A little over 25% of patients failed to get follow-up imaging that their referrers deemed clinically necessary.
Patients from disadvantaged socioeconomic backgrounds are less likely to complete follow-up imaging deemed necessary by referrers.
In a study, radiologists made 5,856 recommendations for follow-up imaging, with referrers agreeing with 4,881 instructions. Of these agreed upon cases, 3,651 patients (74.8%) completed exams, while 25.2% did not. Researchers at Brigham and Women’s Hospital of Harvard Medical School, in Boston, found that most who failed to adhere to follow-up orders live in low-income areas.
Receiving follow-up instructions while in the ED, or upon being discharged from the hospital, and having a surgical specialist as a referrer also contributed to incomplete exams.
“Initiatives for ensuring follow-up imaging completion should target the identified patient groups to reduce disparities in missed and delayed diagnoses,” wrote first author Dr. Neena Kapoor, from the Center for Evidence-Based Imaging at Brigham and Women's.
Kapoor and her colleagues assessed records of a closed-loop communications and tracking tool embedded in their institution’s PACS and EHR. The tool asked referrers to indicate if follow-up recommendations were necessary. If they said yes, the tool tracked if the exam was performed.
If it was not performed within one month of the intended date of completion, the tool alerted a safety net team to perform further patient and referrer follow-up. It also conducted an EHR review to check on possible follow-through at or outside Brigham and Women’s after the one-month period.
Taking into account patient-, referrer, and imaging-related factors, the tool showed that independent predictors of follow-up failure were living in a socioeconomically disadvantaged neighborhood (odds ratio, 0.67), and inpatient (0.25) or emergency (0.09) status.
The authors attributed lower rates among inpatients and ED patients to challenges associated with coordinating follow-up care, even for those with documented primary care providers. They also said surgical referrers may be less likely to order follow-up imaging for findings not related to the reason for the surgical consult.
The findings were published in ARRS’ American Journal of Roentgenology (AJR).
