Standardized Reporting and Management of Suspicious Findings on Chest CT Imaging Is Associated With Improved Lung Cancer Diagnosis in an Observational Study
| Autor: | Douglas A. Corley, Stacey E. Alexeeff, Thomas H. Urbania, Sora Ely, Ashish R. Patel, Lori C. Sakoda, Lisa J. Herrinton, Jennifer R. Dusendang, Todd Osinski |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Delayed Diagnosis Lung Neoplasms Referral Adolescent Disease Critical Care and Intensive Care Medicine 03 medical and health sciences Young Adult 0302 clinical medicine Medicine Humans 030212 general & internal medicine Medical diagnosis Lung cancer Aged Retrospective Studies Aged 80 and over business.industry Incidence (epidemiology) Incidence Hazard ratio Middle Aged medicine.disease United States 030228 respiratory system Current Procedural Terminology Observational study Female Radiography Thoracic Radiology Cardiology and Cardiovascular Medicine business Tomography X-Ray Computed |
| Zdroj: | Chest. 158(5) |
| ISSN: | 1931-3543 |
| Popis: | Background Follow-up of chest CT scan findings suspicious for lung cancer may be delayed because of inadequate documentation. Standardized reporting and follow-up may reduce time to diagnosis and care for lung cancer. Study Design and Methods We implemented a reporting system that standardizes tagging of chest CT scan reports by classifying pulmonary findings. The system also automates referral of patients with findings suspicious for lung cancer to a multidisciplinary care team for rapid review and follow-up. The system was designed to reduce the time to diagnosis, particularly for early-stage lung cancer. We evaluated the effectiveness of this system, using a quasi-experimental stepped wedge cluster design, examining 99,148 patients who underwent diagnostic (nonscreening) chest CT imaging from 2015 to 2017 and who had not received a chest CT scan in the preceding 24 months. We evaluated the association of the intervention with the incidence of diagnosis and surgical treatment of early-stage (I, II) and late-stage (III, IV) lung cancer within 120 days of chest CT imaging. Results Forty percent of patients received the intervention. Among 2,856 patients (2.9%) who received diagnoses of lung cancer, 28% had early-stage disease. In multivariable analyses, the intervention was associated with 24% greater odds of early-stage diagnosis (OR, 1.24; 95% CI, 1.09-1.41) and no change in the odds of late-stage diagnosis (OR, 1.04; 95% CI, 0.95-1.14). The intervention was not associated with the rate of surgical treatment within 120 days. Interpretation In this large quasi-experimental community-based observational study, implementation of a system that combines standardized tagging of chest CT scan reports with clinical navigation was effective for increasing the diagnosis of early-stage lung cancer. |
| Databáze: | OpenAIRE |
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