Abdominal and Interventional Radiology Section, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Abdominal Imaging and Intervention Fellowship Director, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Am Coll Radiol. 2023 Jun;20(6):540-547. doi: 10.1016/j.jacr.2023.03.009. Epub 2023 Mar 27.
To identify factors associated with adherence to radiology follow-up recommendations by the referring physicians.
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 χ, Kruskal-Wallis, and Spearman correlation.
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).
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.
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.
确定与参照医师遵循放射学随访建议相关的因素。
在这项回顾性研究中，纳入了 2019 年 3 月 11 日至 3 月 29 日之间带有“推荐”关键字和同义词的 CT、超声和 MRI 报告。排除了急诊科和住院患者检查以及常规监测建议，如肺结节。将随访检查的执行情况与建议的强度、建议的条件性、结果直接与开单医生沟通以及癌症病史相关联。结果包括对建议的遵循情况和随访时间。使用 χ²、克鲁斯卡尔-沃利斯和斯皮尔曼相关性对组间进行统计学比较。
255 份报告中提供了合格的推荐（年龄 60.1±16.5 岁，女性 255 例中的 151 例，占 59.22%）。在 255 份报告中的 166 份（65%）中进行了影像学随访：166 例中非条件性推荐的有 148 例（89.15%），而条件性推荐的有 18 例（10.48%）（P=0.008），并且在推荐意见较强的患者中更常进行随访（166 例中的 138 例[83.13%]，与 166 例中的 28 例[16.86%]）（P=0.009）。无癌症病史的患者的中位随访时间为 28 天，而有癌症病史的患者为 82 天（P=0.00057）；与没有直接与提供者沟通的患者相比，与提供者进行了直接沟通的患者的中位随访时间为 28 天，而没有沟通的患者为 70 天（P=0.0069）；提供了具体随访间隔的报告（255 份报告中的 86 份，占 33.72%）与没有提供具体随访间隔的报告（255 份报告中的 169 份，占 66.27%）相比，中位随访时间为 82.5 天和 21 天（P<0.001）。
放射学非常规建议的遵循率为 65%。措辞强烈且无条件的随访建议更有可能被执行。与提供者进行直接沟通、无已知癌症病史的患者以及没有特定时间间隔的建议，其随访时间更早。
措辞强烈且无条件的随访建议提高了执行随访的可能性。将影像学随访建议直接与提供者沟通，且没有特定时间间隔，可以缩短中位随访时间，从而减少医疗延误。
