Racial/ethnic status has an impact on whether a patient with an incidental pulmonary nodule receives appropriate follow-up imaging in a timely manner, according to one new study.
Incidental pulmonary nodules are very common and present with a wide range of malignancy probability. Imaging follow-up is crucial to determine growth over time and for optimal management of the patient.
Barbosa
“It is well-documented that patient adherence to follow-up is low, which may lead to poor outcomes,” said RSNA 2020 presenter Eduardo J. Mortani Barbosa Jr., MD, assistant professor of radiology at the University of Pennsylvania. “Racial and ethnic minority and low socioeconomic status groups are at a systemic disadvantage to access health care resources, leading to worse health outcomes.”
In his study, Dr. Barbosa’s goal was to assess not only the extent to which racial-ethnic status contributes to disparities in follow-up, but also to dissect the sequence of steps necessary for a successful outcome when an incidental pulmonary nodule is detected.
Schut
This sequence of testing and treatment is known as a cascade of care model. In their study, Dr. Barbosa and his co-author Rebecca A. Schut, a PhD candidate, outlined a cascade of care framework for their research.
Radiologist detects an incidental pulmonary nodule and makes appropriate recommendation for follow-up imaging or procedure:
- Ordering provider acknowledges receipt of radiology report and recommendation
- Ordering provider communicates the incidental pulmonary nodule and recommended follow-up to the patient
- Ordering provider orders recommended follow-up imaging or procedure
- Patient schedules the recommended follow-up
- Patient adheres to follow-up recommendation in a timely manner
Study Shows Disparities Between Blacks and Whites
The researchers analyzed the medical records of 1,562 patients at the University of Pennsylvania who had an incidental pulmonary nodule detected by CT imaging and the number of patients retained at each step of the cascade-of-care framework.
For all 1,562 patients, the radiology report was sent to the ordering health care provider. Only 1,077 (69%) of the patient cohort received the findings of the radiology report and recommended follow-up. At step four, providers ordered follow-up for 870 patients (56%).
Of the patients who reached step five in the framework, 850 (54%) scheduled follow-up care and 676 (43%), adhered to the follow-up appointment in a timely manner. Less than half of the total patient population reached a successful outcome of undergoing follow-up imaging or a procedure in a timely manner.
The researchers conducted a statistical analysis to determine how racial/ethnicity status affected each step of the cascade and the final adherence outcome.
“The percentage of patients retained at each step decreased progressively,” Dr. Barbosa said. “However, the differential between white patients and minority patients, especially black patients, is wide.”
Black patients in the study had increased odds of never adhering to or delaying adherence to follow-up recommendations compared to white patients.
Results show that the ordering provider communicated the radiology report to 80% of white patients in the study; the percentage of black patients who received their radiology report was 55%.
The second most significant disparity was between ordering and scheduling the recommended follow-up and the patient’s timely adherence to the scheduled follow-up (54% for whites and 29% for blacks, respectively).
“Black patients were most at risk for dropping off the path to adherence compared with white patients, controlling for provider-patient communication and socio-demographic and health characteristics,” Dr. Barbosa said.
Dr. Barbosa and colleagues hope their research offers a step toward rectifying the disparity between blacks and whites in imaging follow-up of an incidental pulmonary nodule.
“Our research offers a framework for health policy and clinical practice interventions aiming to improve outcomes related to incidental pulmonary nodules in the most disadvantaged racial and ethnic groups,” Dr. Barbosa said.
For More Information:
View the RSNA 2020 session Cascade of Care Framework Can Examine Racial Disparities in Adherence among Patients with Incidental Pulmonary Nodules — SSHS03 at RSNA2020.RSNA.org.
