FOLLOWING THE TRAIL:
UNDERSTANDING “LOST TO FOLLOW-UP” IN BREAST IMAGING
Another White Paper by
Another White Paper by
Following the Trail: UNDERSTANDING “LOST
TO FOLLOW-UP” IN BREAST IMAGING
INTRODUCTION
The systematic management of patient follow-ups is critical for breast imaging practices. Tracking follow-ups helps to ensure patient care continuity and gauge the effectiveness of a facility’s breast imaging services within its community.
Patients who are recommended diagnostic or treatment paths but have yet to seek out these services can present a challenge for providers. The term “lost to follow-up” case has become associated with this situation.
THE CONCEPT OF “LOST TO FOLLOW- UP”
Drawing upon concepts presented by Mammologix, this white paper explains the issue of patients being lost to follow-up in mammography and breast imaging practices, focusing on strategies for tracking and mitigating this issue to enhance service quality and patient outcomes.
“Lost to follow-up” occurs in the context of breast imaging when patients who have undergone an initial screening or diagnostic imaging procedure are recommended additional follow-up procedures and fail to schedule or attend further testing, treatment, or review.
Patients are “lost to follow-up” for a myriad of reasons, including—but not limited to—communication barriers, financial constraints, fear and anxiety, or systemic challenges within the healthcare provider’s framework. A patient who is “lost to follow-up” did not complete their recommended care, leaving their health condition unresolved in the context of mammography and breast imaging.
WHY IS IT IMPORTANT TO TRACK “LOST TO FOLLOW-UP CASES?
Tracking patients lost to follow-up is crucial for several reasons:
1. It can help understand the extent to which patients in the breast imaging practice adhere to recommended followup tests and treatments, serving as a measure of the breast imaging service’s effectiveness.
2. It can help identify systemic issues within the practice that may hinder patient compliance, such as scheduling difficulties or a lack of clear communication about the importance of follow-up care.
3. Tracking can highlight specific areas for improvement in patient education and support. Such efforts could reduce the number of lost follow-up cases.
REASONS FOR BECOMING
TO FOLLOW- UP”
“LOST
Patients becoming “lost to follow-up” in a breast imaging practice can occur due to a variety of reasons, reflecting both personal circumstances and systemic issues within the healthcare system. Here’s a breakdown of these reasons:
• Communication Barriers: Language differences, complex or vague instructions, and information overload inhibit patient communication.
• Financial or Insurance Constraints: High costs, limited or no insurance coverage, and changes in insurance status often keep patients from scheduling their follow-up appointments.
• Fear and Anxiety: Fear of diagnosis and medical procedures, as well as past negative healthcare experiences, cause anxiety in some patients and may leave them “lost to follow-up.”
• Systemic and Logistical Challenges: Scheduling difficulties, transportation issues, geographical barriers, complex follow-up processes, or lack of coordination between multiple providers create challenges for patients seeking follow-up treatment.
• Personal and Social Factors: Lack of support, prioritization of other health responsibilities, cultural beliefs, and other social determinants of health impact patient choices regarding following provider recommendations.
• Perceived Importance or Necessity: Patients often do not seek follow-up care because they misunderstand the risks and seriousness of their conditions, especially if they perceive their current results as satisfactory.
• Competition Among Services: The availability of alternative services in the same area may lead patients to seek care elsewhere, especially if these alternatives are perceived as more convenient, higher quality, or less costly.
• Referral Pattern Preferences: A patient’s primary care physician or specialist may prefer to refer patients to a different facility based on personal experience, relationships, or perceived quality of care, leading patients away from their original breast imaging practice.
• Lack of Service Availability: Primary care physicians may refer patients elsewhere for subsequent care if the initial imaging center cannot provide the recommended follow-up services or more advanced care.
• Conflicts in Medical Opinions: A patient’s primary care physician or specialist may receive conflicting recommendations and choose an alternative course of action, diverging from the initial follow-up
• Technology and Information Access: Patients accessing their test results online or through electronic health records may interpret them without further consultation and decide whether to pursue follow-up care independently.
• Privacy and Trust Issues: Concerns over privacy, data security, or mistrust in the healthcare provider or system can lead to patients discontinuing their care with a facility. Understanding these multifaceted reasons helps devise comprehensive strategies to mitigate the number of patients lost to follow-up.
BEST PRACTICES FOR MANAGING LOST TO FOLLOW- UP
1. Robust Communication Strategies: Implementing clear, consistent, and compassionate communication with patients about the importance of follow-up care is vital. These communications should fully explain the need for further testing, potential outcomes, and non-compliance risks.
2. Follow-Up Tracking Systems: Utilize dedicated software or tracking systems to monitor patient followups actively. These systems or services can alert staff to upcoming appointments, flag missed ones, and facilitate outreach efforts to re-engage lost patients.
3. Patient Education and Support: Offer resources to help patients overcome barriers to follow-up care, such as financial counseling, navigation services to assist with appointment logistics, and psychological support services for those experiencing anxiety about their diagnosis or treatment.
4. Healthcare Professional Oversight: Ensure that algorithms or systems used to identify and manage unresolved cases operate under the supervision of healthcare professionals. This oversight ensures that each case is evaluated on its merits, considering patient care and communication nuances.
