TABLE OF CONTENTS
- Background
- Project Planning
- Collaborative Measures
- Current State Analysis
- Key Drivers
- Intervention Resources
Background
Up to 10% of all radiology reports contain follow-up recommendations, and approximately half of the recommended follow-up exams are never performed. Lung nodules represent about half of all imaging follow-up recommendations, and noncompliance with radiology lung nodule follow-up places patients at risk for delayed diagnosis of lung cancer.
Overview
The Recommendations Follow up Improvement Collaborative uses two outcome measures to improve the inclusion of appropriate and actionable follow-up recommendations for incidentally detected pulmonary nodules and the completion of timely follow-up for these recommendations.
A team's experience can be found in the December 2023 Bulletin: Following Patients Through Incidental Findings A case study on Hudson Valley Radiologists P.C. in Poughkeepsie, N.Y.
Project Management Template
Recommendations Follow-up Project Charter, A3, and Sustain Plan (Click Here to Download Project Set)
Project Planning
| Project Title | Improving the completion of recommended Follow-up for Incidental Pulmonary Nodules at {Organization} |
| Global Aim | To improve early detection of lung cancer for incidentally detected pulmonary nodules. |
| Potential Team Members | Radiologist Patient care coordinator Primary care physician/team Radiology manager Radiology scheduler |
Collaborative Measures
| Appropriateness Measure | Completion Measure | |
|---|---|---|
| Problem Statements | Not all patients with indeterminant lung nodules are consistently receiving actionable and appropriate recommendations for follow-up. | The recommended follow-up for patients identified as having an indeterminant lung nodule is not being adequately completed within the identified time frame putting them at risk for delayed diagnosis. |
| Measure Specification Documents | Percentage of imaging exams with one or more >= 6 mm lung nodule(s) with an indeterminate cancer risk for which an appropriate and actionable follow up recommendation was made. | Percentage of patients having an actionable recommendation for follow-up of one or more lung nodules who received recommended follow-up within the recommended time interval. |
| SMART Goal | Improve Percentage of patients who have an indeterminant lung nodule with an appropriate and actionable recommendation for follow-up from (baseline)% to (goal) % by July 2024. | Improve the percentage of exams that receive timely follow-up from (baseline)% to (goal) % by July 2024. |
| Data Submission | HUB: Recommendations Follow up: Data Collection and Control Chart in the Learning Network Hub | |
Current State Analysis
Use these Recommendations Follow up Current State Analysis Questions to plan your Gemba walk. Observations should be recorded on a cause-and-effect or fishbone diagram and root causes prioritized in a pareto chart.
Recommendations Follow up Current State Analysis Questions (Click Here to Download CSA Questions)
Key Drivers
The following are common key drivers seen over multiple cohorts. Each project will select Key Drivers, that may or may not be on this list, related to the root causes identified during the Current State Analysis.
| Appropriateness Measure | Completion Measure |
|---|---|
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Intervention Resources
- ACS NLCR Best Practice Guide for Building Lung Cancer Early Detection Programs Data Template
- ACS NLCR Best Practice Guide for Building Lung Cancer Early Detection Programs