Adherence to National Guidelines for Timeliness of Test Results Communication to Patients in the Veterans Affairs Health Care System

Abstract

Failure to communicate test results to patients remains a persistent problem leading to diagnosis and management delays, [1][2][3] with up to 62% of abnormal laboratory results and 36% of abnormal radiology results lacking timely follow up. 4 The Department of Veterans Affairs (VA) developed a national policy in 2015 stating that practitioners authorized to order laboratory tests (referred to in the policy as providers), or their designees, must communicate abnormal test results to patients within 7 days if action is required and within 14 days if no action is required or results are normal. 5 Acceptable communication modes include face-to-face, telehealth, telephone, secure messages, or letters. To assess policy adherence, the VA implemented a quality measurement system for feedback and improvement. We analyzed the first full year of these measures to determine timeliness of test results communication to patients. MethodsThis cross-sectional study had VA institutional review board approval and was exempt from informed consent because no patient identifiable information was included in the data set.This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Data collection was implemented through the External Peer Review Program (EPRP), the VA's performance measurement system that is used for quality improvement and benchmarking. Computerized algorithms randomly sample a set of abnormal and normal results related to 8 predetermined tests for each VA facility and each quarter (Table ). Trained EPRP chart reviewers evaluated documentation of the communication of results to patients in medical records.The sample included data from October 2018 to September 2019 for all 141 VA facilities. EPRP measures examined timeliness of communication to patients with abnormal results(Յ7 days if action required; Յ14 days if no action required), normal results (Յ14 days), and all test results (Յ30 days). Additionally, we evaluated 1 item from the Survey of Healthcare Experiences of Patients (SHEP) during the same timeframe (ie, "in the last 6 months, when this provider ordered a blood test, x-ray, or other test for you, how often did someone from this provider's office follow up to give you those results?").We used descriptive statistics to examine EPRP and SHEP data and a Pearson correlation between the EPRP measure for all test results and the SHEP item. Using Stata version 15.1 (StataCorp), statistical analysis was conducted using a significance threshold of P < .05 with a 2-tailed test. Data were given to us between February and May 2021 and were analyzed between March and November 2021. ResultsEPRP measures showed timely communication for 5925 of 8372 abnormal results (70.8%) (ie, within 7 days if action was required and within 14 days if no action was required); for 9472 of 11 784 normal Author affiliations and article information are listed at the end of this article.

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