Factors Affecting Adherence to Outpatient Radiology Report Recommendations
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Published on: August 1, 2019
Hadiseh Kavandi1, Jesse L Wei2, Yarab Al Bulushi3
1Abdominal and Interventional Radiology Section, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Insights
Radiology follow-up recommendations are more likely to be followed when they are strong and unconditional. Direct communication and lack of specific time intervals speed up patient follow-up, potentially reducing care delays.
Area of Science:
- Radiology
- Medical Imaging
- Healthcare Management
Background:
- Adherence to radiology follow-up recommendations is crucial for timely patient care.
- Factors influencing physician adherence to these recommendations require identification.
Purpose of the Study:
- To identify factors associated with referring physician adherence to radiology follow-up recommendations.
- To analyze the impact of recommendation characteristics and communication methods on follow-up adherence and timing.
Main Methods:
- Retrospective analysis of CT, ultrasound, and MRI reports containing follow-up recommendations.
- Exclusion of emergency department, inpatient, and routine surveillance recommendations.
- Correlation of follow-up performance with recommendation strength, conditionality, direct communication, and patient cancer history using statistical methods.
Main Results:
- Adherence rate for nonroutine radiological recommendations was 65%.
- Strong, nonconditional recommendations showed higher adherence rates (P = .009 and P = .008, respectively).
- Direct communication, no cancer history, and unspecified time intervals were associated with earlier follow-up (P < .001 to P = .0069).
Conclusions:
- Strong and nonconditional radiology follow-up recommendations improve adherence.
- Direct provider communication and absence of specific time intervals expedite follow-up, potentially reducing care delays.
Purpose:
To identify factors associated with adherence to radiology follow-up recommendations by the referring physicians.
Materials And Methods:
In this retrospective study, CT, ultrasound, and MRI reports with the keyword "recommend" and synonyms between March 11, 2019, and March 29, 2019, were included. Emergency department and inpatient examinations and routine surveillance recommendations, such as lung nodules, were excluded. Performance of follow-up examinations was correlated with the strength of recommendation, conditionality of recommendation, direct communication of results to ordering provider, and history of cancer. Outcomes included adherence to recommendations and time to follow-up. Statistical comparison between groups was performed using χ2, Kruskal-Wallis, and Spearman correlation.
Results:
Qualifying recommendations were provided in 255 reports (age 60.1 ± 16.5 years, female: 151 of 255, 59.22%). Imaging follow-up was performed in 166 of 255 (65%) reports: 148 of 166 (89.15%) nonconditional versus 18 of 166 (10.48%) conditional recommendations (P = .008), and more frequently in the patients with a strong follow-up recommendation (138 of 166 [83.13%], versus 28 of 166 [16.86%]) (P = .009). The median time to follow-up was 28 days versus 82 days in patients without versus with a history of cancer (P = .00057), 28 days versus 70 days with direct communication with the provider versus without (P = .0069), 82.5 versus 21 days for reports in which a specific follow-up interval was provided (86 of 255, 33.72%) versus those without (169 of 255, 66.27%) (P < .001).
Conclusion:
The adherence rate for radiological nonroutine recommendations was 65%. Reports with strongly worded and nonconditional follow-up recommendations were followed more frequently. Direct communication with providers, patients without a known cancer history, and recommendations with no specified time interval identified were followed up earlier.
Clinical Relevance:
Strongly worded and nonconditional follow-up recommendations increase the likelihood of follow-up being performed. Direct communication of imaging follow-up recommendations to the provider and lack of specific time intervals decreases the median time to follow-up, which in turn may decrease the delay in medical care.
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