Impact of a Health Information Technology Intervention on the Follow-up Management of Pulmonary Nodules

Abstract

Lung cancer is the leading cause of cancer deaths in the USA. The most common abnormalities suspicious for lung cancer on CT scan include pulmonary nodules. Recommendations to improve care for patients with pulmonary nodules require follow-up management. However, transitions in care, especially for patients undergoing transitions to ambulatory care sites from the emergency department (ED) and inpatient settings, can exacerbate failures in follow-up testing and compromise patient safety. We evaluate the impact of a discharge module that includes follow-up recommendations for further management of pulmonary nodules on the study outcome and follow-up management of patients with pulmonary nodules within 1 year after discharge. After IRB approval, we collected data on all patients undergoing chest or abdominal CT exams over a 12-month baseline and 12-month intervention period at an academic medical center. The inpatient discharge module was implemented in November 2011; the ED module was implemented in May 2012. Multivariable logistic regression was performed to account for care setting, imaging modality, recommendations, and patient demographics. Implementation of a discharge module resulted in improved follow-up of patients with pulmonary nodules within 1 year after discharge (OR = 1.64, p = 0.01); the ED implementation resulted in better follow-up compared to the inpatient module (OR = 2.24, p < 0.01). Twenty-seven percent of patients with pulmonary nodules received follow-up management, which, although significantly improved from the 18% baseline, remains low. An electronic discharge module is associated with improved follow-up management of patients with pulmonary nodules, and may be combined with interventions to further improve management of these patients.

Application of Three-Dimensional Reconstruction Combined with Dial Positioning in Small Pulmonary Nodules Surgery

“…VATS has been fully proved to be effective in removing lesions due to its high safety and minimal invasion [6]. However, due to the limitations of VATS, it is di cult to accurately locate small nonsuper cial pulmonary nodules, which leads to the occurrence of residual nodules after surgery and jeopardize the prognosis [7]. Therefore, how to locate small pulmonary nodules accurately, e ciently and noninvasively becomes one of the keys to successful operation.…”

Application of three-dimensional reconstruction combined with dial positioning in small pulmonary nodules surgery

“…VATS has been fully proved to be effective in removing lesions due to its high safety and minimal invasion [6]. However, due to the limitations of VATS, it is difficult to accurately locate small non-superficial pulmonary nodules, which leads to the occurrence of residual nodules after surgery and jeopardize the prognosis [7]. Therefore, how to locate small pulmonary nodules accurately, efficiently and noninvasively becomes one of the keys to successful operation.…”

Radiologist Variation in the Rates of Follow-up Imaging Recommendations Made for Pulmonary Nodules

“…We used a previously validated information retrieval toolkit, Information from Searching Content with an Ontology-Toolkit (iScout, Boston, Massachusetts), to identify radiology reports for patients with pulmonary nodules and exclude those reports that mentioned lung cancer [19,20]. Lung cancer patients were excluded because they might have a higher follow-up recommendation rate and therefore skew the overall follow-up recommendation rate.…”

“…To identify which reports contained follow-up recommendations for pulmonary nodules, we used a previously developed support vector machine algorithm to perform natural language processing [21]. We performed a power calculation (33% prevalence [19], power: 0.80, estimated sensitivity: 0.85), yielding a size of 340 testing samples for validation of the machine learning algorithm on our patient cohort. A total of 400 reports were randomly selected and manually annotated for the presence of any follow-up recommendations specifically for pulmonary nodules.…”