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Waite S, Davenport MS, Graber ML, Banja JD, Sheppard B, Bruno M. Opportunity and Opportunism in Artificial-Intelligence-Powered Data Extraction: A Value-Centered Approach. AJR Am J Roentgenol 2024. [PMID: 39291941 DOI: 10.2214/ajr.24.31686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Radiologists' traditional role in the diagnostic process is to respond to specific clinical questions and reduce uncertainty enough to permit treatment decisions. This charge is rapidly evolving due to forces such as artificial intelligence [AI], big data [opportunistic imaging, imaging prognostication], and advanced diagnostic technologies. A new "modernistic" paradigm is emerging whereby radiologists, in conjunction with computer algorithms, will be tasked with extracting as much information from imaging data as possible, often without a specific clinical question being posed and independent of any stated clinical need. In addition, AI algorithms are increasingly able to predict long-term outcomes using data from seemingly normal examinations, enabling AI-assisted prognostication. As these algorithms become a standard component of radiology practice, the sheer amount of information they demand will increase the need for streamlined workflows, communication, and data management techniques. In addition, the provision of such information raises reimbursement, liability, and access issues. Guidelines will be needed to ensure all patients have access to the benefits of this new technology and guarantee mined data do not inadvertently create harm. In this article, we discuss challenges and opportunities relevant to radiologists in this changing landscape, with an emphasis on ensuring that radiologists provide high-value care.
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Affiliation(s)
- Stephen Waite
- Clinical Associate Professor of Radiology and Internal Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY 11203
| | - Matthew S Davenport
- William Martel Collegiate Professor of Radiology and Professor of Urology, Co-Director, Ronald Weiser Center for Prostate Cancer, Service Chief for Radiology, Vice Chair (Research, Academic Affairs, Faculty Development) Michigan Medicine, Michigan Medicine, 1500 E Medical Center Dr, B2A209P, Ann Arbor, MI 48109-5030
| | - Mark L Graber
- Professor Emeritus, Stony Brook University, NY; Founder and President Emeritus, Society to Improve Diagnosis in Medicine (SIDM)
| | - John D Banja
- Professor: Department of Rehabilitation Medicine; Medical Ethicist: Center for Ethics; Associate Editor: Radiology: Artificial Intelligence; Principal Investigator: Radiology, Ethics and Artificial Intelligence Project, Emory University, 1531 Dickey Drive, Room 184
| | - Brian Sheppard
- Professor of Law, Seton Hall University, One Newark Center, Newark, NJ 07102
| | - Michael Bruno
- Professor of Radiology and Medicine, Vice-Chair for Radiology Quality and Safety, Chief Section Emergency Medicine, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033
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Kanemaru N, Yasaka K, Fujita N, Kanzawa J, Abe O. The Fine-Tuned Large Language Model for Extracting the Progressive Bone Metastasis from Unstructured Radiology Reports. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01242-3. [PMID: 39187702 DOI: 10.1007/s10278-024-01242-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/03/2024] [Accepted: 08/19/2024] [Indexed: 08/28/2024]
Abstract
Early detection of patients with impending bone metastasis is crucial for prognosis improvement. This study aimed to investigate the feasibility of a fine-tuned, locally run large language model (LLM) in extracting patients with bone metastasis in unstructured Japanese radiology report and to compare its performance with manual annotation. This retrospective study included patients with "metastasis" in radiological reports (April 2018-January 2019, August-May 2022, and April-December 2023 for training, validation, and test datasets of 9559, 1498, and 7399 patients, respectively). Radiologists reviewed the clinical indication and diagnosis sections of the radiological report (used as input data) and classified them into groups 0 (no bone metastasis), 1 (progressive bone metastasis), and 2 (stable or decreased bone metastasis). The data for group 0 was under-sampled in training and test datasets due to group imbalance. The best-performing model from the validation set was subsequently tested using the testing dataset. Two additional radiologists (readers 1 and 2) were involved in classifying radiological reports within the test dataset for testing purposes. The fine-tuned LLM, reader 1, and reader 2 demonstrated an accuracy of 0.979, 0.996, and 0.993, sensitivity for groups 0/1/2 of 0.988/0.947/0.943, 1.000/1.000/0.966, and 1.000/0.982/0.954, and time required for classification (s) of 105, 2312, and 3094 in under-sampled test dataset (n = 711), respectively. Fine-tuned LLM extracted patients with bone metastasis, demonstrating satisfactory performance that was comparable to or slightly lower than manual annotation by radiologists in a noticeably shorter time.
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Affiliation(s)
- Noriko Kanemaru
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Koichiro Yasaka
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Nana Fujita
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Jun Kanzawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Wu KY, Beaulieu É, Daigle P. Interdisciplinary quality improvement in oculoplastic surgery: transforming biopsy follow-up through PDSA cycles. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00217-5. [PMID: 39153736 DOI: 10.1016/j.jcjo.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 06/06/2024] [Accepted: 07/02/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVE To evaluate and improve the quality of periocular biopsy follow-up by determining the absolute compliance rate, examining delays between stages, identifying obstacles to high-quality follow-up, and offering recommendations for improvement. METHODS Phase 1: A retrospective, observational, and descriptive study was conducted using chart reviews of adult patients who underwent periocular biopsies at the Centre Hospitalier Universitaire de Sherbrooke (CHUS) from January 2019 to October 2022. Phase 2: Three simultaneous Plan-Do-Study-Act (PDSA) cycles were implemented, focusing on enhancing communication channels between clinicians and pathologists, introducing a priority system for urgent cases, and establishing an automatic reminder system for pathologists. RESULTS Phase 1: Among the 103 patients analyzed, 29 had malignant lesions, while 74 had nonmalignant lesions. The absolute compliance rate was 37.9% for malignant lesions. All of these noncompliances were due to excessive turnaround time (TT) to issue the pathology report. The percentage of cases that had adequate pathology TT (≤ 7 days) were 37.9% for malignant lesions, much lower than the Quebec Ministry of Health's target (80% at ≤7 days). Phase 2: The implemented PDSA cycles led to significant increases in absolute compliance rates and pathology TT compliance rates for malignant lesions. Primary outcomes showed that the absolute compliance rate increased to 93.3%. Secondary outcomes indicated that the pathology TT compliance rate also reached 93.3%. CONCLUSIONS Delayed pathology reporting was identified as the primary cause of suboptimal follow-up. The successful implementation of targeted PDSA cycles improved communication, prioritization, and reminder systems, resulting in considerable improvements in primary and secondary outcomes.
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Affiliation(s)
- Kevin Y Wu
- Department of Surgery - Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Patrick Daigle
- Department of Surgery - Division of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada.
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Jhala K, Lynch EA, Eappen S, Curley P, Desai SP, Brink J, Khorasani R, Kapoor N. Financial Impact of a Radiology Safety Net Program for Resolution of Clinically Necessary Follow-up Imaging Recommendations. J Am Coll Radiol 2024; 21:1258-1268. [PMID: 38147905 DOI: 10.1016/j.jacr.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/01/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Health care safety net (SN) programs can potentially improve patient safety and decrease risk associated with missed or delayed follow-up care, although they require financial resources. This study aimed to assess whether the revenue generated from completion of clinically necessary recommendations for additional imaging (RAI) made possible by an IT-enabled SN program could fund the required additional labor resources. METHODS Clinically necessary RAI generated October 21, 2019, to September 24, 2021, were tracked to resolution as of April 13, 2023. A new radiology SN team worked with existing schedulers and care coordinators, performing chart review and patient and provider outreach to ensure RAI resolution. We applied relevant Current Procedural Terminology, version 4 codes of the completed imaging examinations to estimate total revenue. Coprimary outcomes included revenue generated by total performed examinations and estimated revenue attributed to SN involvement. We used Student's t test to compare the secondary outcome, RAI time interval, for higher versus lower revenue-generating modalities. RESULTS In all, 24% (3,243) of eligible follow-up recommendations (13,670) required SN involvement. Total estimated revenue generated by performed recommended examinations was $6,116,871, with $980,628 attributed to SN. Net SN-generated revenue per 1.0 full-time equivalent was an estimated $349,768. Greatest proportion of performed examinations were cross-sectional modalities (CT, MRI, PET/CT), which were higher revenue-generating than non-cross-sectional modalities (x-ray, ultrasound, mammography), and had shorter recommendation time frames (153 versus 180 days, P < .001). DISCUSSION The revenue generated from completion of RAI facilitated by an IT-enabled quality and safety program supplemented by an SN team can fund the required additional labor resources to improve patient safety. Realizing early revenue may require 5 to 6 months postimplementation.
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Affiliation(s)
- Khushboo Jhala
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elyse A Lynch
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sunil Eappen
- Senior Vice President of Medical Affairs, Chief Medical Officer, Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patrick Curley
- Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Executive Director, Quality and Safety, Enterprise Radiology, Mass General Brigham
| | - Sonali P Desai
- Chief Quality Officer, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Brink
- Chair, Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Chief, Enterprise Radiology Service, Mass General Brigham
| | - Ramin Khorasani
- Vice Chair, Department of Radiology, Center for Evidence-Based Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Director, Center for Evidence-Based Imaging, Brigham and Women's Hospital
| | - Neena Kapoor
- Associate Chair, Patient Experience and Clinically Significant Results, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Watson J, Duncan P, Burrell A, Bennett-Britton I, Hodgson S, Merriel SWD, Waqar S, Razumovskaya-Hough A, Whiting PF. Patient safety in actioning and communicating blood test results in primary care: a UK wide audit using the Primary care Academic CollaboraTive (PACT). BMJ Open Qual 2024; 13:e002632. [PMID: 39059792 DOI: 10.1136/bmjoq-2023-002632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Errors associated with failures in filing, actioning and communicating blood test results can lead to delayed and missed diagnoses and patient harm. This study aimed to audit how blood tests in primary care are filed, actioned and communicated in primary care, to identify areas for patient safety improvements. METHODS UK primary care clinicians were recruited through the Primary Care Academic CollaboraTive (PACT). PACT members audited 50 recent sets of blood tests from their practice and retrospectively extracted data on blood test result coding, actioning and communication. PACT members received a practice report, showing their own results, benchmarked against other participating practices. RESULTS PACT members from 57 general practices across all four UK nations collected data on 2572 patients who had blood tests in April 2021. In 89.9% (n=2311) they agreed with the initial clinician's actioning of blood tests; 10.1% disagreed, either partially (7.1%) or fully (3.0%).In 44% of patients (n=1132) an action (eg, 'make an appointment') was specified by the filing clinician. This action was carried out in 89.7% (n=1015/1132) of cases; in 6.8% (n=77) the action was not carried out, in 3.5% (n=40) it was unclear. In the 117 cases where the test result had not been actioned 38% (n=45) were felt to be at low risk of harm, 1.7% (n=2) were at high risk of harm, 0.85% (n=1) came to harm.Overall, in 47% (n=1210) of patients there was no evidence in the electronic health records that results had been communicated. Out of 1176 patients with one or more abnormal results there was no evidence of test communication in 30.6% (n=360). There were large variations between practices in rates of actioning and communicating tests. CONCLUSION This research demonstrates variation in the way blood test results are actioned and communicated, with important patient safety implications.
