Identifying an unexpected, incidental finding – such as a lung nodule – during a radiology exam represents an opportunity to diagnose malignancy at an early, treatable stage. Yet, nationally it is known that 30 percent to 70 percent of recommended follow-up tests for incidental findings are never performed, placing patients at risk for delayed diagnosis.
Following an audit that confirmed inconsistent follow-up compliance in the Thompson Health system, a team at UR Medicine Thompson Hospital – led by Ben Wandtke, M.D., chief of diagnostic imaging – developed an innovative, three-stage, follow-up tracking system called Backstop. It serves as a safety net for existing outpatient office tracking systems. Radiology recommendations that contain both a recommended imaging modality and due date are tracked in a database. A clinical navigator monitors the database and initiates a series of sequential interventions when any recommendation is not completed one month after the due date.
The clinical navigator sends the radiology report containing the recommendation again to the patient’s primary care provider, along with a cover letter explaining the Backstop program. Two months after the recommendation’s due date, the clinical navigator calls the primary care office staff, offering to assist with scheduling the follow-up. If the exam hasn’t been completed after three months, the radiologist who recommended additional imaging personally calls the primary care physician. Patients are informed by letter of outstanding recommendations when the system cannot document a satisfactory care outcome.
The results of the Backstop program have been impressive. During its first 13 months, there was a 52 percent increase in the recommended exam completion rate, from 46 percent to more than 70 percent. In addition, through improved communication between hospital staff and office-based practices, the Backstop team began to understand why many patients were not obtaining follow-up imaging. They identified patients with a variety of satisfactory non-imaging clinical outcomes, such as surgery to treat the incidental finding or those receiving palliative care. The number of patients with unknown follow-up compliance – those at risk for delay in diagnosis – was reduced by 74 percent.
“This is important because the impact of diagnosing cancer at an early stage versus a late stage can result in a 50 percent difference in five-year mortality for the patient,” Wandtke says. “In addition, the cost of treating early stage cancer can be more than 30 percent cheaper than treating late-stage cancer, saving more than $15,000 in unnecessary health care costs per delay.”
In 2017, Backstop expanded from Thompson Hospital to the entire UR Imaging network, increasing tenfold the number of patients benefitting from the safety net. By eliminating preventable delay in diagnosis, the team attempts to give each patient the best chance for a cure.