TY - JOUR
T1 - Patient characteristics associated with adherence to pulmonary nodule guidelines
AU - Iaccarino, Jonathan M.
AU - Steiling, Katrina
AU - Slatore, Christopher G.
AU - Drainoni, Mari Lynn
AU - Wiener, Renda Soylemez
N1 - Publisher Copyright:
© 2020 Elsevier Ltd
PY - 2020/9
Y1 - 2020/9
N2 - Background: While pulmonary nodule guidelines provide follow-up recommendations based on nodule size and malignancy risk, these are inconsistently followed in clinical practice. In this study, we sought to identify patient characteristics associated with guideline-concordant nodule follow-up. Methods: We conducted a retrospective cohort study of patients diagnosed with a pulmonary nodule between 2011 and 2014 at Boston Medical Center. Appropriate nodule follow-up evaluation was based upon the 2005 Fleischner Society Guidelines. In primary analysis, we compared patients with guideline-concordant follow-up to those with delayed or absent follow-up. In secondary analysis, we compared those with any follow-up to those without follow-up as well as the rate of guideline-concordant follow-up in patients seen by a pulmonologist. Results: Of 3916 patients diagnosed with a pulmonary nodule, 1117 were included for analysis. Overall, 598 (53.5%) patients received guideline-concordant follow-up. Lower rates of guideline concordance were seen in patients of Hispanic ethnicity (OR 0.60, 95% CI 0.36–1.00), while higher rates were seen for nodules 7–8 mm (OR 1.55, 95% CI 1.02–2.35) and nodules >8 mm (OR 1.49, 95% CI 1.01–2.20). Having a history of COPD (OR 1.75, 95% CI 1.26–2.43), and being seen by a pulmonologist (OR 1.97, 95% CI 1.51–2.58) were also associated with guideline concordance. Among patients seen by a pulmonologist, 62.2% received guideline-concordant follow-up. Conclusion: Overall rates of pulmonary nodule follow-up are low. Patient ethnicity, COPD history, nodule size and involvement of a pulmonologist may impact follow-up rates and are potential targets for implementation interventions to improve pulmonary nodule follow-up.
AB - Background: While pulmonary nodule guidelines provide follow-up recommendations based on nodule size and malignancy risk, these are inconsistently followed in clinical practice. In this study, we sought to identify patient characteristics associated with guideline-concordant nodule follow-up. Methods: We conducted a retrospective cohort study of patients diagnosed with a pulmonary nodule between 2011 and 2014 at Boston Medical Center. Appropriate nodule follow-up evaluation was based upon the 2005 Fleischner Society Guidelines. In primary analysis, we compared patients with guideline-concordant follow-up to those with delayed or absent follow-up. In secondary analysis, we compared those with any follow-up to those without follow-up as well as the rate of guideline-concordant follow-up in patients seen by a pulmonologist. Results: Of 3916 patients diagnosed with a pulmonary nodule, 1117 were included for analysis. Overall, 598 (53.5%) patients received guideline-concordant follow-up. Lower rates of guideline concordance were seen in patients of Hispanic ethnicity (OR 0.60, 95% CI 0.36–1.00), while higher rates were seen for nodules 7–8 mm (OR 1.55, 95% CI 1.02–2.35) and nodules >8 mm (OR 1.49, 95% CI 1.01–2.20). Having a history of COPD (OR 1.75, 95% CI 1.26–2.43), and being seen by a pulmonologist (OR 1.97, 95% CI 1.51–2.58) were also associated with guideline concordance. Among patients seen by a pulmonologist, 62.2% received guideline-concordant follow-up. Conclusion: Overall rates of pulmonary nodule follow-up are low. Patient ethnicity, COPD history, nodule size and involvement of a pulmonologist may impact follow-up rates and are potential targets for implementation interventions to improve pulmonary nodule follow-up.
KW - Clinical guidelines
KW - Health services research
KW - Pulmonary nodule
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U2 - 10.1016/j.rmed.2020.106075
DO - 10.1016/j.rmed.2020.106075
M3 - Article
C2 - 32658836
AN - SCOPUS:85087383709
SN - 0954-6111
VL - 171
JO - Respiratory Medicine
JF - Respiratory Medicine
M1 - 106075
ER -