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Affiliation(s)
- Jessica Watson
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Polly Duncan
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | | | | | - Samuel W D Merriel
- Exeter Collaboration for Academic Primary Care (APEx), University of Exeter Medical School, Exeter, UK
- Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK
| | | | | | - Penny F Whiting
- Population Health Sciences, University of Bristol, Bristol, UK
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Zaki-Metias KM, McKee H, Applewhaite C, Davis MK, Keyes M, LeVasseur N, Nguyen ET, Seely JM, Yong-Hing CJ. Breast Arterial Calcifications on Mammography: Awareness and Reporting Preferences Amongst Referring Physicians in Canada. Can Assoc Radiol J 2024:8465371241262292. [PMID: 39039993 DOI: 10.1177/08465371241262292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Abstract
Purpose: Breast arterial calcifications (BAC) on mammography have been correlated with increased cardiovascular risk. The Canadian Society of Breast Imaging released a position statement on BAC reporting in January 2023. This study evaluates the awareness of the clinical significance of BAC and reporting preferences of referring physicians in Canada. Methods: A 15-question survey was distributed to Canadian physicians who may review mammography results via regional and subspecialty associations and on social media following local institutional ethical approval. Responses were collected over 10 weeks from February to April 2023. Results: Seventy-two complete responses were obtained. We are unable to determine the response rate, given the means of distribution. Only 17% (12/72) of responding physicians were previously aware of the association between BAC and increased cardiovascular risk, and 51% (37/72) preferred the inclusion of BAC in the mammography report. Fifty-six percent (40/72) indicated that BAC reporting would prompt further investigation, and 63% (45/72) would inform patients that their mammogram showed evidence of BAC. Sixty-nine percent (50/72) would find grading of BAC beneficial and 71% (51/72) agreed that there is a need for national guidelines. Conclusion: Less than a quarter of responding Canadian referring physicians were previously aware of the association between BAC and cardiovascular risk, although half of respondents indicated a preference for BAC reporting on mammography. Most participating physicians would inform their patients of the presence of BAC and consider further cardiovascular risk management. There was consensus that a national BAC grading system and clinical management guidelines would be beneficial.
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Affiliation(s)
- Kaitlin M Zaki-Metias
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Hayley McKee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Margot K Davis
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Mira Keyes
- Radiation Oncology, BC Cancer, Vancouver, BC, Canada
- Department of Radiation Oncology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
| | - Jean M Seely
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Charlotte J Yong-Hing
- Diagnostic Imaging, BC Cancer, Vancouver, BC, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Hanganu CB, Isswiasi S, Adigun A, Nichita V, Sen R, Anwaar M, Drye E. Timely Review and Communication of Histopathology Reports Following Appendicectomy: Insights from a Two-Cycle Clinical Audit. Cureus 2024; 16:e58539. [PMID: 38957822 PMCID: PMC11218433 DOI: 10.7759/cureus.58539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Appendicectomy is the most frequent emergency general surgical procedure. Prior research highlights the importance of histopathology analysis after appendicectomy which is the practice in many countries including the United Kingdom (UK), aiming to prevent any oversight of vital findings and the avoidance of potential delays in patient care. Our primary objective was to audit the extent to which surgeons adhere to the NHS England patient safety guidelines from 2016 when it comes to timely reviewing and effectively communicating histopathology results to patients and/or their general practitioners following appendicectomy procedures. Our secondary objective was to amend practice, if deemed necessary, following the implementation of agreed-upon protocols, with the expected improvements being observable in the second cycle of the audit. METHODS In our two-cycle audit, we performed a retrospective analysis using online patient records from a single centre in the UK. The initial cycle involved cases of emergency appendectomies carried out consecutively for suspected appendicitis from April 2018 to June 2019. Following the clinical governance meeting and the implementation of recommendations, the second audit cycle covered cases between September 2020 and October 2020. RESULTS In the first cycle, among 418 laparoscopic appendectomies, 207 (49.52%) and 47 reports (11.24%) were reviewed within a 15-day and a 16-30-day window, respectively, following the online availability of histopathology results. Notably, 116 reports (27.75%) remained unreviewed by surgeons, and only 67 (16.02%) of these reports documented communication with patients and/or their general practitioners. In the second cycle, involving 49 patients, 38 reports (77.55%) were reviewed within the first 15 days, and 10 reports (20.4%) were reviewed between 16-30 days. Among these, 16 reports (32.65%) documented communication with patients and/or their general practitioners. CONCLUSIONS Our adherence to the aforementioned guidance was poor prior to this audit. This two-cycle audit highlighted the need for improvement in the timely review and communication of histopathology reports following appendectomy at our centre. The second cycle showed promising progress, suggesting that changes implemented between the cycles had a positive impact. Nevertheless, continuous efforts may be required to enhance and sustain adherence to these vital patient safety guidelines.
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Affiliation(s)
- Christine-Bianca Hanganu
- General Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Sanad Isswiasi
- General Surgery, West Suffolk Hospital, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
| | - Abiodun Adigun
- Cardiothoracic Surgery, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Wythenshawe, GBR
| | - Vladimir Nichita
- General Surgery, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, GBR
| | - Rishi Sen
- General Surgery, West Suffolk Hospital, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
| | - Muhammadhasan Anwaar
- General Surgery, West Suffolk Hospital, West Suffolk NHS Foundation Trust, Bury St Edmunds, GBR
| | - Elisabeth Drye
- General Surgery, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, GBR
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Nankervis H, Huntley A, Whiting P, Hamilton W, Singh H, Dawson S, Sprackman J, Ferguson Montague A, Watson J. Blood test result communication in primary care: mixed-methods systematic review protocol. BJGP Open 2023; 7:BJGPO.2023.0105. [PMID: 37407088 PMCID: PMC11176682 DOI: 10.3399/bjgpo.2023.0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND After testing, ensuring test results are communicated and actioned is important for patient safety, with failure or delay in diagnosis the most common cause of malpractice claims in primary care worldwide. Identifying interventions to improve test communication from the decision to test through to sharing of results has important implications for patient safety, GP workload, and patient engagement. AIM To assess the factors around communication of blood test results between primary care providers (for example GPs, nurses, reception staff) and their patients and carers. DESIGN & SETTING A mixed methods systematic review including primary studies involving communication of blood test results in primary care. METHOD The review will use a segregated convergent synthesis method. Qualitative information will be synthesised using a meta-aggregative approach, and quantitative data will be meta-analysed or synthesised if pooling of studies is appropriate and data are available. If not, data will be presented in tabular and descriptive summary form. CONCLUSION This review has the potential to provide conclusions about blood test result communication interventions and factors important to stakeholders, including barriers and facilitators to improved communication.
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Yoon S, Goh H, Phang JK, Kwan YH, Low LL. Socioeconomic and behavioral determinants of non-compliance with physician referrals following community screening for diabetes, hypertension and hyperlipidemia: a mixed-methods study. Sci Rep 2023; 13:20554. [PMID: 37996479 PMCID: PMC10667337 DOI: 10.1038/s41598-023-47168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
Early detection of undiagnosed diabetes, hypertension or hyperlipidemia through screening could reduce healthcare costs resulting from disease complications. To date, despite ample research on the factors linked to the uptake of community health screening programs, little attention has been directed at delayed or incomplete follow-up after positive outcomes are identified in community screening tests. This study aimed to investigate the socioeconomic and behavioral factors that influence non-compliance with recommendations for primary care physician referrals, following community-based screening for diabetes, hypertension and hyperlipidemia. A parallel mixed-methods study was conducted. For quantitative data, we performed multivariable analysis on community-based chronic disease screening data. The qualitative component involved semi-structured interviews with individuals with both non-compliance and compliance with referral recommendations. Thematic data analysis was undertaken using the Theoretical Domains Framework (TDF). The quantitative analysis showed that older age (OR = 0.92, 95%CI [0.89-0.96]), non-Chinese ethnicity (OR = 0.24; 95% CI [0.08-0.44]) and residing in 5-room public/ private housing (OR = 0.40; 95% CI [0.14-0.74]) were associated with lower odds of non-compliance with referral recommendations. Thematic analysis identified multiple behavioral-level determinants acting as enablers or barriers within 7 TDF domains: awareness of health risks after receiving screening results, self-management orientation and behavioral control, fear of formal diagnosis and concerns about healthcare cost, optimistic belief driven by the lack of symptoms, interpersonal relationship and social obligations, aversion to medication, communication at the result collection and sense of uncertainty regarding self-scheduling of appointment. Findings provide valuable implications for the development of interventions aimed at improving adherence to referral recommendation. Future endeavors should include culturally sensitive outreach, evidence-based information dissemination, family-centered education, positive public health messaging, brief counseling during result collection and an opt-out appointment system to enhance follow-up care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore.
| | - Hendra Goh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- SingHealth Internal Medicine Residency Programme, Singapore, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation (CPHRI), Singapore Health Services, Singapore, Singapore
- Population Health and Integrated Care Office (PHICO), Singapore General Hospital, Singapore, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Sveiven M, Gassman A, Rosenberg J, Chan M, Boniface J, O’Donoghue AJ, Laurent LC, Hall DA. A dual-binding magnetic immunoassay to predict spontaneous preterm birth. Front Bioeng Biotechnol 2023; 11:1256267. [PMID: 37790251 PMCID: PMC10542577 DOI: 10.3389/fbioe.2023.1256267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023] Open
Abstract
Complications posed by preterm birth (delivery before 37 weeks of pregnancy) are a leading cause of newborn morbidity and mortality. The previous discovery and validation of an algorithm that includes maternal serum protein biomarkers, sex hormone-binding globulin (SHBG), and insulin-like growth factor-binding protein 4 (IBP4), with clinical factors to predict preterm birth represents an opportunity for the development of a widely accessible point-of-care assay to guide clinical management. Toward this end, we developed SHBG and IBP4 quantification assays for maternal serum using giant magnetoresistive (GMR) sensors and a self-normalizing dual-binding magnetic immunoassay. The assays have a picomolar limit of detections (LOD) with a relatively broad dynamic range that covers the physiological level of the analytes as they change throughout gestation. Measurement of serum from pregnant donors using the GMR assays was highly concordant with those obtained using a clinical mass spectrometry (MS)-based assay for the same protein markers. The MS assay requires capitally intense equipment and highly trained operators with a few days turnaround time, whereas the GMR assays can be performed in minutes on small, inexpensive instruments with minimal personnel training and microfluidic automation. The potential for high sensitivity, accuracy, and speed of the GMR assays, along with low equipment and personnel requirements, make them good candidates for developing point-of-care tests. Rapid turnaround risk assessment for preterm birth would enable patient testing and counseling at the same clinic visit, thereby increasing the timeliness of recommended interventions.
