Patient characteristics associated with adherence to pulmonary nodule guidelines. (September 2020)

• Record Type: Journal Article
• Authors: Iaccarino, Jonathan M.; Steiling, Katrina; Slatore, Christopher G.; Drainoni, Mari-Lynn; Wiener, Renda Soylemez
• Is Part Of: Respiratory medicine. Volume 171(2020)
• Publication Date: 2020-09
• Subjects: Pulmonary nodule -- Clinical guidelines -- Health services research; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2020.106075
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: 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. Highlights: Low rates of pulmonary nodule follow-up in an academic safety-net hospital. Pulmonary nodule follow-up rates are decreased in patients of Hispanic ethnicity and who have smaller nodules. Pulmonary nodule follow-up rates are increased in patients with COPD or who have been evaluated by a pulmonologist. Improvement in the implementation of guideline-recommended pulmonary nodule follow-up is needed to optimize patient outcomes.