The ACR Learning Network Recommendations Follow-Up Improvement Collaborative: Ensuring Quality Surveillance of Pulmonary Nodules.

Abstract

Our purpose was to share findings from the first two cohorts of the ACR Learning Network Recommendations Follow-Up Improvement Collaborative. The collaborative targets safe, high-quality practice in the follow-up of incidental pulmonary nodules. Participating sites had the shared goal of improving (1) recommendation adherence to the Fleischner Society Guidelines and (2) follow-up imaging completion rates. The quality improvement initiative was structured around the ACR ImPower Program (ACR, Reston, Virginia), which incorporates elements of shared learning between concurrently participating sites and longitudinal cohorts. Selected sites assembled teams, developed specific goals, benchmarked their performance, identified root causes for low recommendation follow-up, and implemented unique interventions. Performance and strategies were shared at set intervals between sites during the implementation phase and at the conclusion of the project. Summary data reflect findings from seven sites representing academic, private, and community practices. There were variable degrees of success between participating sites for both outcomes, with some achieving significant improvement and others facing challenges. Across all sites, adherence to the guidelines improved from a baseline of 62.3% ± 24.2% to 89.0% ± 16.8%. Similarly, the percentage of patients undergoing recommended follow-up imaging increased from 41.4% ± 25.4% to 61.1% ± 23.9%. A longitudinal, shared learning approach yielded tangible but variable improvements in the management of incidental pulmonary nodules. The most successful sites employed both robust tracking systems and dedicated care coordination teams to ensure appropriate and timely follow-up. These findings suggest that a synergistic combination of people, process, and technological interventions perform better than any single intervention alone.