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Affiliation(s)
- Michael Sveiven
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
| | - Andrew Gassman
- Sera Prognostics, Inc., Salt Lake City, UT, United States
| | - Joshua Rosenberg
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Matthew Chan
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
| | - Jay Boniface
- Sera Prognostics, Inc., Salt Lake City, UT, United States
| | - Anthony J. O’Donoghue
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Louise C. Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Drew A. Hall
- Department of Bioengineering, University of California, San Diego, La Jolla, CA, United States
- Department of Electrical and Computer Engineering, University of California, San Diego, La Jolla, CA, United States
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Abbasi N, Lacson R, Kapoor N, Licaros A, Guenette JP, Burk KS, Hammer M, Desai S, Eappen S, Saini S, Khorasani R. Development and External Validation of an Artificial Intelligence Model for Identifying Radiology Reports Containing Recommendations for Additional Imaging. AJR Am J Roentgenol 2023; 221:377-385. [PMID: 37073901 DOI: 10.2214/ajr.23.29120] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND. Reported rates of recommendations for additional imaging (RAIs) in radiology reports are low. Bidirectional encoder representations from transformers (BERT), a deep learning model pretrained to understand language context and ambiguity, has potential for identifying RAIs and thereby assisting large-scale quality improvement efforts. OBJECTIVE. The purpose of this study was to develop and externally validate an artificial intelligence (AI)-based model for identifying radiology reports containing RAIs. METHODS. This retrospective study was performed at a multisite health center. A total of 6300 radiology reports generated at one site from January 1, 2015, to June 30, 2021, were randomly selected and split by 4:1 ratio to create training (n = 5040) and test (n = 1260) sets. A total of 1260 reports generated at the center's other sites (including academic and community hospitals) from April 1 to April 30, 2022, were randomly selected as an external validation group. Referring practitioners and radiologists of varying sub-specialties manually reviewed report impressions for presence of RAIs. A BERT-based technique for identifying RAIs was developed by use of the training set. Performance of the BERT-based model and a previously developed traditional machine learning (TML) model was assessed in the test set. Finally, performance was assessed in the external validation set. The code for the BERT-based RAI model is publicly available. RESULTS. Among a total of 7419 unique patients (4133 women, 3286 men; mean age, 58.8 years), 10.0% of 7560 reports contained RAI. In the test set, the BERT-based model had 94.4% precision, 98.5% recall, and an F1 score of 96.4%. In the test set, the TML model had 69.0% precision, 65.4% recall, and an F1 score of 67.2%. In the test set, accuracy was greater for the BERT-based than for the TML model (99.2% vs 93.1%, p < .001). In the external validation set, the BERT-based model had 99.2% precision, 91.6% recall, an F1 score of 95.2%, and 99.0% accuracy. CONCLUSION. The BERT-based AI model accurately identified reports with RAIs, outperforming the TML model. High performance in the external validation set suggests the potential for other health systems to adapt the model without requiring institution-specific training. CLINICAL IMPACT. The model could potentially be used for real-time EHR monitoring for RAIs and other improvement initiatives to help ensure timely performance of clinically necessary recommended follow-up.
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Affiliation(s)
- Nooshin Abbasi
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ronilda Lacson
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Neena Kapoor
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Andro Licaros
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey P Guenette
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Kristine Specht Burk
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Mark Hammer
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Sonali Desai
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sunil Eappen
- Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sanjay Saini
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ramin Khorasani
- Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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12
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Roth B, Kampalath R, Nakashima K, Shieh S, Bui TL, Houshyar R. Revenue and Cost Analysis of a System Utilizing Natural Language Processing and a Nurse Coordinator for Radiology Follow-up Recommendations. Curr Probl Diagn Radiol 2023; 52:367-371. [PMID: 37236842 DOI: 10.1067/j.cpradiol.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/04/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Radiology reports often contain recommendations for follow-up imaging, Provider adherence to these radiology recommendations can be incomplete, which may result in patient harm, lost revenue, or litigation. This study sought to perform a revenue assessment of a hybrid natural language processing (NLP) and human follow-up system. Reports generated from January 2020 to April 2021 that were indexed as overdue from follow-up recommendations by mPower Follow-Up Recommendation Algorithm (Nuance Communications Inc., Burlington, MA), were assessed for follow up and revenue. Follow-up exams completed because of the hybrid system were tabulated and given revenue amounts based on Medicare national reimbursement rates. These rates were then summated. A total of n =3011 patients were flagged via the mPower algorithm as having not received a timely follow-up indicated for procedure. Of these, n = 427 required the quality nurse to contact their healthcare provider to place orders. The follow-up imaging of these patients accounted for $62,937.66 of revenue. This revenue was calculated as higher than personnel cost (based on national average quality and safety nurse salary and time allotted on follow-ups). Our results indicate that a hybrid human-artificial intelligence follow-up system can be profitable, while potentially adding to patient safety. Our revenue figure likely significantly underestimates the true revenue obtained at our institution. This was due to the use of Medicare national reimbursement rates to calculate revenue, for the purposes of generalizability.
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Affiliation(s)
- Bradley Roth
- School of Medicine, University of California, Irvine, CA; Department of Radiological Sciences, University of California, Irvine, CA.
| | - Rony Kampalath
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Kayla Nakashima
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Stephanie Shieh
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Thanh-Lan Bui
- Department of Radiological Sciences, University of California, Irvine, CA
| | - Roozbeh Houshyar
- Department of Radiological Sciences, University of California, Irvine, CA
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13
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Doi K, Takegawa H, Yui M, Anetai Y, Koike Y, Nakamura S, Tanigawa N, Koziumi M, Nishio T. Deep learning-based detection of patients with bone metastasis from Japanese radiology reports. Jpn J Radiol 2023; 41:900-908. [PMID: 36988827 DOI: 10.1007/s11604-023-01413-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE Deep learning (DL) is a state-of-the-art technique for developing artificial intelligence in various domains and it improves the performance of natural language processing (NLP). Therefore, we aimed to develop a DL-based NLP model that classifies the status of bone metastasis (BM) in radiology reports to detect patients with BM. MATERIALS AND METHODS The DL-based NLP model was developed by training long short-term memory using 1,749 free-text radiology reports written in Japanese. We adopted five-fold cross-validation and used 200 reports for testing the five models. The accuracy, sensitivity, specificity, precision, and area under the receiver operating characteristics curve (AUROC) were used for the model evaluation. RESULTS The developed model demonstrated classification performance with mean ± standard deviation of 0.912 ± 0.012, 0.924 ± 0.029, 0.901 ± 0.014, 0.898 ± 0.012, and 0.968 ± 0.004 for accuracy, sensitivity, specificity, precision, and AUROC, respectively. CONCLUSION The proposed DL-based NLP model may help in the early and efficient detection of patients with BM.
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Affiliation(s)
- Kentaro Doi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-Shi, Osaka, Japan
- Department of Radiology, Kansai Medical University Graduate School of Medicine, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
| | - Hideki Takegawa
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-Shi, Osaka, Japan.
- Department of Radiology, Kansai Medical University Graduate School of Medicine, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan.
- Department of Radiation Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan.
| | - Midori Yui
- Department of Radiology, Kansai Medical University Graduate School of Medicine, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
- Department of Radiation Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
| | - Yusuke Anetai
- Department of Radiology, Kansai Medical University Graduate School of Medicine, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
- Department of Radiation Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
| | - Yuhei Koike
- Department of Radiology, Kansai Medical University Graduate School of Medicine, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
- Department of Radiation Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University Graduate School of Medicine, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
- Department of Radiation Oncology, Kansai Medical University Hospital, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University Graduate School of Medicine, 2-5-1 Shinmachi, Hirakata-Shi, Osaka, Japan
| | - Masahiko Koziumi
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-Shi, Osaka, Japan
| | - Teiji Nishio
- Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita-Shi, Osaka, Japan
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14
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Jiang LG, Cahill M, Chansakul A, Steel PAD, Sullivan D, Pua BB. A Collaborative Emergency Medicine and Radiology Pulmonary Nodule Program: Identification of Associated Efficacy and Outcomes. J Am Coll Radiol 2023; 20:796-803. [PMID: 37422161 DOI: 10.1016/j.jacr.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Incidental radiologic findings are commonplace, but the episodic nature of emergency department (ED) care makes it challenging to ensure that patients obtain appropriate follow-up. Rates of follow-up range from 30% to 77%, with some studies demonstrating that more than 30% have no follow-up at all. The aim of this study is to describe and analyze the outcomes of a collaborative emergency medicine and radiology initiative to establish a formal workflow for the follow-up of pulmonary nodules identified during ED care. METHODS A retrospective analysis was performed of patients referred to the pulmonary nodule program (PNP). Patients were divided into two categories: those with follow-up and those who do not have post-ED follow-up. The primary outcome was determining follow-up rates and outcomes, including patients referred for biopsy. The characteristics of patients who completed follow-up compared with those lost to follow-up were also examined. RESULTS A total of 574 patients were referred to the PNP. Initial follow-up was established in 390 (69.1%); 30.8% were considered lost to follow-up, and more than half of these patients did not respond to initial contact. There were minimal differences in characteristics between patients in these two categories. Of the 259 patients who completed PNP follow-up, 26 were referred for biopsy (13%). CONCLUSIONS The PNP provided effective transitions of care and potentially improved patient health care. Strategies to further enhance follow-up adherence will provide iterative improvement of the program. The PNP provides an implementation framework for post-ED pulmonary nodule follow-up in other health care systems and can be modified for use with other incidental diagnostic findings.
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Affiliation(s)
- Lynn G Jiang
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York.
| | - Meghan Cahill
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Aisara Chansakul
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Peter A D Steel
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Deirdre Sullivan
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Bradley B Pua
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
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15
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Heaney RM, Zaki-Metias KM, McKee H, Wang H, Ogunde B, Yong-Hing CJ, Freitas V, Ghai S, Seely JM, Nguyen ET. Correlation Between Breast Arterial Calcifications and Higher Cardiovascular Risk: Awareness and Attitudes Amongst Canadian Radiologists Who Report Mammography. Can Assoc Radiol J 2023; 74:582-591. [PMID: 36541871 DOI: 10.1177/08465371221140347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Breast arterial calcification (BAC) on mammography correlates with increased cardiovascular risk. Reporting BAC is not standard practice. Our study evaluates the awareness of Canadian radiologists who report mammography of the clinical significance of BAC and their attitudes towards reporting BAC compared to their European and American counterparts. Methods: Following local institutional ethics approval, a 25 question survey (SurveyMonkey) was disseminated to Canadian radiologists via provincial and national society email lists. Responses were collected over 5 weeks (April-June 2022). Results: One hundred and eighty-six complete responses were collected. Sixty percent (112/186) were aware of the association between BAC and cardiovascular risk and 16% (29/186) document its presence in mammogram reports. Thirty five percent (65/186) occasionally document BAC if severe or in a young patient. Four percent (7/186) had local departmental guidelines on BAC reporting and 82% (153/186) agreed there is a need for national BAC reporting guidelines. Fewer Canadian radiologists were aware of the association between BAC and cardiovascular risk compared to European radiologists (60% vs 81%), report the presence of BAC compared to both European (15% vs 62%) and American (15% vs 35%) radiologists, and inform the patient of the presence of BAC compared to European radiologists (1% vs 46%). Conclusion: Canadian radiologists who report mammography were less aware of the association between BAC and cardiovascular risk than their European and American counterparts and were less likely to document the presence of BAC. Given the correlation of BAC with increased cardiovascular event risk, there is increased need for awareness as well as national BAC reporting guidelines.
