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  11. Association Of Patient And Health Care Organization Factors With Incidental Nodule Guidelines Adherence: A Multi-system Observational Study

Association of patient and health care organization factors with incidental nodule guidelines adherence: A multi-system observational study

Christopher G Slatore1, Elizabeth R Hooker2, Sarah Shull2

  • 1Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239, USA; Division of Pulmonary & Critical Care Medicine, Department of Medicine, and Department of Radiation Medicine, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.

Lung Cancer (Amsterdam, Netherlands)
|March 7, 2024

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View abstract on PubMed

Summary
This summary is machine-generated.

Radiologist adherence to pulmonary nodule guidelines was 69%, but only 48% of patients had guideline-concordant follow-up. Healthcare systems need better tools to ensure appropriate patient follow-up for incidental pulmonary nodules.

Area of Science:

  • Pulmonary Medicine
  • Radiology
  • Health Services Research

Background:

  • Healthcare organizations are implementing systems to improve guideline adherence for pulmonary nodule care.
  • This study aimed to identify factors influencing radiologist adherence and patient/clinician concordance with 2005 Fleischner Society guidelines for incidental pulmonary nodule follow-up.

Purpose of the Study:

  • To determine patient and organizational factors associated with radiologist adherence to 2005 Fleischner Society guidelines for incidental pulmonary nodule follow-up.
  • To assess clinician and patient concordance with these guidelines.

Main Methods:

  • Data abstracted from electronic health records of 3150 patients with incidental pulmonary nodules from two Veterans Affairs healthcare systems (2008-2016).
  • Radiology reports and patient follow-up data were classified for adherence and concordance with 2005 Fleischner Society guidelines.
Keywords:
AdherenceGuidelinesPulmonary noduleSurveillance

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  • Multivariable-adjusted predicted probabilities were calculated to identify associated factors.

    • Main Results:

    • 69% of radiologist recommendations were guideline-adherent; 27% recommended less aggressive follow-up.
    • Only 48% of patients had follow-up concordant with guidelines; 37% had less aggressive follow-up.
    • Radiologist adherence was associated with clinician/patient concordance, with healthcare system as a potential modifier.

    Conclusions:

    • Clinicians and patients generally follow radiologists' recommendations, but downstream healthcare system processes often lead to non-concordant follow-up.
    • Healthcare organizations require robust systems to ensure appropriate follow-up for patients with pulmonary nodules.