Hansra Shan S, Loehfelm Thomas W, Wilson Machelle, Corwin Michael T
Department of Radiology, University of California, Davis Medical Center, Sacramento, California.
Associate Chair of Informatics, Department of Radiology, University of California, Davis Medical Center, Sacramento, California.
J Am Coll Radiol. 2021 Feb;18(2):233-239. doi: 10.1016/j.jacr.2020.02.021. Epub 2020 Aug 25.
To determine the rate at which recommendations for additional imaging (RAIs) of incidental findings on CT are adhered to at a tertiary-care medical center and what factors influence adherence.
We used a radiology clinical informatics tool (mPower, Nuance Communications Inc, Burlington, Massachusetts) to identify RAIs in reports from all CT examinations performed at a tertiary-care medical center during a 6-month period. For those studies in which the RAI was for incidental findings, we reviewed the patients' charts to determine if there was appropriate follow-up of the lesion in question.
The overall rate of adherence to RAIs was 39.1%, and in patients with a same-institution primary care provider (PCP), 56.8% (P < .0001). Adherence was higher in studies ordered in the outpatient setting (P < .0001) and in patients with a same-institution PCP (P < .0001). Among patients with a same-institution PCP, adherence was highest for outpatients (66.7%), followed by patients seen in the emergency department (46.0%) and inpatients (36.0%). Among outpatients, adherence was highest with PCPs (67%) followed by internal medicine subspecialties (50%) and surgery (38%).
The rate of adherence to recommendations for additional imaging of incidental findings was 39.1% in this study and higher for patients with a same-institution PCP, studies ordered in the outpatient setting, and in studies ordered by PCPs.
确定在一家三级医疗中心，针对CT检查中偶然发现的额外影像学检查建议（RAIs）的遵循率，以及哪些因素会影响遵循情况。
我们使用了一种放射学临床信息工具（mPower，Nuance通信公司，马萨诸塞州伯灵顿）来识别在6个月期间一家三级医疗中心进行的所有CT检查报告中的RAIs。对于那些RAIs是针对偶然发现的研究，我们查阅了患者病历，以确定是否对相关病变进行了适当的随访。
对RAIs的总体遵循率为39.1%，在有同机构初级保健提供者（PCP）的患者中为56.8%（P <.0001）。在门诊环境中开具的研究中遵循率更高（P <.0001），在有同机构PCP的患者中也是如此（P <.0001）。在有同机构PCP的患者中，门诊患者的遵循率最高（66.7%），其次是急诊科患者（46.0%）和住院患者（36.0%）。在门诊患者中，PCP开具的检查遵循率最高（67%），其次是内科亚专科（50%）和外科（38%）。
在本研究中，针对偶然发现的额外影像学检查建议的遵循率为39.1%，对于有同机构PCP的患者、门诊环境中开具的研究以及PCP开具的研究，遵循率更高。
