A Standardized Radiology Template Improves Incidental Adrenal Mass Follow-Up: A Prospective Effectiveness and Implementation Study |
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| Institution: | 1. Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; and Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;2. Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois;3. Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina;4. Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts;5. Department of Psychiatry, University of California San Diego, La Jolla, California;6. Department of Radiology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Abdominal Imaging Fellowship Director, Department of Radiology, Information Technology Officer, Boston Medical Center, Boston, Massachusetts;7. Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts; The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University, Boston, Massachusetts; Codirector of the Evans Center for Implementation and Improvement Sciences, Boston University;8. Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA; Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University, Boston, Massachusetts; and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Codirector of the Evans Center for Implementation and Improvement Sciences, Boston University;9. Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Chief Medical Officer, Senior Vice President of Medical Affairs, Associate Dean for Clinical Affairs, Boston Medical Center;10. Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Chief of Endocrine Surgery, Boston Medical Center;1. University of Texas Southwestern Medical Center, Dallas, Texas;2. Affordability Working Group and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York;3. Affordability Working Group and the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York;1. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;2. Department of Radiology, Université Paris Cité, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France;3. Director, Diagnostic Imaging, Johns Hopkins Hospital, Baltimore, Maryland |
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| Abstract: | PurposeIncidental adrenal masses (IAMs) are common but rarely evaluated. To improve this, we developed a standardized radiology report recommendation template and investigated its implementation and effectiveness.MethodsWe prospectively studied implementation of a standardized IAM reporting template as part of an ongoing quality improvement initiative, which also included primary care provider (PCP) notifications and a straightforward clinical algorithm. Data were obtained via medical record review and a survey of radiologists. Outcomes included template adoption rates and acceptability (implementation measures), as well as the proportion of patients evaluated and time to follow-up (effectiveness outcomes).ResultsOf 4,995 imaging studies, 200 (4.0%) detected a new IAM. The standardized template was used in 54 reports (27.0%). All radiologists surveyed were aware of the template, and 91% affirmed that standardized recommendations are useful. Patients whose reports included the template were more likely to have PCP follow-up after IAM discovery compared with those with no template (53.7% versus 36.3%, P = .03). After adjusting for sex, current or prior malignancy, and provider ordering the initial imaging (PCP, other outpatient provider, or emergency department or inpatient provider), odds of PCP follow-up remained 2.0 times higher (95% confidence interval 1.02-3.9). Patients whose reports included the template had a shorter time to PCP follow-up (log-rank P = .018). PCPs ultimately placed orders for biochemical testing (35.2% versus 18.5%, P = .01), follow-up imaging (40.7% versus 23.3%, P = .02), and specialist referral (22.2% versus 4.8%, P < .01) for a higher proportion of patients who received the template compared with those who did not.ConclusionsUse of a standardized template to communicate IAM recommendations was associated with improved IAM evaluation. Our template demonstrated high acceptability, but additional strategies are necessary to optimize adoption. |
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| Keywords: | Adrenal masses implementation science incidental findings standardized recommendations |
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