Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program
Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program
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DOI：
10.1016/j.jacr.2017.10.014
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发表时间：
2018-02-01
影响因子：
4.5
通讯作者：
Wald, Christoph
中科院分区：
文献类型：
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作者：
Alshora, Sama;McKee, Brady J.;Wald, Christoph
背景：评估患者在临床 CT 肺癌筛查计划中对放射科医生建议的遵守情况。方法：2012 年 1 月 12 日至 2013 年 6 月 12 日期间接受 CT 肺癌筛查的患者均纳入机构审查委员会批准的回顾性审查中。从我们机构外部转诊的患者被排除在外。所有患者均符合国家综合癌症网络指南肺癌筛查高风险标准。全职项目导航员使用 CT 肺部筛查项目管理系统来安排患者预约，生成详细说明放射科医生后续建议的患者结果通知信，并跟踪患者和转诊医生在 30、60 和 90 天错过预约的通知。要被视为依从性，截至 2014 年 9 月 12 日，患者进行下一次推荐检查的时间不得超过 90 天。死亡、被诊断患有癌症或以其他方式变得不符合筛查资格的患者被视为依从性。对多个变量的依从率进行了评估。结果：在研究间隔期间，对 1,162 名高危患者进行了筛查，并排除了 1,162 名外部转诊患者中的 261 名 (22.5%)。其余 901 名患者中，503 名（55.8%）为男性，414 名（45.9%）为活跃吸烟者，377 名（41.8%）年龄为 65 至 73 岁，>95% 为白人。在 901 名患者中，772 名（85.7%）坚持治疗。不依从的最常见原因是患者拒绝随访检查（66.7%）、无法成功联系患者（20.9%）以及无法从转诊提供者处获得随访指令（7.8%）； 901 名患者中，有 23 名 (2.6%) 因其他原因出院。结论：对于参加临床 CT 肺部筛查计划的网络内患者，对放射科医生建议的遵守率很高。
Background: Assess patient adherence to radiologist recommendations in a clinical CT lung cancer screening program.Methods: Patients undergoing CT lung cancer screening between January 12, 2012, and June 12, 2013, were included in this institutional review board approved retrospective review. Patients referred from outside our institution were excluded. All patients met National Comprehensive Cancer Network Guidelines Lung Cancer Screening high-risk criteria. Full-time program navigators used a CT lung screening program management system to schedule patient appointments, generate patient result notification letters detailing the radiologist follow-up recommendation, and track patient and referring physician notification of missed appointments at 30, 60, and 90 days. To be considered adherent, patients could be no more than 90 days past due for their next recommended examination as of September 12, 2014. Patients who died, were diagnosed with cancer, or otherwise became ineligible for screening were considered adherent. Adherence rates were assessed across multiple variables.Results: During the study interval, 1,162 high-risk patients were screened, and 261 of 1,162 (22.5%) outside referrals were excluded. Of the remaining 901 patients, 503 (55.8%) were male, 414 (45.9%) were active smokers, 377 (41.8%) were aged 65 to 73, and >95% were white. Of the 901 patients, 772 (85.7%) were adherent. Most common reasons for nonadherence were patient refusal of follow-up exam (66.7%), inability to successfully contact the patient (20.9%), and inability to obtain the follow-up order from the referring provider (7.8%); 23 of 901 (2.6%) were discharged for other reasons.Conclusions: High rates of adherence to radiologist recommendations are achievable for in-network patients enrolled in a clinical CT lung screening program.