Implementing a care model to enhance patient outcomes and limit liability in patients with incidental pulmonary nodules.

Abstract

e18247 Background: Patients with incidental pulmonary nodules are at risk for loss to follow-up due to fragmented health care delivery systems. The purpose of this study is to describe implementation of a care model to eliminate gaps in care for these patients. Methods: A multifaceted intervention was implemented to improve follow-up of incidental pulmonary nodules in at-risk patients. The intervention included education of all patients with incidental nodules in the emergency room and inpatient setting upon discharge. Other key steps included: (i) engagement of physician leadership, (ii) development of a patient tracking database, (iii) designation of a nurse navigator to ensure timely notification of radiological findings, (iv) ensuring patients received timely follow-up and (v) coordination communication with the primary care physician (PCP) or assistance in establishing a relationship with a PCP. Finally, smoking history was added to all CT body radiology reports to stratify risk and determine follow-up intervals using nationally accepted guidelines. The study was reviewed by the St Joseph Mercy Health System Institutional Review Board and was considered exempt. Results: Over the course of 36 months, 7,962 patients with incidental pulmonary nodules were identified by radiologists and flagged for entry into the follow-up program. 2.6% of patients enrolled were found to have lung neoplasms (68% of which were stage I, II or III non-small cell lung cancer). Conclusions: Integrated care models with a seamless combination of nurse navigation and optimal use of health information technology improves care and outcomes for patients with incidental pulmonary nodules while simultaneously mitigating liability for physicians and health care institutions.