Title: Location, Location, Location: The Association Between Imaging Setting and Follow-Up of Findings of Indeterminate Malignant Potential
Country: United States
Age: Adult Only
Sex: All Sexes
Care Setting: Outpatient Ambulatory and Primary Care
Clinical Setting: Incidental Finding Follow Up
Data Level: Single Institution
Data Type: EHR
Data Source: Local data
Conclusion: Disparities In All Minority Groups
Health OutComes Reported: No
Free Text Conclusion: Black patients less likely to get follow up imaging of incidental lesions.
Abstract: Purpose: To evaluate the relationship between patient location at time of imaging and completion of relevant imaging follow-up for findings with indeterminate malignant potential. Methods: We used a mandatory hospital-wide standardized assessment categorization system to analyze all ultrasound, CT, and MRI examinations performed over a 7-month period. Multivariate logistic regression, adjusted for imaging modality, characteristics of patients, ordering clinicians, and interpreting radiologists, was used to evaluate the relationship between patient location (outpatient, inpatient, or emergency department)at the time of index examination and completion of relevant outpatient imaging follow-up. Results: Relevant follow-up occurred in 49% of index examinations, with a greater percentage among those performed in the outpatient setting compared with those performed in the inpatient or emergency department settings (62% versus 18% versus 17%, respectively). Compared with examinations obtained in the outpatient setting, examinations performed in the emergency department (adjusted odds ratio [aOR]0.07; 95% confidence interval [CI], 0.03-0.19)and inpatient (aOR 0.14; 95% CI, 0.09-0.23) settings were less likely to be followed up. Black patients and those residing in lower-income neighborhoods were also less likely to receive relevant follow-up. Few lesions progressed to more suspicious lesions (4.6%). Conclusions: Patient location at time of imaging is associated with the likelihood of completing relevant follow-up imaging for lesions with indeterminate malignant potential. Future work should evaluate health system-level care processes related to care setting, as well as their effects on appropriate follow-up imaging. Doing so would support efforts to improve appropriate follow-up imaging and reduce health care disparities.