Using a tailored web-based intervention to set goals to reduce unnecessary recall.
OBJECTIVE
To examine whether an intervention strategy consisting of a tailored web-based intervention, which provides individualized audit data with peer comparisons and other data that can affect recall, can assist radiologists in setting goals for reducing unnecessary recall.


METHODS
In a multisite randomized controlled study, we used a tailored web-based intervention to assess radiologists' ability to set goals to improve interpretive performance. The intervention provided peer comparison audit data, profiled breast cancer risk in each radiologist's respective patient populations, and evaluated the possible impact of medical malpractice concerns. We calculated the percentage of radiologists who would consider changing their recall rates, and examined the specific goals they set to reduce recall rates. We describe characteristics of radiologists who developed realistic goals to reduce their recall rates, and their reactions to the importance of patient risk factors and medical malpractice concerns.


RESULTS
Forty-one of 46 radiologists (89.1%) who started the intervention completed it. Thirty-one (72.1%) indicated they would like to change their recall rates and 30 (69.8%) entered a text response about changing their rates. Sixteen of the 30 (53.3%) radiologists who included a text response set realistic goals that would likely result in reducing unnecessary recall. The actual recall rates of those who set realistic goals were not statistically different from those who did not (13.8% vs. 15.1%, respectively). The majority of selected goals involved re-reviewing cases initially interpreted as Breast Imaging Reporting and Data System category 0. More than half of radiologists who commented on the influence of patient risk (56.3%) indicated that radiologists planned to pay more attention to risk factors, and 100% of participants commented on concerns radiologists have about malpractice with the primary concern (37.5%) being fear of lawsuits.


CONCLUSIONS
Interventions designed to reduce unnecessary recall can succeed in assisting radiologists to develop goals that may ultimately reduce unnecessary recall.
Departments of Family Medicine and Public Health and Preventive Medicine, Oregon Health & Science University, Portland, 97239-3098, USA. carneyp@ohsu.edu
Patricia A
PA
Carney
Erin J Aiello
EJ
Bowles
Edward A
EA
Sickles
Berta M
BM
Geller
Stephen A
SA
Feig
Sara
S
Jackson
David
D
Brown
Andrea
A
Cook
Bonnie C
BC
Yankaskas
Diana L
DL
Miglioretti
Joann G
JG
Elmore
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D003194:Computer-Assisted Instruction / Q000379:methods*; D003951:Diagnostic Errors / Q000517:prevention & control*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D011361:Professional Competence / Q000706:statistics & numerical data; D011871:Radiology / Q000193:education*; D014481:United States / Q000453:epidemiology
J Natl Cancer Inst. 2008 Aug 6;100(15):1082-91
18664650
J Natl Cancer Inst. 2002 Sep 18;94(18):1373-80
12237283
Int J Fertil Womens Med. 2004 Sep-Oct;49(5):228-30
15633481
Acad Radiol. 2011 Mar;18(3):369-76
21193335
J Natl Cancer Inst. 2005 Mar 2;97(5):358-67
15741572
Arch Intern Med. 1996 Jan 22;156(2):209-13
8546556
Radiology. 2005 Jul;236(1):37-46
15987961
JAMA. 2003 Oct 22;290(16):2129-37
14570948
AJR Am J Roentgenol. 2009 Feb;192(2):361-9
19155395
Med Decis Making. 2005 May-Jun;25(3):283-9
15951455
Perm J. 2004 Spring;8(2):12-8
26704912
Med Decis Making. 2004 May-Jun;24(3):255-64
15155014
J Natl Cancer Inst. 2008 Jun 18;100(12):876-87
18544742
J Natl Cancer Inst. 2007 Dec 19;99(24):1854-63
18073379
Radiology. 2009 Dec;253(3):641-51
19864507
Radiology. 2010 May;255(2):354-61
20413750
J Contin Educ Health Prof. 2003 Spring;23(2):81-93
12866327
J Clin Epidemiol. 2012 Feb;65(2):219-30
22000816
J Natl Cancer Inst. 2004 Dec 15;96(24):1840-50
15601640
Radiology. 2006 Oct;241(1):55-66
16990671
Am J Epidemiol. 2000 Aug 15;152(4):371-8
10968382
AJR Am J Roentgenol. 2006 Jul;187(1):42-6
16794153
Radiology. 2009 Dec;253(3):632-40
19789234
N Engl J Med. 1994 Dec 1;331(22):1493-9
7969300