Contacting Patients About Abnormal Findings Isn’t Enough to Prompt Follow-Up

It takes more than just a letter or a phone call to prompt patients to follow-up with their doctors on any abnormal imaging findings, industry researchers have found.

In a study that examines the impact of a new law – Pennsylvania Act 112: The Patient Test Result Information Act – investigators from the University of Pennsylvania determined the law directly impacted behavior in less than 1 percent of patients, underscoring the need for more timely patient-provider conversations, as well as more direct radiologist intervention.

“Act 112 has a small impact at our institution on improving completed follow-up for abnormal imaging findings,” wrote the team led by Tessa Cook, M.D., assistant professor of radiology at Perelman School of Medicine at the University of Pennsylvania. “Our results also imply that health systems should encourage timeliness of patient-provider discussions of abnormal findings and facilitate direct radiologist communication with ordering providers.”

Act 112 requires diagnostic imaging facilities to notify outpatients within 20 days of any abnormal findings that should be re-assessed by a provider within three months. To determine the law’s efficacy and impact, the team analyzed findings flagged for patient follow-up during a one-month time period.

Primarily interested in whether – and by whom – the law prompted discussions, the team also investigated how much time elapsed between completion of the imaging study and the discussion with the patient. They published their findings in the June 22 Journal of the American College of Radiology.

Based on an evaluation of 235 findings that fell under Act 112 from 213 imaging reports, including CT, fluoroscopy, MRI, PET/CT, ultrasound, and X-ray studies, there were documented discussions for 88 percent of patients and 87 percent of findings. Providers initiated 42 percent of conversations compared to 17 percent prompted by patients. And, the average time between study and discussion was six days with it taking less time for providers to initiate follow-up discussions than patients.

Although appropriate conversations occurred for the majority of abnormal findings, the team was only able to potentially attribute 3 percent to Act 112 patient-initiated conversations – and only one case – 0.04 percent – could verifiably be attributed to the law.

The team also noted that interpreting radiologists contacted referring providers in 44 percent of cases even though almost all – 89 percent – of cases clearly included a radiologist note about needed follow-up. The radiologists did, however, add standard follow-up templates for 41 percent of index findings, leading patients to receive follow-up care in 75 percent of cases.

In cases where the interpreting radiologist got involved, the team found, there was more proactive activity around follow-up.

“We found that radiologist contact significantly predicted both the occurrence of follow-up discussions for imaging abnormalities and the length of time from imaging to follow-up completion on adjusted analysis,” the team wrote. “This finding may reflect the severity of the abnormal imaging findings.”

But, Act 112 offers little guidance for radiologists on what type of findings should be flagged for the law, potentially leading some radiologists to err on the side of caution and flag every finding that could require any follow-up.

Overall, the team said, the efficacy of Act 112 could be augmented with interventions designed to both improve the timeliness of conversations between patient and providers and possible follow-up to abnormal imaging findings and prompt higher levels of radiologist-referring provider communication. A greater use of automated monitoring systems could be one option, they suggested.

“The impact of these interventions can be maximized through coproduction by radiologists, ordering providers, and even patients,” the team wrote.