AR: Online learning may trim high mammo recall rates

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Mammogram reveals increased density (arrow) of the right breast.
Image source: Indian J Radiol Imaging 2010 May;20(2):98–104.

Web-based educational interventions may prove an effective method for improving physicians’ adherence to clinical guidelines, with findings published in the April issue of Academic Radiology suggesting preliminary success in helping radiologists develop realistic goals to reduce high mammography recall rates.

Several studies have demonstrated the usefulness of educational interventions in improving the performance of radiologists, although many have been broad programs that have not allowed specific understanding of which interventions are most likely to succeed. The authors investigated the effects of a web-based continuing medical education (CME) intervention in affecting the recall goals of a sample of breast imaging radiologists.

The sample included radiologists whose institutions were part of the Breast Cancer Surveillance Consortium (BCSC), with the average radiologist showing a recall rate nearly 50 percent higher than the nationally recommended 5 to 7 percent recall rates, according to Patricia A. Carney, PhD, from the department of family medicine at Oregon Health & Science University in Portland, and colleagues.

The intervention consisted of web-based education designed to encourage radiologists to alter their performance by illustrating factors, information and methods that can influence performance. Three chief components made up the intervention: statistics on sensitivity, specificity, recall rates and similar BCSC data; common radiologic misperceptions about breast cancer; and misperceptions about malpractice suits.

A total of 41 radiologists completed all surveys and the one-hour web-based intervention. Following the program, 73 percent of radiologists indicated they would consider changing their recall rates, with 50 percent of these participants explicating specific and author-identified “realistic” goals for doing so.

Common plans for adjusting recall rates included altering interpretive threshold, re-review of images, implementing changes to interpretive practices and considering seeking double-reads in some cases. Nine radiologists also indicated that they would pay more attention to breast cancer risk factors when considering recall, following the intervention’s risk-factor module.

No statistically significant differences were observed by the authors between the recall rates and the reported importance of risk factors between radiologists who developed goals for improving performance and those who did not.

The authors noted that “after illustrating to participants during the 1-hour CME intervention that recall rates beyond 7 percent are not likely to identify many more cancers, nearly 72 percent of participants reported considering changing clinical practice to reduce unnecessary recall.”

Carney and co-authors also observed that, among radiologists who set realistic goals for changing recall, the average score allotted to how much influence malpractice concerns would have on interpretation decreased by half.

“This study successfully recruited radiologists with recall rates that were, on average, between two and almost three times that of national recommended targets (5 percent to 7 percent) and above the upper bound of 12 percent for recently set criteria for recall. This suggests that radiologists who agreed to take part in this study may have done so to reduce what they acknowledge to be excessive recall rates,” Carney and colleagues argued.

The authors acknowledged that the absence of current follow-up information on whether radiologists’ post-intervention goals actually adjusted their performance limited their determination of the effectiveness of the program.

Carney and colleagues nevertheless contended that radiologists’ initial responsiveness demonstrated that web-based “interventions designed to reduce unnecessary recall can succeed in assisting radiologists to develop goals that may ultimately reduce unnecessary recall.”