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Affiliation(s)
- Roisin M Heaney
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
| | - Kaitlin M Zaki-Metias
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Hayley McKee
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Huijuan Wang
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Barakat Ogunde
- Department of Radiology, Trinity Health Oakland Hospital/Wayne State University School of Medicine, Pontiac, MI, USA
| | - Charlotte J Yong-Hing
- Diagnostic Imaging, BC Cancer, Vancouver, BC, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vivianne Freitas
- Joint Department of Medical Imaging, Princess Margaret Hospital, Toronto, ON, Canada
| | - Sandeep Ghai
- Joint Department of Medical Imaging, Princess Margaret Hospital, Toronto, ON, Canada
| | - Jean M Seely
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Elsie T Nguyen
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, ON, Canada
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16
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Yun JH, Wang P, Lo KB, Matalon TA, Lee RK. The Effect of Using Artificial Intelligence to Improve Compliance Rates for Imaging Follow-Up Recommendations. J Am Coll Radiol 2023; 20:809-811. [PMID: 37302681 DOI: 10.1016/j.jacr.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 06/13/2023]
Affiliation(s)
- Jung H Yun
- Integrated IR/DR Resident Physician, Department of Diagnostic and Interventional Radiology, Einstein Medical Center, Jefferson Health, Philadelphia, Pennsylvania.
| | - Peter Wang
- Associate Chair, Informatics; Section Chief, Abdominal Imaging; Assistant Program Director; and Attending Diagnostic Radiologist, Department of Diagnostic Radiology, Einstein Medical Center, Jefferson Health, Philadelphia, Pennsylvania. https://twitter.com/PeterWangMD
| | - Kevin Bryan Lo
- Attending Hospitalist, Department of Internal Medicine, Einstein Medical Center, Jefferson Health, Philadelphia, Pennsylvania. https://twitter.com/KevinBryanLo
| | - Terence A Matalon
- Chair Emeritus, Department of Diagnostic Radiology, Einstein Medical Center, Jefferson Health, Philadelphia, Pennsylvania
| | - Ryan K Lee
- Chair, Department of Diagnostic Radiology, Einstein Medical Center, Jefferson Health, Philadelphia, Pennsylvania. https://twitter.com/ryankleemd
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17
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See TC, Uberoi R, Ramsden W. Navigating an effective imaging results notification in our healthcare system. Clin Radiol 2023; 78:159-163. [PMID: 36411090 DOI: 10.1016/j.crad.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Affiliation(s)
- T C See
- Box 219, Radiology Department, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
| | - R Uberoi
- Radiology Department, Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - W Ramsden
- Radiology Department, Leeds teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, UK
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18
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Queraltó J, Brady J, Carobene A, Homšak E, Wieringa G. The European Register of Specialists in Clinical Chemistry and Laboratory Medicine: code of conduct, version 3 - 2023. Clin Chem Lab Med 2023; 61:981-988. [PMID: 36724108 DOI: 10.1515/cclm-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 02/02/2023]
Abstract
Whilst version 2 focussed on the professional conduct expected of a Specialist in Laboratory Medicine, version 3 builds on the responsibilities for ethical conduct from point of planning to point of care. Particular responsibilities that are outlined include: - The need for evidence when planning a new service, providing assurance that a new test does not do harm - Maintaining respect for patient confidentiality, their religious/ethnic beliefs, the need for informed consent to test, agreement on retrospective use of samples as part of governance envelopes in the pre-analytical phase - Ensuring respect for patient autonomy in the response to untoward results generated in the analytical phase - Supporting the safety of patients in the post-analytical phase through knowledge-based interpretation and presentation of results - The duty of candour to disclose and respond to error across the total testing process - Leading initiatives to harmonise and standardise pre-analytical, analytical and post-analytical phases to ensure more consistent clinical decision making with utilisation of demand management to ensure more equitable access to scarce resources - Working with emerging healthcare providers beyond the laboratory to ensure consistent application of high standards of clinical care In identifying opportunities for wider contributions to resolving ethical challenges across healthcare the need is also highlighted for more external quality assurance schemes and ethics-based quality indicators that span the total testing process.
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Affiliation(s)
- Josep Queraltó
- SEQCML - The Spanish Society of Laboratory Medicine SEQCML Barcelona, Spain
| | - Jennifer Brady
- Department of Paediatric Laboratory Medicine, UCD School of Medicine, Children's Health Ireland (CHI) Dublin, Ireland
| | - Anna Carobene
- Laboratory Medicine Department, IRCCS San Raffaele Hospital Milan, Italy
| | - Evgenija Homšak
- European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Milan, Italy
| | - Gijsbert Wieringa
- European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Milan, Italy
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Singh H, Mushtaq U, Marinez A, Shahid U, Huebner J, McGaffigan P, Upadhyay DK. Developing the Safer Dx Checklist of Ten Safety Recommendations for Health Care Organizations to Address Diagnostic Errors. Jt Comm J Qual Patient Saf 2022; 48:581-590. [PMID: 36109312 DOI: 10.1016/j.jcjq.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Most health care organizations (HCOs) find diagnostic errors hard to address. The research team developed a checklist (the Safer Dx Checklist) of 10 high-priority safety practices HCOs can use to conduct a proactive risk assessment to address diagnostic error. METHODS First, the team identified potential practices based on reviews of recent literature, reports by national and international organizations, and interviews with quality/safety leaders. Then a Delphi panel was conducted, followed by an online expert panel, to prioritize 10 practices. The prioritization process considered impact on safety and feasibility of practice implementation within a one- to three-year time frame. Finally, cognitive walkthroughs were conducted for a face-validity check with end users. The team also conducted content analysis in each step to look for themes that influenced prioritization or checklist implementation. RESULTS A total of 71 practices for prioritization were identified through the Delphi panel of 28 experts; 65% of participants reached consensus on 28 practices. A multidisciplinary panel of 10 experts helped prioritize and refine the top 10 practices, which were then developed into a checklist paired with implementation guidance. Practices included themes related to creating organizational and leadership accountability for improving diagnosis, including patients in diagnostic safety work, and developing and implementing organizational infrastructure for measurement and improvement activities. Qualitative analysis revealed insights for implementation. End users at three different HCOs helped refine implementation guidance for the checklist. CONCLUSION The researchers identified 10 safety practices to help organizations conduct a proactive, systematic assessment of risks to timely and accurate diagnosis. The Safer Dx Checklist can enable HCOs to begin implementing strategies to address diagnostic error.
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20
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Hagan S, Wheat C, Laundry R, Deeds S, Singh H, Nelson K, Reddy A. Development and Validation of an Electronic Trigger to Monitor Follow-up for Moderately Elevated, Outpatient Serum Potassium Levels. J Gen Intern Med 2022; 37:3512-3514. [PMID: 35581447 PMCID: PMC9550915 DOI: 10.1007/s11606-022-07637-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/22/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Scott Hagan
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA.
- Department of Health Services, University of Washington, Seattle, WA, USA.
| | - Chelle Wheat
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
| | - Ryan Laundry
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
| | - Stefanie Deeds
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Karin Nelson
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Ashok Reddy
- VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA, 98108, USA
- Department of Health Services, University of Washington, Seattle, WA, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
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21
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Savoy A, Patel H, Shahid U, Offner AD, Singh H, Giardina TD, Meyer AND. Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach. JMIR Hum Factors 2022; 9:e37313. [PMID: 36136374 PMCID: PMC9539640 DOI: 10.2196/37313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Participation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians' commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. OBJECTIVE The aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. METHODS We adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. RESULTS A total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. CONCLUSIONS ECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions.
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Affiliation(s)
- April Savoy
- Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
- Center for Health Information and Communication (Center of Innovation 13-416), Health Services Research and Development Service, Richard L Roudebush Veterans Affairs Medical Center, United States Department of Veterans Affairs, Indianapolis, IN, United States
| | - Himalaya Patel
- Center for Health Information and Communication (Center of Innovation 13-416), Health Services Research and Development Service, Richard L Roudebush Veterans Affairs Medical Center, United States Department of Veterans Affairs, Indianapolis, IN, United States
| | - Umber Shahid
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, United States Department of Veterans Affairs, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Alexis D Offner
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, United States Department of Veterans Affairs, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, United States Department of Veterans Affairs, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, United States Department of Veterans Affairs, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ashley N D Meyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, United States Department of Veterans Affairs, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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22
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Watson J, Salisbury C, Whiting PF, Hamilton WT, Banks J. 'I guess I'll wait to hear'- communication of blood test results in primary care a qualitative study. Br J Gen Pract 2022; 72:BJGP.2022.0069. [PMID: 35817586 PMCID: PMC9282801 DOI: 10.3399/bjgp.2022.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/24/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Rates of blood testing in primary care are rising. Communicating blood test results generates significant workload for patients, GPs, and practice staff. AIM To explore GPs' and patients' experience of systems of blood test communication. DESIGN AND SETTING Qualitative interviews with patients and GPs in UK primary care in both urban and rural practices in the West of England. METHOD A total of 28 patients and 19 GPs from six practices were recruited, with a range of socioeconomic and demographic characteristics. Patients were interviewed at two time points: a) at or soon after their blood test and b) after they had received their test results. The GPs who requested the tests were also interviewed (they could complete a maximum of two interviews about different patients). Eighty qualitative interviews were undertaken; 54 patient interviews and 26 GP interviews. RESULTS Methods of test result communication varied between doctors and were based on habits, unwritten heuristics, and personal preferences rather than protocols. Doctors expected patients to know how to access their test results. In contrast, patients were often uncertain and used guesswork to decide when and how to access their tests. Patients and doctors generally assumed that the other party would make contact, with potential implications for patient safety. Text messaging and online methods of communication have benefits, but were perceived by some patients as 'flippant' or 'confusing'. Delays and difficulties obtaining and interpreting test results can lead to anxiety and frustration for patients. CONCLUSION Current systems of test result communication are complex and confusing, and mostly based on habits and routines rather than clear protocols. This has important implications for patient-centred care and patient safety.
