The Chain of Adherence for Incidentally Detected Pulmonary Nodules after an Initial Radiologic Imaging Study: A...

Area of Science:

• Pulmonary Medicine
• Radiology
• Healthcare Quality Improvement

Background:

• Millions diagnosed with incidental pulmonary nodules annually require assessment for appropriate follow-up.
• Most pulmonary nodules are benign, but universal assessment is recommended to ensure timely management.
• Existing Fleischner Society guidelines provide a framework for managing incidental pulmonary nodules.

Purpose of the Study:

• To assess concordance and adherence to the 2005 Fleischner Society guidelines among radiologists, clinicians, and patients.
• To evaluate the effectiveness of incidental pulmonary nodule tracking systems in two Veterans Affairs healthcare systems.
• To identify factors influencing adherence to pulmonary nodule follow-up recommendations.

Main Methods:

• Retrospective review of electronic health records for patients with incidental pulmonary nodules (2008-2016).
• Classification of radiology reports and patient follow-up based on 2005 Fleischner Society guidelines.
• Analysis of radiologist-Fleischner adherence, clinician/patient-Fleischner concordance, and clinician/patient-radiologist adherence.

Main Results:

• Radiologist adherence to guidelines was 86.6%, with 4.8% more aggressive and 8.6% less aggressive recommendations.
• Clinician/patient concordance with guidelines was only 46.0%, with 14.5% more aggressive and 39.5% less aggressive follow-up.
• Radiologist adherence was associated with higher clinician/patient concordance (52.0% vs. 11.6%).

Conclusions:

• Radiologist adherence to the 2005 Fleischner Society guidelines for incidental pulmonary nodules is necessary but insufficient for optimal care.
• Achieving guideline-concordant care requires improved clinician and patient adherence to follow-up recommendations.
• Multifaceted improvements in care processes are essential for effective incidental pulmonary nodule management.