Patients in the outpatient setting most likely to complete follow-up imaging

Patients receiving care in the outpatient setting are more likely to complete relevant follow-up imaging than patients in the inpatient or emergency department (ED) settings, according to new research published in the Journal of the American College of Radiology. 

“There is little empirical evidence about the relationship between patient location at the time of imaging and appropriate imaging follow-up—insight that health systems could use to determine which care processes and strategies to prioritize in efforts to improve quality in different care settings,” wrote lead author Geraldine J. Liao, MD, of Virginia Mason Medical Center in Seattle, Washington. 

The researchers sought to determine the relationship between patient location during imaging and the completion of pertinent imaging follow-up for findings with undefined malignant potential.

“Our hypothesis was that findings from examinations performed in the ED setting would be less likely to be appropriately followed up compared with those performed in the outpatient and inpatient settings,” Liao and colleagues noted.

Liao et al. analyzed ultrasound, CT and MRI imaging examinations that were performed from July 1, 2013, to January 31, 2014. About 70 percent of index exams occurred in the outpatient setting, compared to 13 percent in an inpatient setting and 16 percent in an ED setting. 

Relevant follow-up occurred in 49 percent of index exams. About 62 percent of the follow-up exams were performed in an outpatient setting compared to 18 percent in an inpatient setting and 17 percent in an emergency department setting—a contrast to their original hypothesis.

Exams that were performed in the emergency department and in an inpatient setting were less likely to be followed up, compared to when they were performed in an outpatient setting. Though only 4.6 percent of lesions progressed to more suspicious lesions.

“Patient location at time of imaging is associated with the likelihood of completing relevant follow-up imaging for lesions with indeterminate malignant potential,” the researchers wrote.

The findings, the researchers noted, show the need for increased efforts to redesign care processes to improve imaging follow-up for findings with undefined malignant potential. 

“Future work should evaluate health system-level care processes related to care setting, as well as their effects on appropriate follow-up imaging,” they concluded. “Doing so would support efforts to improve appropriate follow-up imaging and reduce health care disparities.”