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Affiliation(s)
| | | | - Penny F Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol
| | | | - Jonathan Banks
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol and National Institute for Health Research, Applied Research Collaboration West, Bristol
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23
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Charmila A, Natarajan S, Chitra TV, Pawar N, Kinjawadekar S, Firke Y, Murugesan U, Yadav P, Ohri N, Modgil V, Rodge A, Swami OC. Efficacy and Safety of Ferric Carboxymaltose in the Management of Iron Deficiency Anemia: A Multi-Center Real-World Study from India. J Blood Med 2022; 13:303-313. [PMID: 35706850 PMCID: PMC9189149 DOI: 10.2147/jbm.s361210] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Parenteral iron preparations, like ferric carboxymaltose (FCM), are commonly used to manage moderate-to-severe iron deficiency anemia (IDA). Real-world data on efficacy and safety of FCM is limited in India. Methods A retrospective, observational and real-world study was conducted to assess the efficacy and safety of FCM in adolescents and adults with IDA across 269 centers in India. Data was retrieved from medical records of patients who received FCM for management of IDA. Physicians’ clinical assessment of efficacy and safety of FCM was also assessed. Data were analyzed for hematological parameters at baseline and at 4 ± 1 week for study population, and for severity of anemia. Results In 1800 patients with IDA, intravenous FCM resulted in a significant increase in hemoglobin (Hb) of 2.76 g/dL, serum ferritin of 35.85 µg/L, red blood cell (RBC) count, hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) (P < 0.001 for all) at 4 ± 1 week as compared to baseline. In subjects with severe IDA, an increase in Hb was of 3.31 g/dL, serum ferritin increased of 35.84 µg/L, RBC count, hematocrit and MCH improved significantly (P < 0.001 for all). In subjects with moderate IDA, Hb (increase of 2.63 g/dL), serum ferritin (increase of 35.92 µg/L), RBC count, hematocrit, MCV, and MCH improved significantly (P < 0.001 for all). In subjects with mild IDA, only the mean Hb values at 4 weeks were significantly higher (P < 0.001; increased by 1.89 g/dL). Physicians rated efficacy of FCM as very good to good in 97.5% of patients. Similarly, safety of FCM was rated very good to good in 97.2% subjects. Conclusion FCM efficiently, safely and quickly corrects moderate-to-severe anemia in Indian patients in a short span of 4 weeks. Physicians’ positive clinical impression of efficacy and safety supports clinical usage of FCM in real-world scenario. ![]()
Point your SmartPhone at the code above. If you have a QR code reader, the video abstract will appear. Or use: https://youtu.be/F--_v5ex9jk
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Affiliation(s)
- Ayyavoo Charmila
- Obstetrics and Gynecology, Aditi Hospital, Tiruchirappalli, Tamil Nadu, India
| | - Suma Natarajan
- Obstetrics and Gynecology, Ganga Medical Centre & Hospitals, Coimbatore, Tamil Nadu, India
| | | | - Nivedita Pawar
- Obstetrics and Gynecology, Nivedita Maternity Home, Nashik, Maharashtra, India
| | - Sucheta Kinjawadekar
- Obstetrics and Gynecology, Kamalesh Mother and Child Hospital, New Mumbai, Maharashtra, India
| | - Yogini Firke
- Obstetrics and Gynecology, Dhanvantari Hospital, Mumbai, Maharashtra, India
| | - Umaiyal Murugesan
- Obstetrics and Gynecology, Sri Kumaran A Speciality Hospital, Chennai, Tamil Nadu, India
| | - Poonam Yadav
- Obstetrics and Gynecology, SDMH Hospital, Jaipur, Rajasthan, India
| | - Neelam Ohri
- Obstetrics and Gynecology, New Life Hospital, Varanasi, Uttar Pradesh, India
| | - Vidhu Modgil
- Obstetrics and Gynecology, Suman Hospital, Ludhiana, Punjab, India
| | - Ajinkya Rodge
- Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
| | - Onkar C Swami
- Medical Services, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, India
- Correspondence: Onkar C Swami, Emcure Pharmaceuticals Ltd., Pune, Maharashtra, 411 057, India, Tel +91-93724 23101, Email
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24
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Scott IA. Using information technology to reduce diagnostic error: still a bridge too far? Intern Med J 2022; 52:908-911. [PMID: 35718736 DOI: 10.1111/imj.15804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ian A Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
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25
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Why test study protocol: a UK-wide audit using the primary care academic collaborative to explore the reasons for primary care testing. BJGP Open 2022; 6:BJGPO.2022.0017. [PMID: 35508322 DOI: 10.3399/bjgpo.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/14/2022] [Accepted: 04/26/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The number of blood tests done in primary care has been increasing over the last 20 years. Some estimates suggest that up to a quarter of these tests may not have been needed. This could lead to a cascade effect of further investigations, appointments, or referrals, as well as anxiety for patients, increased workload and costs to the health service. To better understand the impact and sequelae of blood tests on patients, we need to know why blood tests are requested and what is done with the results. AIMS To explore who orders blood tests and why, and how test results are actioned in primary care. DESIGN & SETTING Retrospective audit of electronic health records in general practices across the UK. METHOD The Primary care Academic CollaboraTive (PACT), a UK-wide network of primary care health professionals, will be utilised to collect data from individual practices. PACT members will be asked to review the electronic health records of 50 patients who had recent blood tests in their practice, and manually extract anonymised data on who requested the test, the indication, the result, and subsequent actions. Data will also be collected from PACT members to assess the feasibility of the collaborative model. CONCLUSION PACT offers a unique opportunity to extract clinical data which cannot otherwise be obtained. Understanding the indications for tests will help identify priority areas for research to optimise testing and patient safety in primary care.
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26
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Meyer AND, Scott TMT, Singh H. Adherence to National Guidelines for Timeliness of Test Results Communication to Patients in the Veterans Affairs Health Care System. JAMA Netw Open 2022; 5:e228568. [PMID: 35452111 PMCID: PMC9034405 DOI: 10.1001/jamanetworkopen.2022.8568] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This cross-sectional study assesses policy adherence to national guidelines for timeliness of test results communication to patients in the Department of Veteran Affairs health care system.
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Affiliation(s)
- Ashley N. D. Meyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Taylor M. T. Scott
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas
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27
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Kopanitsa G. Study of patients' attitude to automatic interpretation of laboratory test results and its influence on follow-up rate. BMC Med Inform Decis Mak 2022; 22:79. [PMID: 35346173 PMCID: PMC8962526 DOI: 10.1186/s12911-022-01805-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background One of the current major factors of not following up on the abnormal test results is the lack of information about the test results and missing interpretations. Clinical decision support systems (CDSS) can become a solution to this problem. However, little is known how patients react to the automatically generated interpretations of the test results, and how this can affect a decision to follow up. In this research, we study how patients perceive the interpretations of the laboratory tests automatically generated by a clinical decision support system depending on how they receive these recommendations and how this affects the follow-up rate. Methods A study of 3200 patients was done querying the regional patient registry. The patients were divided into 4 groups who received:Recommendations automatically generated by a CDSS with a clear indication of their automatic nature. Recommendations received personally from a doctor with a clear indication of their automatic nature. Recommendations from a doctor with no indication of their automated generation. No recommendations, only the test results.
A follow-up rate was calculated as the proportion of patients referred to a laboratory service for a follow-up investigation after receiving a recommendation within two weeks after the first test with abnormal test results had been completed and the interpretation was delivered to the patient. The second phase of the study was a research of the patients’ motivation. It was performed with a group of 789 patients. Results All the patients who received interpretations on the abnormal test results demonstrated a significantly higher rate of follow-up (71%) in comparison to the patients who received only test results without interpretations (49%). Patients mention a time factor as a significant benefit of the automatically generated interpretations in comparison to the interpretations they can receive from a doctor. Conclusion The results of the study show that delivering automatically generated interpretations of test results can support patients in making a decision to follow up. They are trusted by patients and raise their motivations and engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01805-w.
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Murphy M, Wong G, Scott A, Wilson V, Salisbury C. The person-based development and realist evaluation of a summary report for GP consultations. NIHR OPEN RESEARCH 2022; 2:20. [PMID: 35935674 PMCID: PMC7613240 DOI: 10.3310/nihropenres.13258.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Use of telephone, video and e-consultations is increasing. These can make consultations more transactional. This study aimed to develop a complex intervention to address patients’ concerns more comprehensively in general practice and test the feasibility of this in a cluster-randomised framework. The complex intervention used two technologies: a patient-completed pre-consultation form used at consultation opening and a doctor-provided summary report provided at consultation closure. This paper reports on the development and realist evaluation of the summary report. Methods A person-based approach was used to develop the summary report. An electronic protocol was designed to automatically generate the report after GPs complete a clinical template in the patient record. This was tested with 45 patients in 3 rounds each, with iterative adjustments made based on feedback after each round. Subsequently, an intervention incorporating the pre-consultation form with the summary report was then tested in a cluster-randomised framework with 30 patients per practice in six practices: four randomised to intervention, and two to control. An embedded realist evaluation was carried out. The main feasibility study results are reported elsewhere. Results Conclusions The person-based approach was successful. The summary report creates clarity, empowerment and reassurance in certain consultations and patients. As it takes a few minutes per patient, GPs prefer to select patients who will benefit most.
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29
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Zimolzak AJ, Shahid U, Giardina TD, Memon SA, Mushtaq U, Zubkoff L, Murphy DR, Bradford A, Singh H. Why Test Results Are Still Getting "Lost" to Follow-up: a Qualitative Study of Implementation Gaps. J Gen Intern Med 2022; 37:137-144. [PMID: 33907982 PMCID: PMC8739406 DOI: 10.1007/s11606-021-06772-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/29/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Lack of timely follow-up of abnormal test results is common and has been implicated in missed or delayed diagnosis, resulting in potential for patient harm. OBJECTIVE As part of a larger project to implement change strategies to improve follow-up of diagnostic test results, this study sought to identify specifically where implementation gaps exist, as well as possible solutions identified by front-line staff. DESIGN We used a semi-structured interview guide to collect qualitative data from Veterans Affairs (VA) facility staff who had experience with test results management and patient safety. SETTING Twelve VA facilities across the USA. PARTICIPANTS Facility staff members (n = 27), including clinicians, lab and imaging professionals, nursing staff, patient safety professionals, and leadership. APPROACH We conducted a content analysis of interview transcripts to identify perceived barriers and high-risk areas for effective test result management, as well as recommendations for improvement. RESULTS We identified seven themes to guide further development of interventions to improve test result follow-up. Themes related to trainees, incidental findings, tracking systems for electronic health record notifications, outdated contact information, referrals, backup or covering providers, and responsibility for test results pending at discharge. Participants provided recommendations for improvement within each theme. CONCLUSIONS Perceived barriers and recommendations for improving test result follow-up often reflected previously known problems and their corresponding solutions, which have not been consistently implemented in practice. Better policy solutions and improvement methods, such as quality improvement collaboratives, may bridge the implementation gaps between knowledge and practice.
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Affiliation(s)
- Andrew J Zimolzak
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Umber Shahid
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Sahar A Memon
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Umair Mushtaq
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Lisa Zubkoff
- Birmingham/Atlanta VA GRECC, and Division of Preventive Medicine, Department of Veterans Affairs and Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel R Murphy
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Andrea Bradford
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard 152, Houston, TX, 77030, USA. .,Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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30
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Georgiou A, Li J, Thomas J, Dahm MR. Identifying the mechanisms that contribute to safe and effective electronic test result management systems- a multisite qualitative study. J Am Med Inform Assoc 2021; 29:89-96. [PMID: 34741512 PMCID: PMC8714281 DOI: 10.1093/jamia/ocab235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Suboptimal design of health information technology (IT) systems can lead to the introduction of errors in the diagnostic process. We aimed to identify mechanisms that can affect the safety and effectiveness of these systems in hospital settings thus contributing to the building of an explicit and replicable understanding of the variables that can affect the functioning of IT systems. MATERIALS AND METHODS This qualitative study drew from observations and semistructured interviews from a purposive sample of 46 participants (26 emergency department and 20 laboratory and medical imaging staff) across 3 Australian hospitals. Iterative, inductive coding of the data led to the development of higher-level themes based on relationships between codes. RESULTS Two overarching themes emerged: (1) usability and safety of the electronic test result management system; and (2) system redesign considerations about who is meant to follow up, when and how. The usability and safety of digital systems and the way these systems deal with accountability processes are triggered by mechanisms that are contextually dependent. DISCUSSION Our findings highlighted the multitransactional nature of the test result management process involving numerous healthcare professionals across different settings. This communication requires integration of the systems utilized by different departments and transparency of the test result follow-up process to facilitate clear lines of responsibility and accountability. CONCLUSION Identifying mechanisms that shape the functionality and sustainability of electronic result management can offer a valuable appreciation of key elements that need to be accounted for, and the circumstances in which they need to operate effectively.
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Affiliation(s)
- Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- College of Arts and Social Sciences, Institute for Communication in Health Care, Australian National University, Canberra, Australia
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31
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Hughes AEO, Jackups R. Clinical Decision Support for Laboratory Testing. Clin Chem 2021; 68:402-412. [PMID: 34871351 DOI: 10.1093/clinchem/hvab201] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/24/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND As technology enables new and increasingly complex laboratory tests, test utilization presents a growing challenge for healthcare systems. Clinical decision support (CDS) refers to digital tools that present providers with clinically relevant information and recommendations, which have been shown to improve test utilization. Nevertheless, individual CDS applications often fail, and implementation remains challenging. CONTENT We review common classes of CDS tools grounded in examples from the literature as well as our own institutional experience. In addition, we present a practical framework and specific recommendations for effective CDS implementation. SUMMARY CDS encompasses a rich set of tools that have the potential to drive significant improvements in laboratory testing, especially with respect to test utilization. Deploying CDS effectively requires thoughtful design and careful maintenance, and structured processes focused on quality improvement and change management play an important role in achieving these goals.
