Comparative Effectiveness of a Pilot Patient-Centered Ultrasound Report for Hydronephrosis Management

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1 Comparative Effectiveness of a Pilot Patient-Centered Ultrasound Report for Hydronephrosis Management Geolani W. Dy, MD Society of Women in Urology 6 th Annual Winter Meeting January 21, 2017

2 Cultural shifts in medical communication Shared decision-making 1,2 HITECH (2009) Meaningful Use criteria Comprehension barriers higher with radiologic studies than other areas of PHR 3 Patients request imaging most 3 1. Truog et al. NEJM Bruno et al. J Am Coll Rad Keselman et al. J Am Med Inform Assn 2008

3 Accessibility of radiology Focus on clarity, accuracy, standardization 1 Structured reporting 1 Patients prefer lay language explanations for abnormal CT and MRI 2 1. Bruno et al. J Am Coll Rad Johnson et al. J Am Coll Rad Arnold J Am Med Inform Assn 2013

4 Ultrasonography in pediatric urology Most common imaging modality Parental anxiety and distress from fetal abnormality on US, even mild ANH, is high 1,2 1. Malone et al. JR Soc Med Harding et al. Prenat Diag 1999

5 Developing a patient-centered US report Expert panel Patient Advisory Board Urology clinic 1. Review existing 2. Identify clinically important elements 1. Review existing 2. Review clinically important elements 3. Generate candidate with patientcentered language 1. Prospective pilot 2. Patients received standard + PC radiology report 3. Outcomes relevant to PC radiology

6 Developing a patient-centered US report Expert panel Patient Advisory Board Urology clinic 1. Review existing 2. Identify clinically important elements 1. Review existing 2. Review clinically important elements 3. Generate candidate with patientcentered language 1. Prospective pilot 2. Patients received standard + PC radiology report 3. Outcomes relevant to PC radiology

7 ANH expert prioritization of renal US report elements (n=18) Severity Uni vs. bilaterality Parenchymal thickness Parenchymal echogenicity Ureteral dilation Renal size Bladder appearance Renal position Laterality Most important Least important

8 Developing a patient-centered US report Expert panel Patient Advisory Board Urology clinic 1. Review existing 2. Identify clinically important elements 1. Review existing 2. Review clinically important elements 3. Generate candidate with patientcentered language 1. Prospective pilot 2. Patients received standard + PC radiology report 3. Outcomes relevant to PC radiology

9 Developing a patient-centered US report Expert panel Patient Advisory Board Urology clinic 1. Review existing 2. Identify clinically important elements 1. Review existing 2. Review clinically important elements 3. Generate candidate with patientcentered language 1. Prospective pilot 2. Patients received standard + PC radiology report 3. Outcomes relevant to PC radiology

10 CLINICAL HISTORY: Assess for hydronephrosis EXAMINATION: US Renal Sonogram Complete. DATE: 04/21/2014. COMPARISON: 3/28/2014. TECHNIQUE: Grayscale sonographic image acquisition was performed of the kidneys and bladder. FINDINGS: Expected renal length for age is 4.9 +/- 1.6 cm for two standard deviations. The right kidney measures 7.4 cm in length compared with 7.1 cm on the prior study. No calculi. No masses. Compared to 3/28/2014 similar appearance to severe hydronephrosis and cortical thinning (SFU grade 4), with interval increase in layering echogenic collecting system debris. The left kidney measures 6.5 cm in length compared with 6.3 cm on the prior study. No calculi. No masses. Compared to 3/28/2014 similar appearance to severe hydronephrosis and cortical thinning (SFU grade 4), with interval increase in layering echogenic collecting system debris. There is bilateral hydroureter, with interval increase in layering echogenic debris. No definite urinary bladder is seen. IMPRESSION: Compared to 3/28/2014: 1. Similar appearance to severely dilated bilateral collecting systems consistent with SFU grade Interval increase in layering echogenic collecting system debris. 3. No definite urinary bladder is seen.

11 Bullet point format Severity Mild, moderate, severe Explication of elements Graphical representations Renal growth curve

12 Developing a patient-centered US report Expert panel Patient Advisory Board Urology clinic 1. Review existing 2. Identify clinically important elements 1. Review existing 2. Review clinically important elements 3. Generate candidate with patientcentered language 1. Prospective pilot 2. Patients received standard + PC radiology report 3. Outcomes relevant to PC radiology

13 Developing a patient-centered US report Expert panel Patient Advisory Board Urology clinic 1. Review existing 2. Identify clinically important elements 1. Review existing 2. Review clinically important elements 3. Generate candidate with patientcentered language 1. Prospective pilot 2. Patients received standard + PC radiology report 3. Outcomes relevant to PC radiology

14 Percent answering correctly Parent accuracy in reporting US elements 67% 70% 75% 85% 88% 45% Unilateral vs. Bilateral Standard (n=20) Parenchymal abnormalities Patient-Centered (n=24) Bladder appearance

15 Percent of respondents Reported utility of standard vs. PCRR 90% 79% * 92% 92% 80% 60% Read more than half Standard (n=20) Confident in understanding Report is useful Patient-Centered (n=24)

16 Applying the patient-centered report Improving pilot PCRR Assessing accuracy of autogenerated document Integration into CIS VCUG Prenatal studies

17 References Nguyen, H. T., Herndon, C. D., Cooper, C. et al.: The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol, 6: 212, 2010 Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics. 2006;118(2): Harding, L. J., Malone, P. S., Wellesley, D. G.: Antenatal minimal hydronephrosis: is its follow-up an unnecessary cause of concern? Prenat Diagn, 19: 701, 1999 Truog, R. D.: Patients and doctors--evolution of a relationship. N Engl J Med, 366: 581, 2012 Bruno, M. A., Petscavage-Thomas, J. M., Mohr, M. J. et al.: The "open letter": radiologists' in the era of patient web portals. J Am Coll Radiol, 11: 863, 2014 Commission, J.: 2009 National Patient Safety Goals Hospital Program. Online publication, 2009 White, S., Dillow, S.: Key Concepts and Features of the 2003 National Assessment of Adult Literacy. NCES National Center for Education Statistics, 2005 Keselman, A., Logan, R., Smith, C. A. et al.: Developing informatics tools and strategies for consumer-centered health communication. J Am Med Inform Assoc, 15: 473, 2008 Bosmans, J. M., Weyler, J. J., De Schepper, A. M. et al.: The radiology report as seen by radiologists and referring clinicians: results of the COVER and ROVER surveys. Radiology, 259: 184, 2011 Larson, D. B., Towbin, A. J., Pryor, R. M. et al.: Improving consistency in radiology reporting through the use of department-wide standardized structured reporting. Radiology, 267: 240, 2013 Johnson, A. J., Easterling, D., Nelson, R. et al.: Access to radiologic via a patient portal: clinical simulations to investigate patient preferences. J Am Coll Radiol, 9: 256, 2012