Improvement in Follow-up Imaging With a Patient Tracking System and Computerized Registry for Lung Nodule Management |
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| Institution: | 1. Chair, Department of Radiology, National Jewish Health, Denver, Colorado;2. Research Informatics Services, National Jewish Health, Denver, Colorado;3. Past President, Medical Executive Committee; Division of Oncology, Department of Medicine, National Jewish Health, Denver, Colorado;4. Chief, Division of Medical, Behavioral and Community Health, Department of Medicine; Past Chair, Institutional Review Board; Chair, Ethics Resource Committee, National Jewish Health, Denver, Colorado;1. Department of Radiology, University of Washington School of Medicine, Seattle, Washington;2. Department of Radiology, University of Michigan School of Medicine, Ann Arbor, Michigan;1. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;2. Director, Center for Translational Imaging Informatics, Perelmen School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;4. Vice Chairman, Department of Radiology, University of Pennsylvania Health System, Philadelphia, Pennsylvania;5. Associate Professor, Co-director, Automated Radiology Recommendation Tracking Engine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;1. Brighton Radiology Associates, Beaver, Pennsylvania;2. Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania |
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| Abstract: | PurposeDespite established guidelines, radiologists’ recommendations and timely follow-up of incidental lung nodules remain variable. To improve follow-up of nodules, a system using standardized language (tracker phrases) recommending time-based follow-up in chest CT reports, coupled with a computerized registry, was created.Materials and MethodsData were obtained from the electronic health record and a facility-built electronic lung nodule registry. We evaluated two randomly selected patient cohorts with incidental nodules on chest CT reports: before intervention (September 2008 to March 2011) and after intervention (August 2011 to December 2016). Multivariable logistic regression was used to compare the cohorts for the main outcome of timely follow-up, defined as a subsequent report within 13 months of the initial report.ResultsIn all, 410 patients were included in the pretracker cohort versus 626 in the tracker cohort. Before system inception, 30% of CT reports lacked an explicit time-based recommendation for nodule follow-up. The proportion of patients with timely follow-up increased from 46% to 55%, and the proportion of those with no documented follow-up or follow-up beyond 24 months decreased from 48% to 31%. The likelihood of timely follow-up increased 41%, adjusted for high risk for lung cancer and age 65 years or older. After system inception, reports missing a tracker phrase for nodule recommendation averaged 6%, without significant interyear variation.ConclusionsStandardized language added to CT reports combined with a computerized registry designed to identify and track patients with incidental lung nodules was associated with improved likelihood of follow-up imaging. |
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| Keywords: | Chest CT incidental pulmonary nodule lung nodule lung nodule follow-up lung nodule registry lung nodule tracking |
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