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Affiliation(s)
- Andrew E O Hughes
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ronald Jackups
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
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32
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Nehls N, Yap TS, Salant T, Aronson M, Schiff G, Olbricht S, Reddy S, Sternberg SB, Anderson TS, Phillips RS, Benneyan JC. Systems engineering analysis of diagnostic referral closed-loop processes. BMJ Open Qual 2021; 10:bmjoq-2021-001603. [PMID: 34844935 PMCID: PMC8634018 DOI: 10.1136/bmjoq-2021-001603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/03/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Closing loops to complete diagnostic referrals remains a significant patient safety problem in most health systems, with 65%-73% failure rates and significant delays common despite years of improvement efforts, suggesting new approaches may be useful. Systems engineering (SE) methods increasingly are advocated in healthcare for their value in studying and redesigning complex processes. OBJECTIVE Conduct a formative SE analysis of process logic, variation, reliability and failures for completing diagnostic referrals originating in two primary care practices serving different demographics, using dermatology as an illustrating use case. METHODS An interdisciplinary team of clinicians, systems engineers, quality improvement specialists, and patient representatives collaborated to understand processes of initiating and completing diagnostic referrals. Cross-functional process maps were developed through iterative group interviews with an urban community-based health centre and a teaching practice within a large academic medical centre. Results were used to conduct an engineering process analysis, assess variation within and between practices, and identify common failure modes and potential solutions. RESULTS Processes to complete diagnostic referrals involve many sub-standard design constructs, with significant workflow variation between and within practices, statistical instability and special cause variation in completion rates and timeliness, and only 21% of all process activities estimated as value-add. Failure modes were similar between the two practices, with most process activities relying on low-reliability concepts (eg, reminders, workarounds, education and verification/inspection). Several opportunities were identified to incorporate higher reliability process constructs (eg, simplification, consolidation, standardisation, forcing functions, automation and opt-outs). CONCLUSION From a systems science perspective, diagnostic referral processes perform poorly in part because their fundamental designs are fraught with low-reliability characteristics and mental models, including formalised workaround and rework activities, suggesting a need for different approaches versus incremental improvement of existing processes. SE perspectives and methods offer new ways of thinking about patient safety problems, failures and potential solutions.
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Affiliation(s)
- Nicole Nehls
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
| | - Tze Sheng Yap
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
| | - Talya Salant
- Bowdoin Street Health Center, Beth Israel Deaconess Medical Center, Dorchester, Massachusetts, USA
| | - Mark Aronson
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gordon Schiff
- Center for Patient Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne Olbricht
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Swapna Reddy
- Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Scot B Sternberg
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Timothy S Anderson
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Russell S Phillips
- Center for Primary Care, Harvard Medical School, Boston, Massachusetts, USA.,Healthcare Associates, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston, Massachusetts, USA
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Mitri M. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:652-655. [PMID: 34521705 PMCID: PMC9683370 DOI: 10.46747/cfp.6709652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Mira Mitri
- Médecin de famille au Sherman Health and Wellness Centre à Vaughan (Ontario) et chargée de cours à l'Université de Toronto.
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Mitri M. Managing Tests policy in Ontario: Analysis using the 3-i framework. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:644-646. [PMID: 34521703 PMCID: PMC9683375 DOI: 10.46747/cfp.6709644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Mira Mitri
- Family physician at the Sherman Health and Wellness Centre in Vaughan, Ont, and is Lecturer at the University of Toronto.
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35
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St John A, O'Kane M, Christenson R, Jülicher P, Oellerich M, Price CP. Implementation of medical tests in a Value-Based healthcare environment: A framework for delivering value. Clin Chim Acta 2021; 521:90-96. [PMID: 34242637 DOI: 10.1016/j.cca.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 11/27/2022]
Abstract
Significant variation in the utilisation of medical tests is known to have an adverse impact on health outcomes and analysis of this variation is an important tool for quality assurance in healthcare. The introduction of a new medical test into a care pathway requires two distinct processes, termed adoption and implementation. One cause of the unwarranted variation in the use of medical tests is poor adoption and implementation. Adoption is the decision to acquire a technology and make it available to the users and is supported with evidence of clinical and cost effectiveness. Implementation is delivering the benefits promised in the business case, based on evidence of the impact of a test on each stakeholder involved in delivering the care pathway. The business case will have identified the benefits delivered to all stakeholders, as set out in a value proposition, and according to the quality domains typically addressed in quality improvement, namely clinical, process and structure (resource utilisation) outcomes. The outcome measures extend beyond those of clinical and cost effectiveness required for adoption. We describe an implementation framework which is designed to document the changes to the care pathway, the resource inputs and the expected outcomes with associated quality metrics.
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Affiliation(s)
| | - Maurice O'Kane
- Clinical Chemistry Laboratory, Altnagelvin Hospital, Londonderry, N. Ireland, United Kingdom
| | - Robert Christenson
- Laboratories of Pathology, University of Maryland Medical Centre, 22 South Green Street, Baltimore, MD 21201, USA
| | - Paul Jülicher
- Health Economics and Outcomes Research, Medical Affairs, Abbott Laboratories, Wiesbaden, Germany
| | - Michael Oellerich
- Department of Clinical Pharmacology, University Medicine Göttingen (UMG), Kreuzbergring 36, 37075 Göttingen, Germany
| | - Christopher P Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
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Abass G, Asery A, Al Badr A, AlMaghlouth A, AlOtaiby S, Heena H. Patient satisfaction with the emergency department services at an academic teaching hospital. J Family Med Prim Care 2021; 10:1718-1725. [PMID: 34123918 PMCID: PMC8144764 DOI: 10.4103/jfmpc.jfmpc_8_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Healthcare reform efforts focus on patient-centered care is measured by patient satisfaction. Emergency department (ED) satisfaction ratings are often the lowest. Since ED is the first point of contact for the patient care to receive primary care, we aimed to explore patient satisfaction related to ED healthcare services at our institution. Methods: In this cross-sectional study, ED-CAHPS, a standardized validated nine-item survey questionnaire, was administered via telephonic interviews to Arabic-speaking patients who attended ED at our institution. Patient demographics, ED operation parameters, and healthcare utilization factors were evaluated as patient satisfaction predictors. Results: Out of 713 patients who were contacted 200 patients responded to the survey. In all, 70% of respondents were aged 35-64 years and 55% had secondary or higher education levels. The dimension average for the questions regarding arrival, waiting time, and urgency of treatment was 36%. Regarding satisfaction with pain management was 42%, medication information was 34% and interpreter services were only 40%. The overall dimension average for satisfaction regarding nursing care was 43%, doctor care was 36%. The overall dimension average for satisfaction regarding the discharge process was 56%. The highest scores were observed for whether the patients were asked about follow-up care (61%), whether they understood the symptoms to look for after leaving the ED (58%), and whether they received care within 30 min of arriving at the ED (56%). On the other hand, the worst scores were recorded for whether the patients were made to understand regarding the side effects of new medications (29%), whether nurses spent enough time with them (33%), and whether doctors spent enough time with them (34%). Conclusions: Based on these results, recommendations were made to improve patients' perceptions/experience in receiving the care and the overall rating. This study presents specific recommendations for maximizing patient satisfaction in primary ED settings in Saudi Arabia.
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Affiliation(s)
- Ghassan Abass
- Patient Experience Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ali Asery
- Patient Experience Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed Al Badr
- Department of Urogynecology and Pelvic Reconstructive Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.,Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Adnan AlMaghlouth
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia.,Dentistry Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shahad AlOtaiby
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Humariya Heena
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Glushko T, Teytelboym O, Cook T. Impact of PTRIA (Patient Test Result Information Act) on patient follow up management. Clin Imaging 2021; 79:20-23. [PMID: 33865172 DOI: 10.1016/j.clinimag.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We aim to study if direct patient notification in accordance with the Patient Test Results Information Act (Act 112) in Pennsylvania leads to decreased loss to follow up and prompt management of actionable imaging findings. METHODS For this IRB-approved study, radiology reports were randomly identified using the Nuance mPower™ search engine. The actionable finding group (prior to Act-112) contained 300 patients for which a voice notification was sent by radiologists to alert ordering physicians about significant imaging findings. The PTRIA group (after Act-112) contained 300 patients who were mailed a standardized letter one day after the final report was issued. The electronic medical records were reviewed to evaluate how patients were managed. RESULTS There was no difference in loss to follow up rates and time to follow up completion between the two groups. In both groups, 34% of patients were lost to follow up in transition of care from generalists to specialists; 24% cases were lost to follow up when imaging findings were not in the area of the initial ordering provider expertise. CONCLUSION The goal of Act 112 is to increase patients' role in the timely management of their significant medical conditions and prevent medical errors, specifically loss to follow up. Our study suggests that presumed patients' awareness does not contribute to improved follow up rates or decreased time to a follow up visit. 13% of patients are lost to follow up in both groups. A tracking system is required to prevent delayed management of the significant findings.
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Affiliation(s)
- Tetiana Glushko
- Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Diagnostic Radiology, 601 N. Caroline Street, JHOC 3235-A, Baltimore, MD 21287, United States of America.
| | - Oleg Teytelboym
- Mercy Catholic Medical Center, Radiology Department, 1500 Lansdowne Ave, Darby, PA 19023, United States of America
| | - Tessa Cook
- Hospital of the University of Pennsylvania, Department of Radiology, 3400 Spruce Street, 1, Silverstein Ste. 130, Philadelphia, PA 19104, United States of America. https://twitter.com/asset25
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Thomas J, Dahm MR, Li J, Georgiou A. Can patients contribute to enhancing the safety and effectiveness of test-result follow-up? Qualitative outcomes from a health consumer workshop. Health Expect 2020; 24:222-233. [PMID: 33283413 PMCID: PMC8077113 DOI: 10.1111/hex.13150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/21/2020] [Accepted: 10/14/2020] [Indexed: 12/24/2022] Open
Abstract
Background Missed test‐results and failure to follow‐up test‐results are major patient safety concerns. Strategies to improve test‐results management have predominantly focused on clinician‐based interventions, with patients principally involved in studies of test‐result communication preferences, the impact of patient portals or experiences with reporting processes in primary care. Objective To identify consumer perspectives and experiences of the challenges they have faced with test‐results management, through consumer participation in qualitative data analysis. Design and participants Volunteers (n = 10) were recruited to participate in a health consumer reference group workshop on test‐results management. Prior to the workshop, consumers selected topics for discussion using a preference poll. During the workshop, consumers participated in qualitative data analysis of de‐identified excerpts of previously collected interview data discussing hospital test‐results management. Researchers (n = 5) guided consumers through the analytical process and discussion of themes. Discussions were audio‐recorded and transcribed for qualitative analysis. Results Consumer‐selected topics for discussion were ‘Transitions of Care’ and ‘Access’. Consumer data analysis prompted broader discussion including lived experiences. Following the workshop, a second level of content analysis pinpointed issues with implications for patient safety highlighting that consumers were astutely aware of macrolevel ‘Systems Factors’ relating to ‘Emergency Departments’ and the health system, as well as microlevel ‘Patient Factors’ (eg patient preferences and circumstances) which impact a patient's understanding during the ‘Communication’ (clinician to patient/between clinicians) of test‐results ‘Information’ (or lack thereof). Conclusions Consumers identified the challenges patients experience with test‐results management, and our findings highlight areas for potential improvement in patient safety. Patient or public contribution Ten health consumer volunteers actively participated in the test‐results management data analysis workshop conducted in this study. Two health consumers also volunteered to read and comment on the draft manuscript.
