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Patients don't hear of abnormal results 7% of time

Primary care doctors fail to inform patients of about one in 14 abnormal test results, according to a study of 5,434 medical records at 23 physician practices in the Midwest and on the West Coast. Few practices have rules on how to manage test results and often leave the process to individual physicians, according to the study published in the June 22 Archives of Internal Medicine (archinte.ama-assn.org/cgi/content/abstract/169/12/1123/). Having electronic medical records was no guarantee of better test-results tracking. Lawrence P. Casalino, MD, PhD, the study's lead author, said physician practices should be able to improve their performance on this basic measure of doctor-patient communication. "For things that are susceptible to being dealt with in an organized systems approach, I think the failure rate can be very low," said Dr. Casalino, chief of the division of outcomes and effectiveness research in the Weill Cornell Medical College Dept. of Public Health in New York. "We may never get to zero, but we should get pretty close to zero." Researchers gave physicians the benefit of the doubt when determining whether doctors informed their patients about abnormal test results. They included only test results that were "clinically significantly abnormal," and which an expert doctors' panel believed "nearly any physician would agree that the patient should be informed of the result." The study authors also gave doctors credit even if they did not document informing the patient in the record. For example, if physicians changed a relevant medication after the test, repeated the test, ordered a related test or surgical procedure, then they were counted as having communicated the abnormal results to their patients. Best practices There are steps practices can take to make sure patients get word of abnormal test results, Dr. Casalino said. Clinics should ensure that: * All results are routed to the responsible physician. * The physician signs off on all results. * Patients are informed of all results, normal and abnormal. Clinics should steer clear of the "no news is good news" approach. * The patient test-result communication is documented. * Patients have been asked to check on their test results if they have not been notified within a given time frame. Physician practices that best implemented these processes did not tell patients about abnormal test results 5.1% of the time. The clinics that did not enact these systemic changes fared nearly four times worse, failing to inform patients in about 20% of cases. Adherence to good processes was more important to success than having an electronic medical records system, the study found. Dr. Casalino said the systems of care surrounding physicians must be excellent for doctors to offer the highest quality care. "No matter how good a physician you are as an individual, if you are in practice in a group that doesn't systematically try to improve care and doesn't try to do the things to make the processes for dealing with things like test results better, then you are not a high-quality physician," Dr. Casalino said. The full and original article can be found here: http://www.ama-assn.org/amednews/2009/07/13/prsd0716.htm
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