2019.
• The RADAR initiative, implemented in March 2018, included an electronic alert system for radiologists and a care coordination team.
• Pre- and post-intervention cohorts were established using natural language processing and manual chart review to determine timely follow-up rates.

Main Results:

• Timely follow-up for IPNs increased significantly from 64.5% in the pre-intervention cohort to 84.3% in the post-intervention cohort (p=0.001).
• The study assessed 110 IPN alerts pre-intervention and 108 post-intervention.
• Post-intervention, agreement between primary care providers (PCPs) and radiologists on the follow-up plan was high at 87.0%.

Conclusions:

• The RADAR QI initiative demonstrated a positive impact on increasing timely follow-up for incidental pulmonary nodules.
• The safety net model employed by RADAR shows potential for broader application to other radiology findings.
• This approach can be scaled to various clinical settings to improve care coordination and patient outcomes.