title: Feasibility and satisfaction with a tailored web-based audit intervention for recalibrating radiologists' thresholds for conducting additional work-up.
abstract: OBJECTIVE
  To examine the feasibility of and satisfaction with a tailored web-based intervention designed to decrease radiologists' recommendation of inappropriate additional work-up after a screening mammogram.
  
  
  METHODS
  We developed a web-based educational intervention designed to reduce inappropriate recall. Radiologists were randomly assigned to participate in an early intervention group or a late (control) intervention group, the latter of which served as a control for a 9-month follow-up period, after which they were invited to participate in the intervention. Intervention content was derived from our prior research and included three modules: 1) an introduction to audit statistics for mammography performance; 2) a review of data showing radiologists' inflated perceptions of medical malpractice risks related to breast imaging, and 3) a review of data on breast cancer risk among women seen in their practices. Embedded within the intervention were individualized audit data for each participating radiologists obtained from the national Breast Cancer Surveillance Consortium.
  
  
  RESULTS
  Seventy-four radiologists (37.8%; 74/196) consented to the intervention, which was completed by 67.5% (27/40) of those randomized to the early intervention group and 41.2% (14/34) of those randomized to the late (control) group. Thus, a total of 41 (55%) completed the intervention. On average, three log-ins were used to complete the program (range 1-14), which took approximately 1 hour. Ninety-five percent found the program moderately to very helpful in understanding how to calculate basic performance measures. Ninety-three percent found viewing their own performance measures moderately to very helpful, and 83% reported it being moderately to very important to learn that the breast cancer risk in their screening population program was lower than perceived. The percentage of radiologists who reported that the risk of medical malpractice influences their recall rates dropped from 36.3% preintervention to 17.8% after intervention with a similar drop in perceived influence of malpractice risk on their recommendations for breast biopsy (36.4 to 17.3%). More than 75% of radiologists answered the postintervention knowledge questions correctly, and the percent of time spent in breast imaging did not appear to influence responses. The majority (>92%) of participants correctly responded that the target recall rate in the United States is 9%. The mean self-reported recall rates were 13.0 for radiologists spending <40% time in breast imaging and 14.9% for those spending >40% time spent in breast imaging, which was highly correlated with their actual recall rates (0.991; P < .001).
  
  
  CONCLUSIONS
  Radiologists who begin an internet-based tailored intervention designed to help reduce unnecessary recall will likely complete it, although only 55% who consented to the study actually undertook the intervention. Participants found the program useful in helping them understand why their recall rates may be elevated.
authors.affiliation: Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA. carneyp@ohsu.edu
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.forename: Edward A
authors.initials: EA
authors.lastname: Sickles
authors.forename: Diana L
authors.initials: DL
authors.lastname: Miglioretti
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Aiello Bowles
authors.forename: Linn
authors.initials: L
authors.lastname: Abraham
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Feig
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: Cook
authors.forename: Bonnie C
authors.initials: BC
authors.lastname: Yankaskas
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D001291:Attitude of Health Personnel; D003133:Commission on Professional and Hospital Activities / Q000706:statistics & numerical data*; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D015588:Observer Variation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011361:Professional Competence / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology