title: Communicating Findings of Delayed Diagnostic Evaluation to Primary Care Providers.
abstract: We previously found that an intervention involving electronic algorithms to detect delays in follow-up of cancer-related abnormal or "red-flag" findings and communicating this information to primary care providers (PCPs) led to more timely diagnostic evaluation. In this study, we examined the effectiveness of various communication strategies to inform PCPs about the delayed follow-up.
  
  
  
  After identifying follow-up delays through electronic health record-based algorithms and record reviews, we communicated this information to PCPs using 3 escalating steps. First, we sent secure E-mails. If no evidence of follow-up was found in a medical record review after 1 week, we made up to 3 attempts to reach the PCPs or their nurses via telephone. If they could not be reached, we informed clinic directors as the third and final step. In this analysis, we evaluate PCPs' follow-up in response to these methods of communication.
  
  
  
  A total of 733 patients with follow-up delays were identified (369 patients in the intervention group and 364 patients in the control group). Communicating information to PCPs about possible follow-up delays led to decreased times to diagnostic evaluation, but communication related to delays did not always lead to follow-up for the patients in the intervention group. Specifically, secure E-mails led to follow-up in 11.1% of cases (41 of 369), telephone calls led to follow-up in 68.6% of cases (225 of 328), and contacting clinic directors led to follow-up in 5 of 11 cases in which communication escalated to this level.
  
  
  
  Strategies to communicate to PCPs information on delayed follow-up of findings suspicious for cancer were useful, but not fail-safe. Additional back-up strategies, such as using case coordinators, might be needed.
authors.affiliation: From the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston. ameyer@bcm.edu.
authors.forename: Ashley N D
authors.initials: AN
authors.lastname: Meyer
authors.affiliation: From the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Murphy
authors.affiliation: From the Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D057210:Delayed Diagnosis; D057286:Electronic Health Records; D034742:Electronic Mail; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009369:Neoplasms / Q000175:diagnosis*; D008486:Physician Executives; D011320:Primary Health Care / Q000458:organization & administration*; D013689:Telephone; D013997:Time Factors
keywords: Algorithms; Ambulatory Care Facilities; Communication; Control Groups; Electronic Health Records; Electronic Mail; Follow-Up Studies; Humans; Neoplasms; Primary Care Providers; Telephone