Reducing Delay in Diagnosis: Multistage Recommendation Tracking
Reducing Delay in Diagnosis: Multistage Recommendation Tracking
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DOI：
10.2214/ajr.17.18332
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发表时间：
2017-11-01
影响因子：
5
通讯作者：
Gallagher, Sarah
中科院分区：
文献类型：
--
作者：
Wandtke, Ben;Gallagher, Sarah
OBJECTIVE.本研究的目的是确定多阶段跟踪系统是否可以改善医疗保健提供者之间的沟通，降低与不一致的沟通和跟踪放射学随访建议相关的诊断延迟的风险。将所有诊断成像模式（不包括乳腺X线摄影）的无条件成像随访建议（n = 589）输入数据库，并通过多级跟踪系统跟踪13个月。对于在推荐到期日后1个月无法确定完成推荐随访成像的患者，进行跟踪干预。干预后对随访建议的依从性要求完成检查或临床关闭（即，活组织检查、预期寿命有限或死亡，或亚专科转诊）。在建议到期日后1个月进行的基线放射学信息系统检查显示，在干预前，我们机构及时完成了43.1%的建议影像学检查。研究了三种单独的跟踪干预措施，显示有效性在29.0%至57.8%之间。多阶段跟踪系统将检查完成率提高到70.5%（增加52%），并将未知随访依从性和诊断延迟的相关风险降低到13.9%（降低74%）。跟踪干预后完成的检查产生的收入是劳动力成本的4.1倍。执行顺序放射学建议跟踪干预可以大大降低未知的后续遵守率，并为卫生系统增加价值。未知的随访依从性是诊断延迟的一个风险因素，这是一种可预防的医疗错误，通常在涉及放射科医生和办公室从业人员的医疗事故索赔中发现。
OBJECTIVE. The purpose of this study was to determine whether a multistage tracking system could improve communication between health care providers, reducing the risk of delay in diagnosis related to inconsistent communication and tracking of radiology follow-up recommendations.MATERIALS AND METHODS. Unconditional recommendations for imaging follow-up of all diagnostic imaging modalities excluding mammography (n = 589) were entered into a database and tracked through a multistage tracking system for 13 months. Tracking interventions were performed for patients for whom completion of recommended follow-up imaging could not be identified 1 month after the recommendation due date. Postintervention compliance with the follow-up recommendation required examination completion or clinical closure (i.e., biopsy, limited life expectancy or death, or subspecialist referral).RESULTS. Baseline radiology information system checks performed 1 month after the recommendation due date revealed timely completion of 43.1% of recommended imaging studies at our institution before intervention. Three separate tracking interventions were studied, showing effectiveness between 29.0% and 57.8%. The multistage tracking system increased the examination completion rate to 70.5% (a 52% increase) and reduced the rate of unknown follow-up compliance and the associated risk of delay in diagnosis to 13.9% (a 74% decrease). Examinations completed after tracking intervention generated revenue of 4.1 times greater than the labor cost.CONCLUSION. Performing sequential radiology recommendation tracking interventions can substantially reduce the rate of unknown follow-up compliance and add value to the health system. Unknown follow-up compliance is a risk factor for delay in diagnosis, a form of preventable medical error commonly identified in malpractice claims involving radiologists and office-based practitioners.