title: Timeliness of Recommended Follow-Up After an Abnormal Finding on Diagnostic Chest CT in Smokers at High Risk of Developing Lung Cancer.
abstract: OBJECTIVE
  Diagnostic chest CT frequently results in abnormal findings that require follow-up. We assessed the timeliness of follow-up after CT abnormalities were identified in symptomatic smokers at high risk for developing lung cancer.
  
  
  METHODS
  In an academic primary care network, we identified current smokers aged 55-79 years who received a diagnostic chest CT to evaluate symptoms during 2012. Medical chart abstraction identified radiologist recommendations and follow-up care. The outcome was the proportion of patients who received timely follow-up (within 30 days of recommendation) after an abnormal chest CT. We assessed for predictors of compliance with recommended follow-up.
  
  
  RESULTS
  Of 3,257 eligible smokers, 446 (14%) had a chest CT during 2012. We excluded 70 patients who already had lung cancer, died, had imaging done elsewhere, or left the practice. Of the remaining 376 patients, 337 (90%) had abnormal chest CT findings, and 184 (55%) had a specific follow-up recommendation. Among those with recommended follow-up, only 102 of 184 (55%) had timely follow-up. Those who had a CT performed to evaluate pulmonary disease and those receiving care in community health centers were more likely to receive timely follow-up. Of 27 patients newly diagnosed with lung cancer, 18 (67%) had their first oncology visit within 30 days of diagnosis.
  
  
  CONCLUSIONS
  Among patients undergoing diagnostic chest CTs, most received follow-up for abnormal findings, but it was often delayed. Systems to support patients in obtaining recommended follow-up are needed to ensure that the benefits of lung cancer screening translate into usual clinical practice.
authors.affiliation: Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts. Electronic address: Spercaclima@mgh.harvard.edu.
authors.forename: Sanja
authors.initials: S
authors.lastname: Percac-Lima
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Ashburner
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jo-Anne O
authors.initials: JA
authors.lastname: Shepard
authors.affiliation: Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
authors.forename: Inga T
authors.initials: IT
authors.lastname: Lennes
authors.affiliation: Harvard Medical School, Boston, Massachusetts.
authors.forename: Dorothy E
authors.initials: DE
authors.lastname: Rimmelin
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Atlas
mesh_terms: D000368:Aged; D015897:Comorbidity; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
keywords: CT; lost to follow-up; pulmonary nodule; smokers