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Affiliation(s)
- Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia.,Institute for Communication in Health Care (ICH), College of Arts and Social Sciences, Australian National University, Canberra, ACT, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
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Implementing a multilevel intervention to accelerate colorectal cancer screening and follow-up in federally qualified health centers using a stepped wedge design: a study protocol. Implement Sci 2020; 15:96. [PMID: 33121536 PMCID: PMC7599111 DOI: 10.1186/s13012-020-01045-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022] Open
Abstract
Background Screening for colorectal cancer (CRC) not only detects disease early when treatment is more effective but also prevents cancer by finding and removing precancerous polyps. Because many of our nation’s most disadvantaged and vulnerable individuals obtain health care at federally qualified health centers, these centers play a significant role in increasing CRC screening among the most vulnerable populations. Furthermore, the full benefits of cancer screenings must include timely and appropriate follow-up of abnormal results. Thus, the purpose of this study is to implement a multilevel intervention to increase rates of CRC screening, follow-up, and referral-to-care in federally qualified health centers, as well as simultaneously to observe and to gather information on the implementation process to improve the adoption, implementation, and sustainment of the intervention. The multilevel intervention will target three different levels of influences: organization, provider, and individual. It will have multiple components, including provider and staff education, provider reminder, provider assessment and feedback, patient reminder, and patient navigation. Methods This study is a multilevel, three-phase, stepped wedge cluster randomized trial with four clusters of clinics from four different FQHC systems. In the first phase, there will be a 3-month waiting period during which no intervention components will be implemented. After the 3-month waiting period, we will randomize two clusters to cross from the control to the intervention and the remaining two clusters to follow 3 months later. All clusters will stay at the same phase for 9 months, followed by a 3-month transition period, and then cross over to the next phase. Discussion There is a pressing need to reduce disparities in CRC outcomes, especially among racial/ethnic minority populations and among populations who live in poverty. Single-level interventions are often insufficient to lead to sustainable changes. Multilevel interventions, which target two or more levels of changes, are needed to address multilevel contextual influences simultaneously. Multilevel interventions with multiple components will affect not only the desired outcomes but also each other. How to take advantage of multilevel interventions and how to implement such interventions and evaluate their effectiveness are the ultimate goals of this study. Trial registration This protocol is registered at clinicaltrials.gov (NCT04514341) on 14 August 2020.
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Rogith D, Satterly T, Singh H, Sittig DF, Russo E, Smith MW, Roosan D, Bhise V, Murphy DR. Application of Human Factors Methods to Understand Missed Follow-up of Abnormal Test Results. Appl Clin Inform 2020; 11:692-698. [PMID: 33086395 DOI: 10.1055/s-0040-1716537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE This study demonstrates application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings. METHODS We identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method (CDM)-based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. We analyzed transcribed responses using a contextual inquiry (CI)-based methodology to identify contextual factors contributing to missed results. We then developed a CI-based flow model and conducted a fault tree analysis (FTA) to identify hierarchical relationships between factors that delayed action. RESULTS The flow model highlighted barriers in information flow and decision making, and the hierarchical model identified relationships between contributing factors for delayed action. Key findings including underdeveloped methods to track follow-up, as well as mismatches, in communication channels, timeframes, and expectations between patients and physicians. CONCLUSION This case report illustrates how human factors-based approaches can enable analysis of contributing factors that lead to missed results, thus informing development of preventive strategies to address them.
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Affiliation(s)
- Deevakar Rogith
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, Texas, United States
| | - Tyler Satterly
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, United States.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, United States
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, United States.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, United States
| | - Dean F Sittig
- The University of Texas Health Science Center at Houston School of Biomedical Informatics, Houston, Texas, United States.,UT-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas, United States
| | - Elise Russo
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Michael W Smith
- Department of Industrial and Mechanical Engineering, Universidad de las Americas Puebla, Cholula, Mexico
| | - Don Roosan
- Department of Pharmacy Practice and Administration, College of Pharmacy Western University of Health Sciences, Pomona, California, United States
| | - Viraj Bhise
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, United States
| | - Daniel R Murphy
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas, United States.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, Texas, United States
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Gomez-Cano M, Lyratzopoulos G, Abel GA. Patient Experience Drivers of Overall Satisfaction With Care in Cancer Patients: Evidence From Responders to the English Cancer Patient Experience Survey. J Patient Exp 2020; 7:758-765. [PMID: 33294612 PMCID: PMC7705845 DOI: 10.1177/2374373519889435] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Surveys collecting patient experience data often contain a large number of items covering a wide range of experiences. Knowing which areas to prioritize for improvements efforts can be difficult. OBJECTIVE To examine which aspects of care experience are the key drivers of overall satisfaction with cancer care. METHODS Secondary analysis of the National Cancer Patient Experience Survey. Logistic regression was used to examine the relationship between overall satisfaction and 10 core questions covering aspects of experience applicable to all patients. Supplementary analyses examined a further 16 questions applying only to patients in certain groups or on specific treatment pathways. RESULTS Of 68 340 included patients, 58 697 (86%) rated overall satisfaction highly (8 or more out of 10). The strongest predictors of overall satisfaction across all models were responses to 2 questions on experience of care administration and care coordination (odds ratio [OR] = 2.11, 95% confidence interval [95% CI = 2.05-2.17, P < .0001; OR = 2.03, 95% CI = 1.97-2.09, P < .0001, respectively, per 1 standard deviation change). CONCLUSION Focusing improvement efforts on care administration and coordination has potential to improve overall satisfaction with oncological care across diverse patient groups/care pathways.
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Affiliation(s)
- Mayam Gomez-Cano
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare & Outcomes (ECHO) Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, United Kingdom
| | - Gary A Abel
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
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Price CP, McGinley P, St John A. Where Is the Value of Laboratory Medicine and How Do You Unlock It? J Appl Lab Med 2020; 5:1050-1060. [PMID: 32916715 DOI: 10.1093/jalm/jfaa116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The innovation pathway by which a newly discovered biomarker is developed into a medical test and used in routine clinical practice comprises a number of different processes split between 2 phases. The first follows on from biomarker discovery and involves the development of a robust analytical method, the accumulation of evidence to show its clinical and cost-effectiveness, and then adoption into clinical pathways. The second phase is one of implementation and sustainability, with active performance management to ensure that the test continues to deliver the benefits promised at the time of its adoption. CONTENT To date there has been much more emphasis on the first phase of discovery and accumulation of evidence to demonstrate effectiveness. Insufficient attention has been paid to the second phase of translating that evidence into routine practice, with little real-world evidence to demonstrate the benefits to all of the stakeholders involved in delivering and receiving care. Changes in healthcare that include a move away from activity-based costing to a more value-based approach require more attention be paid to what happens after a test is adopted, including an understanding of the clinical pathway, the stakeholders within that pathway, and the benefits and "disbenefits" that accrue to these stakeholders. SUMMARY The value proposition provides a guide for successful implementation of a test. Although it can address both adoption and implementation, it highlights that the requirements for test implementation are quite different to those of adoption, with an emphasis on real-world evidence and outcomes.
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Affiliation(s)
- Christopher P Price
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Patrick McGinley
- Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
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Fleming S, Nicholson BD, Bhuiya A, de Lusignan S, Hirst Y, Hobbs R, Perera R, Sherlock J, Yonova I, Bankhead C. CASNET2: evaluation of an electronic safety netting cancer toolkit for the primary care electronic health record: protocol for a pragmatic stepped-wedge RCT. BMJ Open 2020; 10:e038562. [PMID: 32843517 PMCID: PMC7449309 DOI: 10.1136/bmjopen-2020-038562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Safety-netting in primary care is the best practice in cancer diagnosis, ensuring that patients are followed up until symptoms are explained or have resolved. Currently, clinicians use haphazard manual solutions. The ubiquitous use of electronic health records provides an opportunity to standardise safety-netting practices.A new electronic safety-netting toolkit has been introduced to provide systematic ways to track and follow up patients. We will evaluate the effectiveness of this toolkit, which is embedded in a major primary care clinical system in England:Egerton Medical Information System(EMIS)-Web. METHODS AND ANALYSIS We will conduct a stepped-wedge cluster RCT in 60 general practices within the RCGP Research and Surveillance Centre (RSC) network. Groups of 10 practices will be randomised into the active phase at 2-monthly intervals over 12 months. All practices will be activated for at least 2 months. The primary outcome is the primary care interval measured as days between the first recorded symptom of cancer (within the year prior to diagnosis) and the subsequent referral to secondary care. Other outcomes include referrals rates and rates of direct access cancer investigation.Analysis of the clustered stepped-wedge design will model associations using a fixed effect for intervention condition of the cluster at each time step, a fixed effect for time and other covariates, and then include a random effect for practice and for patient to account for correlation between observations from the same centre and from the same participant. ETHICS AND DISSEMINATION Ethical approval has been obtained from the North West-Greater Manchester West National Health Service Research Ethics Committee (REC Reference 19/NW/0692). Results will be disseminated in peer-reviewed journals and conferences, and sent to participating practices. They will be published on the University of Oxford Nuffield Department of Primary Care and RCGP RSC websites. TRIAL REGISTRATION NUMBER ISRCTN15913081; Pre-results.
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Affiliation(s)
- Susannah Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Afsana Bhuiya
- North Central and East London Cancer Alliance, London, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
- Research and Surveillance Centre, Royal College of General Practitioners, London, London, UK
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, University College, London, UK
| | - Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julian Sherlock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
| | - Ivelina Yonova
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, Surrey, UK
- Research and Surveillance Centre, Royal College of General Practitioners, London, London, UK
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Thomas J, Dahm MR, Li J, Smith P, Irvine J, Westbrook JI, Georgiou A. Variation in electronic test results management and its implications for patient safety: A multisite investigation. J Am Med Inform Assoc 2020; 27:1214-1224. [PMID: 32719839 PMCID: PMC7481032 DOI: 10.1093/jamia/ocaa093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 05/06/2020] [Indexed: 11/15/2022] Open
Abstract
Objective The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Materials and Methods Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Results Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Discussion Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Conclusions Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.
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Affiliation(s)
- Judith Thomas
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Maria R Dahm
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Peter Smith
- Emergency Medicine, Illawarra Shoalhaven Local Health District, New South Wales, Australia.,Graduate School of Medicine, University of Wollongong, New South Wales, Australia
| | - Jacqui Irvine
- Emergency Medicine, Illawarra Shoalhaven Local Health District, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, New South Wales, Australia
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Jacob M, Romano J, Araújo D, Pereira JM, Ramos I, Hespanhol V. Predicting lung nodules malignancy. Pulmonology 2020; 28:454-460. [PMID: 32739327 DOI: 10.1016/j.pulmoe.2020.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is critical to developing an accurate method for differentiating between malignant and benign solitary pulmonary nodules. This study aimed was to establish a predicting model of lung nodules malignancy in a real-world setting. METHODS The authors retrospectively analysed the clinical and computed tomography (CT) data of 121 patients with lung nodules, submitted to percutaneous CT-guided transthoracic biopsy, between 2014 and 2015. Multiple logistic regression was used to screen independent predictors for malignancy and to establish a clinical prediction model to evaluate the probability of malignancy. RESULTS From a total of 121 patients, 75 (62%) were men and with a mean age of 64.7 years old. Multivariate logistic regression analysis identified six independent predictors of malignancy: age, gender, smoking status, current extra-pulmonary cancer, air bronchogram and nodule size (p<0.05). The area under the curve (AUC) was 0.8573. CONCLUSIONS The prediction model established in this study can be used to assess the probability of malignancy in the Portuguese population, thereby providing help for the diagnosis of lung nodules and the selection of follow-up interventions.
