Applying Implementation Science Principles to Systematize High-Quality Care for Potentially Significant Imaging Findings

Richard E Sharpe Jr; Ryan I Huffman; Christopher G McLaughlin; Patrick Blubaugh; Mary Jo Strobel; Ted Palen

doi:10.1016/j.jacr.2022.11.019

Applying Implementation Science Principles to Systematize High-Quality Care for Potentially Significant Imaging Findings

J Am Coll Radiol. 2023 Mar;20(3):324-334. doi: 10.1016/j.jacr.2022.11.019.

Authors

Richard E Sharpe Jr¹, Ryan I Huffman², Christopher G McLaughlin³, Patrick Blubaugh⁴, Mary Jo Strobel⁵, Ted Palen⁶

Affiliations

¹ Division Chair of Breast Imaging and Radiologist, Mayo Clinic, Phoenix, Arizona; Member, ACR Peer Learning Committee; Member, ACR Appropriateness Panel for Breast Imaging; and Member, ACR Commission on Screening & Emerging Technology Committee. Electronic address: Sharpe.Richard@Mayo.edu.
² Radiologist, Scripps Clinic Medical Group, La Jolla, California.
³ Radiologist, Department Technical Lead, Radiology, Colorado Permanente Medical Group, Denver, Colorado.
⁴ Data Analyst, Kaiser Permanente Colorado, Denver, Colorado.
⁵ Director, Clinical Quality Oversight, Quality, Risk, and Patient Safety, Kaiser Permanente Colorado, Denver, Colorado.
⁶ Internal Medicine Physician and Scientific Investigator, Colorado Permanente Medical Group, Denver, Colorado.

PMID: 36922106
DOI: 10.1016/j.jacr.2022.11.019

Abstract

Objective: Use principles of implementation science to improve the diagnosis and management of potentially significant imaging findings.

Methods: Multidisciplinary stakeholders codified the diagnosis and management of potentially significant imaging findings in eight organs and created a finding tracking management system that was embedded in radiologist workflows and IT systems. Radiologists were trained to use this system. An automated finding tracking management system was created to support consistent high-quality care through care pathway visualizations, increased awareness of specific findings in the electronic medical record, templated notifications, and creation of an electronic safety net. Primary outcome was the rate of quality reviews related to eight targeted imaging findings. Secondary outcome was radiologist use of the finding tracking management tool.

Results: In the 4 years after implementation, the tool was used to track findings in 7,843 patients who received 10,015 ultrasound, CT, MRI, x-ray, and nuclear medicine examinations that were interpreted by all 34 radiologists. Use of the tool lead to a decrease in related quality reviews (from 8.0% to 0.0%, P < .007). Use of the system increased from 1.7% of examinations in the early implementation phase to 3.1% (+82%, P < .00001) in the postimplementation phase. Each radiologist used the tool on an average of 294.6 unique examinations (SD 404.8). Overall, radiologists currently use the tool approximately 4,000 times per year.

Discussion: Radiologists frequently used a finding tracking management system to ensure effective communication and raise awareness of the importance of recommended future follow-up studies. Use of this system was associated with a decrease in the rate of quality review requests in this domain.

Keywords: Implementation science; incidental findings; quality improvement; standardization; systems engineering.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Implementation Science*
Magnetic Resonance Imaging
Quality of Health Care
Radiography
Radiologists*