Research Spotlight: New System of Care Improves Imaging Follow-Up and Reduces Diagnostic Errors

Lead author Nooshin Abbasi, MD, MPH, and senior author Ramin Khorasani MD, MPH, both of the Department of Radiology at Brigham and Women’s Hospital, published a paper in Radiology, “Cumulative Effect of Targeted Interventions on Radiologists’ Recommendations for Additional Imaging.”

Q: How would you summarize your study for a lay audience?

Resilient systems that ensure patients receive timely, recommended and clinically necessary diagnostic imaging are lacking, which may lead to delayed diagnosis and patient harm.

Each year, over 349 million diagnostic imaging examinations (ex. X-ray, ultrasound, CT or MRI) are performed in the United States. When interpreting these exams, radiologists recommend additional imaging more than 10% of the time to further evaluate any unexpected or unexplained findings. It is estimated that one-fourth to one-half of the radiologists’ recommendations, including clinically necessary exams, are not performed in a timely fashion or at all. This puts patients at risk for diagnostic errors (missed or delayed diagnosis) and potential harm.

To address this, we assessed the impact of a new ‘system of care’ quality initiative to improve follow-up diagnostic imaging to reduce diagnostic errors developed by stakeholders within Mass General Brigham.

Q: What question were you investigating?

Our goal in this study was to evaluate the impact of this new ‘system of care’ on radiologists’ follow-up imaging recommendations.

We assessed the impact of a series of technology-enabled quality improvement initiatives developed at Brigham and Women’s Hospital to improve imaging follow-ups for patients:

1. An information technology tool for ‘closed-loop’ communication
2. “Safety Net” staff to help with tracking and scheduling of follow up imaging exams that may have otherwise been potentially overlooked in busy clinics
3. Feedback reports for radiologists about how often they make follow up recommendations compare to their peers

Q: What methods or approach did you use?

We analyzed 7.5 million radiology reports of diagnostic imaging examinations for 1.3 million patients performed between January 2015 and December 2022. Using logistic regression analyses, we compared 1) rates of recommendations for additional imaging, 2) recommendation actionability, and 3) resolution rates between the Brigham and Women’s Hospital (as the study site) and Massachusetts General Hospital (as a control site representing the current national standard of practice).

Q: What did you find?

At the study site, the quality improvement initiatives were associated with a 44% reduction in recommendations for additional imaging, but recommendation rates remained unchanged at the control site. Actionability of the recommendations increased 7.6-fold at the study site, from 5.5% to 42.3%, but remained unchanged at the control site. Actionable recommendations were more frequently resolved (performed or scheduled) at the study site than at the control site, 84.7% vs. 59.6%, respectively.

Q: What are the implications?

This new ‘system of care’ quality initiative is more resilient, helping ensure patients get timely, clinically necessary additional imaging to reduce diagnostic errors and potential harm. The decreasing rate of imaging recommendations may also help decrease overall health care costs and reduce health risks associated with unnecessary additional imaging, such as radiation exposure.

Q: What are the next steps?

Overseen by the Mass General Brigham Office of the Chief Medical Officer, the initiative to improve radiologists’ recommendations for additional imaging has been expanded across the system since October 2024 as part of the Mass General Brigham For Every Patient strategy for quality transformation. Funding from the Agency for Healthcare Research and Quality (AHRQ) provides resources to assess the impact of this initiative on diagnostic errors and patient harm and to help disseminate resulting best practices nationally.

Authorship: In addition to Abbasi and Khorasani, Mass General Brigham authors include Neena Kapoor, Ronilda Lacson, Jeffrey P. Guenette, Sonali Desai, David Lucier, Sanjay Saini, Rachel Sisodia, Ali S. Raja, and David W. Bates

Paper cited: Abbasi N, et al. “Cumulative Effect of Targeted Interventions on Radiologists’ Recommendations for Additional Imaging” Radiology DOI: 10.1148/radiol.243750

Funding: This work was supported by the Agency for Healthcare Research and Quality (R18 HS029348).

Disclosures: N/A