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Affiliation(s)
- M Jacob
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
| | - J Romano
- Physical Medicine and Rehabilitation Department, Unidade de Saúde Local de Matosinhos, Porto, Portugal
| | - D Araújo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J M Pereira
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - I Ramos
- Radiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
| | - V Hespanhol
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine of Porto University, Porto, Portugal
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Uptake of referrals for women with positive perinatal depression screening results and the effectiveness of interventions to increase uptake: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2020; 29:e143. [PMID: 32677601 PMCID: PMC7372167 DOI: 10.1017/s2045796020000554] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Perinatal depression threatens the health of maternal women and their offspring. Although screening programs for perinatal depression exist, non-uptake of referral to further mental health care after screening reduces the utility of these programs. Uptake rates among women with positive screening varied widely across studies and little is known about how to improve the uptake rate. This study aimed to systematically review the available evidence on uptake rates, estimate the pooled rate, identify interventions to improve uptake of referral and explore the effectiveness of those interventions. METHODS This systematic review has been registered in PROSPERO (registration number: CRD42019138095). We searched Pubmed, Web of Science, Cochrane Library, Ovid, Embase, CNKI, Wanfang Database and VIP Databases from database inception to January 13, 2019 and scanned reference lists of relevant researches for studies published in English or Chinese. Studies providing information on uptake rate and/or effectiveness of interventions on uptake of referral were eligible for inclusion. Studies were excluded if they did not report the details of the referral process or did not provide exact uptake rate. Data provided by observational studies and quasi-experimental studies were used to estimate the pooled uptake rate through meta-analysis. We also performed meta-regression and subgroup analyses to explore the potential source of heterogeneity. To evaluate the effectiveness of interventions, we conducted descriptive analyses instead of meta-analyses since there was only one randomised controlled trial (RCT). RESULTS Of 2302 records identified, 41 studies were eligible for inclusion, including 39 observational studies (n = 9337), one quasi-experimental study (n = 43) and one RCT (n = 555). All but two studies were conducted in high-income countries. The uptake rates reported by included studies varied widely and the pooled uptake rate of referral was 43% (95% confidence intervals [CI] 35-50%) by a random-effect model. Meta-regression and subgroup analyses both showed that referral to on-site assessment or treatment (60%, 95% CI 51-69%) had a significantly higher uptake rate than referral to mental health service (32%, 95% CI 23-41%) (odds ratio 1.31, 95% CI 1.13-1.52). The included RCT showed that the referral intervention significantly improved the uptake rate (p < 0.01). CONCLUSIONS Almost three-fifths of women with positive screening results do not take up the referral offers after perinatal depression screening. Referral to on-site assessment and treatment may improve uptake of referral, but the quality of evidence on interventions to increase uptake was weak. More robust studies are needed, especially in low-and middle-income countries.
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Challen R, Tsaneva-Atanasova K, Edwards T, Gompels L, Dayer M, Pitt M, Danon L. Factors influencing digital review of pathology test results in an inpatient setting: a cross-sectional study. JAMIA Open 2020; 3:290-298. [PMID: 32734170 PMCID: PMC7382616 DOI: 10.1093/jamiaopen/ooaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 11/27/2019] [Accepted: 02/05/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Delay or failure to view test results in a hospital setting can lead to delayed diagnosis, risk of patient harm, and represents inefficiency. Factors influencing this were investigated to identify how timeliness and completeness of test review could be improved through an evidence-based redesign of the use of clinical test review software. METHODS A cross-section of all abnormal hematology and biochemistry results which were published on a digital test review platform over a 3-year period were investigated. The time it took for clinicians to view these results, and the results that were not viewed within 30 days, were analyzed relative to time of the week, the detailed type of test, and an indicator of patient record data quality. RESULTS The majority of results were viewed within 90 min, and 93.9% of these results viewed on the digital platform within 30 days. There was significant variation in results review throughout the week, shown to be due to an interplay between technical and clinical workflow factors. Routine results were less likely to be reviewed, as were those with patient record data quality issues. CONCLUSION The evidence suggests that test result review would be improved by stream-lining access to the result platform, differentiating between urgent and routine results, improving handover of responsibility for result review, and improving search for temporary patient records. Altering the timing of phlebotomy rounds and a review of the appropriateness of routine test requests at the weekend may also improve result review rates.
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Affiliation(s)
- Robert Challen
- EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, Devon, UK
- Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - Krasimira Tsaneva-Atanasova
- EPSRC Centre for Predictive Modelling in Healthcare, University of Exeter, Exeter, Devon, UK
- The Alan Turing Institute, British Library, London, UK
| | - Tom Edwards
- Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - Luke Gompels
- Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - Mark Dayer
- Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, UK
| | - Martin Pitt
- NIHR CLAHRC for the South West Peninsula, St Luke’s Campus, University of Exeter Medical School, Exeter, UK
| | - Leon Danon
- The Alan Turing Institute, British Library, London, UK
- Data Science Institute, College of Engineering, Mathematics and Physical Sciences, University of Exeter, Exeter, UK
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Li J, Paoloni R, Li L, Callen J, Westbrook JI, Runciman WB, Georgiou A. Does health information technology improve acknowledgement of radiology results for discharged Emergency Department patients? A before and after study. BMC Med Inform Decis Mak 2020; 20:100. [PMID: 32493463 PMCID: PMC7268495 DOI: 10.1186/s12911-020-01135-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 05/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The inadequate follow-up of test results is a key patient safety concern, carrying severe consequences for care outcomes. Patients discharged from the emergency department are at particular risk of having test results pending at discharge due to their short lengths of stay, with many hospitals acknowledging that they do not have reliable systems for managing such results. Health information technology hold the potential to reducing errors in the test result management process. This study aimed to measure changes in the proportion of acknowledged radiology reports pre and post introduction of an electronic result acknowledgement system and to determine the proportion of reports with abnormal results, including clinically significant abnormal results requiring follow-up action. METHODS A before and after study was conducted in the emergency department of a 450-bed metropolitan teaching hospital in Australia. All radiology reports for discharged patients for a one-month period before and after implementation of the electronic result acknowledgement system were reviewed to determine; i) those that reported abnormal results; ii) evidence of test result acknowledgement. All unacknowledged radiology results with an abnormal finding were assessed by an independent panel of two senior emergency physicians for clinical significance. RESULTS Of 1654 radiology reports in the pre-implementation period 70.6% (n = 1167) had documented evidence of acknowledgement by a clinician. For reports with abnormal results, 71.6% (n = 396) were acknowledged. Of 157 unacknowledged abnormal radiology reports reviewed by an independent emergency physician panel, 34.4% (n = 54) were identified as clinically significant and 50% of these (n = 27) were deemed to carry a moderate likelihood of patient morbidity if not followed up. Electronic acknowledgement occurred for all radiology reports in the post period (n = 1423), representing a 30.4% (95% CI: 28.1-32.6%) increase in acknowledgement rate, and an increase of 28.4% (95% CI: 24.6-32.2%) for abnormal radiology results. CONCLUSIONS The findings of this study demonstrate the potential of health information technology to improve the safety and effectiveness of the diagnostic process by increasing the rate of follow up of results pending at hospital discharge.
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Affiliation(s)
- Julie Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia.
| | - Richard Paoloni
- Emergency Department, Concord Repatriation General Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Joanne Callen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
| | - William B Runciman
- Australian Centre for Precision Health, Cancer Research Institute, University of South Australia, Adelaide, Australia
- Australian Patient Safety Foundation, Adelaide, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd, Sydney, NSW, 2109, Australia
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Powell L, Sittig DF, Chrouser K, Singh H. Assessment of Health Information Technology-Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System: A Qualitative Study of Aggregated Root Cause Analysis Data. JAMA Netw Open 2020; 3:e206752. [PMID: 32584406 PMCID: PMC7317596 DOI: 10.1001/jamanetworkopen.2020.6752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Diagnostic delay in the outpatient setting is an emerging safety priority that health information technology (HIT) should help address. However, diagnostic delays have persisted, and new safety concerns associated with the use of HIT have emerged. OBJECTIVE To analyze HIT-related outpatient diagnostic delays within a large, integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved qualitative content analysis of safety concerns identified in aggregated root cause analysis (RCA) data related to HIT and outpatient diagnostic delays. The setting was the US Department of Veterans Affairs using all RCAs submitted to the Veterans Affairs (VA) National Center for Patient Safety from January 1, 2013, to July 31, 2018. MAIN OUTCOMES AND MEASURES Common themes associated with the role of HIT-related safety concerns were identified and categorized according to the Health IT Safety framework for measuring, monitoring, and improving HIT safety. This framework includes 3 related domains (ie, safe HIT, safe use of HIT, and using HIT to improve safety) situated within an 8-dimensional sociotechnical model accounting for interacting technical and nontechnical variables associated with safety. Hence, themes identified enhanced understanding of the sociotechnical context and domain of HIT safety involved. RESULTS Of 214 RCAs categorized by the terms delay and outpatient submitted during the study period, 88 were identified as involving diagnostic delays and HIT, from which 172 unique HIT-related safety concerns were extracted (mean [SD], 1.97 [1.53] per RCA). Most safety concerns (82.6% [142 of 172]) involved problems with safe use of HIT, predominantly sociotechnical factors associated with people, workflow and communication, and a poorly designed human-computer interface. Fewer safety concerns involved problems with safe HIT (14.5% [25 of 172]) or using HIT to improve safety (0.3% [5 of 172]). The following 5 key high-risk areas for diagnostic delays emerged: managing electronic health record inbox notifications and communication, clinicians gathering key diagnostic information, technical problems, data entry problems, and failure of a system to track test results. CONCLUSIONS AND RELEVANCE This qualitative study of a national RCA data set suggests that interventions to reduce outpatient diagnostic delays could aim to improve test result management, interoperability, data visualization, and order entry, as well as to decrease information overload.
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Affiliation(s)
- Lauren Powell
- Veterans Affairs (VA) National Center for Patient Safety, Ann Arbor, Michigan
| | - Dean F Sittig
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston
| | | | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas
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Campione JR, Mardon RE, McDonald KM. Patient Safety Culture, Health Information Technology Implementation, and Medical Office Problems That Could Lead to Diagnostic Error. J Patient Saf 2020; 15:267-273. [PMID: 30138158 DOI: 10.1097/pts.0000000000000531] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment or by leading to unnecessary or harmful treatment. OBJECTIVES The aim of the study was to investigate the relationship between patient safety culture, health information technology (IT) implementation, and the frequency of problems that could lead to diagnostic errors in the medical office setting, such as unavailable test results, unavailable medical records, or unpursued abnormal results. METHODS We used survey data from 925 medical offices nationwide that voluntarily submitted results to the 2012 Agency for Healthcare Research and Quality Medical Office Surveys on Patient Safety Culture database. At the office level, we ran a multivariate regression model to estimate the effect of culture on problem frequency while controlling for office-reported implementation levels of health IT, office characteristics such as the number of locations, and survey characteristics such as the percent of respondents that were physicians. RESULTS The most frequent problem was "results from a lab or imaging test were not available when needed"; across 925 offices, the average was 15% reporting that it happened daily or weekly. Higher overall culture scores were significantly associated with fewer occurrences of each problem assessed. Compared with offices with completed health IT implementation, offices in the process of health IT implementation had higher frequency of problems. CONCLUSIONS This study offers insight into how patient safety culture and health IT implementation in medical offices can influence the frequency of breakdowns in processes of care, thereby identifying potential vulnerabilities that can increase diagnostic errors.
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Affiliation(s)
| | | | - Kathryn M McDonald
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California
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