Facilitating Surveillance of Incidental Findings Using a Novel Reporting Template: Proof of Concept in Patients With Pancreatic Abnormalities |
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| Affiliation: | 1. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;2. Chief, Division of Body MRI; Associate Chief, Division of Abdominal Imaging, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;3. Department of Internal Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas;4. Director of Quality, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;5. Clinical Chief, Division of Digestive and Liver Diseases; Director of Endoscopy, Clements University Hospital, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas;6. Vice Chair of Quality, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas;7. AR Curreri Professor and Chair, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;8. APP Program Manager, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas;9. Primary PA provider, Pancreatic Cancer Prevention Multidisciplinary Program, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas;10. Vice Chair of Research, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;11. Vice Chair of Academic Affairs, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;1. Fellowship Director of Cardiothoracic Radiology, Research Director, Duke Lung Cancer Screening Program, Department of Radiology, Duke University Medical Center, Durham, North Carolina;2. Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest, North Carolina;3. Department of Cardiology, Wake Forest Baptist Medical Center, Wake Forest, North Carolina;4. Medical Director, Pulmonary Function Test and Bronchoscopy Services; Service Chief, Pulmonary Inpatient Service, Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine; Director, Lung Cancer Screening Program, University of North Carolina School of Medicine., Chapel Hill, North Carolina;5. Department of Surgery, Duke University Medical Center, Durham, North Carolina;6. Clinical Director, Lung Cancer Screening Program, Duke University Health System, Duke Cancer Institute, Duke University, Durham, North Carolina;7. Department of Radiology, Duke University Medical Center, Durham, North Carolina;8. Department of Radiology, University of North Carolina School of Medicine., Chapel Hill, North Carolina;9. Duke Cancer Institute, Duke University, Durham, North Carolina;10. Manager, Duke Cancer Institute (DCI) Biostatistics Shared Resource and Internship Director, Biostatistics Core Training and Internship Program, Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina;11. Director Epidemiology Research Team, Director Carolina Mammography Registry; Co-Lead, Cancer Epidemiology Program at Lineberger Comprehensive Cancer Center; Department of Radiology, University of North Carolina School of Medicine., Chapel Hill, North Carolina;1. Vice Chair of Academic Affairs and Associate Program Director of the Diagnostic Radiology Residency in the Department of Radiology, Boston University Medical Center, Boston, Massachusetts;2. Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts;3. Chair of Radiology, Department of Radiology, Boston University Medical Center, Boston, Massachusetts;4. Director of Academic Innovation for the Department of Medical Imaging Department, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois;5. Director of Radiology, Denver Health, Denver, Colorado;6. Professor and Vice Chair, Department of Radiology, University of Colorado School of Medicine, Denver, Colorado;1. Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts;2. Vice Chair for Quality and Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts;3. Division Chief of Vascular and Interventional Radiology, Vice Chair for Interventional Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts;4. Abdominal Radiology Section Chief at Beth Israel Deaconess Medical Center, Boston, Massachusetts;1. University Hospital Llandough, Llandough, Penarth, UK;2. Office of Quality & Safety, NYC Health + Hospitals, New York, New York;3. Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut;4. Department of Diagnostic Radiology, Nationwide Children’s Hospital, Columbus, Ohio;1. Department of Radiology, Ohio State University Wexner Medical Center, Columbus, Ohio;2. Northwest Radiology, St Vincent Health, Indianapolis, Indiana;3. Harvey L. Neiman Health Policy Institute, Reston, Virginia;4. Executive Director, Harvey L. Neiman Health Policy Institute, Reston, Virginia;5. Director of Scholarly Activity/Research, Department of Radiology, Ohio State University, Wexner Medical Center, Columbus, Ohio |
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| Abstract: | ObjectiveTo determine the surveillance impact of utilizing a discrete field in structured radiology reports in patients with incidental pancreatic findings.MethodsWe implemented a dictation template containing a discrete structured field element to auto-trigger listing of patients with incidental pancreatic findings on a pancreas clinic registry in the electronic health record. We isolated CT and MRI reports with incidental pancreatic findings over a 24-month period. We stratified patients by presence or absence of the discrete field element in reports (flagged versus unflagged) and evaluated the impact of report flagging on likelihood of clinic follow-up, follow-up imaging, endoscopic ultrasound, surgical intervention, genetics referral, obtaining pathologic diagnosis, and time interval between index imaging to various outcomes.ResultsPatients with flagged reports were more likely to be seen or discussed in a pancreas clinic compared with those with unflagged reports (189 of 376, 50.3% versus 79 of 474, 16.7%; P <. 001). Patients with flagged reports were more likely to get follow-up imaging than patients with unflagged reports (188 of 376, 50.0% versus 121 of 474, 25.5%; P < .001) and were more likely to undergo appropriate management of actionable findings compared with patients in the unflagged group (23 of 62, 37.1% versus 28 of 129, 21.7%; P = .036).DiscussionImplementation of a structured discrete field element for reporting of patients with incidental pancreatic findings had positive impact on surveillance measures and can be applied in other organ systems with established surveillance guidelines to standardize patient care. |
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| Keywords: | Dictation template incidental finding structured report surveillance pancreatic cyst |
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