August 10, 2016
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Emails, phone calls useful in alerting PCPs to delayed follow-ups

Strategies such as emailed reminders and telephone calls were useful in communicating information to PCPs regarding delayed follow-up appointments about suspicious test results, but were not fail-safe, according to data published in the Journal of the American Board of Family Medicine.

The researchers concluded that additional, back-up strategies, such as case coordinators, may be needed.

“Failure to follow-up abnormal or ‘red flag’ clinical findings (test results, signs and symptoms) can lead to delays in diagnostic evaluation and poor clinical outcomes,” Ashley N.D. Meyer, PhD, of the Michael E. DeBakey Veterans Affairs Medical Center, in Houston, and colleagues wrote. “To our knowledge, no studies have explored how to effectively communicate information about these delays, once identified, to frontline providers in near real time.”

To determine the effectiveness of various communication strategies, the researchers recruited 72 PCPs from two sites — a large, urban Veterans Affairs facility and a private health system — and randomly assigned them to either a control group or the intervention group. The researchers then reviewed electronic health records (EHR) of approximately 118,400 patients to identify follow-up delays in diagnostic evaluation for lung, colorectal or prostate cancer. A total of 733 patients with follow-up delays were found, with 369 in the intervention group.

The researchers alerted PCPs in the intervention group of such delays using three escalating steps, the first of which was an email. If no evidence of a follow-up was found in the medical record after 1 week, the researchers made up to three attempts to contact the PCP or their nurses by telephone. If they still could not be reached the researchers informed the clinic directors. Final patient outcomes were assessed by chart review 7 months after the initial “red flag” findings.

According to the researchers, communicating information to PCPs regarding delayed follow-ups led to decreased times to diagnostic evaluation. However, communication related to delays did not always lead to follow-up in the intervention group. Emails led to follow-up appointments in 11.1% of cases in the intervention group, while telephone calls led to follow-ups in 68.6% of cases. Contacting the clinic directors led to follow-up in five of the 11 cases in which such communication was necessary.

“To leverage the wealth of EHR data and bring it to the point of care to improve health care quality, more robust strategies for communicating information on follow-up delays are needed,” Meyer and colleagues wrote. “… In addition, back-up strategies using organizational mechanisms (such as case coordinators) could also be considered to support PCPs in tracking and follow-up.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.