5. Categorizing Resolutions: Adopt a nuanced approach to resolving cases to capture patient outcomes accurately. To do this, facilities must distinguish the patients who have completed their follow-up from those who have not, and they must emphasize understanding the reasons behind each lost case.
CHANGE THE IMPACT OF YOUR BREAST IMAGING PRACTICE BY UNDERSTANDING “LOST TO FOLLOW- UP”
In the quest to enhance the caliber of breast imaging services, the challenge of patients becoming “lost to follow-up” looms large, casting a shadow on both patient outcomes and the efficacy of healthcare practices.
From personal fears to systemic inefficiencies—the myriad reasons patients may not seek follow-up care are a puzzle that healthcare providers must solve. Yet, within this complexity lies the opportunity for transformational change. By delving deep into the root causes, an imaging practice can make strategic decisions that minimize “lost to follow-up” cases and elevate the standard of care provided.
The adoption of personalized communication strategies stands out as a pivotal decision for a first step. Utilizing patientfriendly language in all communications and offering multiple communication channels tailored to patient preferences will boost a patient’s trust and reduce anxiety-driven avoidance of follow-up appointments. By coupling this with recognizing the diversity in patient backgrounds, preferences, and fears, practices can significantly improve the rate of “lost to follow-up.”
Embracing technological advancements is another way breast imaging practices can revolutionize patient engagement. Investing in user-friendly methods, portals, and services offering easy access to test results, educational materials, and appointment scheduling helps demystify the follow-up process. The decision to harness technology streamlines operations and empowers patients, making them active participants in their healthcare journeys.
Furthermore, innovative service models and partners to address financial and logistical barriers can drastically reduce obstacles to follow-up care. By making strategic decisions to alleviate these external pressures, practices can significantly enhance accessibility and convenience for their patients.
Implementing these strategies could profoundly impact those who engage in follow-up care. Enhanced communication and support would likely increase patient satisfaction, adherence to recommended follow-up, and improved health outcomes. Patients who complete their follow-up care enjoy a clearer understanding of their health status, which can lead to early detection of issues, more effective treatment plans, and, potentially, better prognoses.
Breast imaging practices that proactively address the challenge of patients “lost to follow-up” by deeply understanding why some patients choose not to follow through with recommended care position themselves at the forefront of industry best practices. Comprehensive analysis of the factors influencing patient decisions empowers imaging practices to make strategic choices that mitigate these issues and enhance the overall quality of care they provide.
CONCLUSION
Whether through improved communication, technological innovation, or addressing logistical barriers, each step is a stride toward better service delivery. The ripple effect of these decisions promises to reduce the number of individuals lost to follow-up and elevate the overall patient experience, resulting in a community that feels supported, informed, and empowered to pursue their breast health proactively. This strategic approach fortifies the foundation of trust between patients and healthcare providers. It charts a course toward a future where every patient’s health journey reaches its optimal conclusion.
REFERENCES
Breast Health: Follow-up After an Abnormal Mammogram. National Cancer Institute. (n.d.). https://www.cancer.gov/types/ breast/breast-changes Centers for Disease Control and Prevention. (2024, April 9). Cost and Access Are Not the Only Barriers Women Face in Getting Lifesaving Mammograms. Centers for Disease Control and Prevention.
https://www.cdc.gov/media/releases/2024/s0409-vsmammography.html
Follow-Up After an Abnormal Mammogram. Susan G. Komen®. (2024, March 20).
https://www.komen.org/breast-cancer/ screening/follow-up/
Getting Called Back After a Mammogram: Mammogram Call Back. Mammogram Call Back | American Cancer Society. (n.d.). https://www.cancer.org/cancer/types/breast-cancer/screeningtests-and-early-detection/mammograms/getting-called-backafter-a-mammogram.html
Kuo, C.-S., Chen, G.-R., Hung, S.-H., Liu, Y.-L., Huang, K.-C., & Cheng, S.-Y. (2016, June). Women with Abnormal Screening Mammography Lost to Follow-Up: An Experience from Taiwan. Medicine.
https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC4998469/ Mammograms. National Cancer Institute. (n.d.). https://www. cancer.gov/types/breast/mammograms-fact-sheet
Mammography and Breast Imaging Resources. American College of Radiology. (n.d.). https://www.acr.org/ClinicalResources/Breast-Imaging-Resources Official Statements. The American Society of Breast Surgeons. (n.d.). https://www.breastsurgeons.org/resources/statements Rosenberg, R. D., Haneuse, S. J. P. A., Geller, B. M., Buist, D. S. M., Miglioretti, D. L., Brenner, R. J., Smith-Bindman, R., Taplin, S. H., & Breast Cancer Surveillance Consortium. (2011, November).
Timeliness of Follow-Up After Abnormal Screening Mammogram: Variability of Facilities. Radiology. https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3198220/ Sung, W.-Y., Yang, H.-C., Liao, I.-C., Su, Y.-T., Chen, F.-H., & Chen, S.-L. (2022, January 18). Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study. International journal of environmental research and public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834256/ WebMD. (n.d.). Suspicious Mammogram Result: Next Steps. WebMD. https://www.webmd.com/breast-cancer/suspiciousmammogram-results
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