A new study at Rhode Island Hospital has found that academic medical centers have higher rates of recall following mammography than community radiology centers. The recall rate is the frequency at which a radiologist interprets an examination as positive and the patient is instructed to return for more testing. The study is published online in advance of print in the journal Radiology.
"Recalling a patient for a mammogram has an impact on both the patient, and on the hospital," said lead researcher and author Ana Lourenco, M.D., a radiologist at Rhode Island Hospital. "Hearing that they need to return for another mammogram can cause a great deal of anxiety for patients. Additionally, the federal government uses recall rates as a quality indicator for the hospital or outpatient center in order to calculate Medicare payments."
The study found that the patient population at each of the sites contributed significantly to the rates of recall, which were 8.6 percent and 6.9 percent for the hospital and community practice, respectively. The patients who received their mammogram at the hospital were typically younger – average age 56 at the hospital and 63 at the community practice – and younger patients have a higher rate of recall. The hospital patients also had a higher incidence of previous surgeries and biopsies, which can complicate the interpretation of the images.
The study followed five radiologists who worked at both sites, and compared the rates of recall for each site. The only major systemic difference between the two sites is the occasional presence of a medical resident/trainee at the hospital site.
"The difference in recall rates does not indicate the quality of the centers," Lourenco said. "Demographics such as age and prior procedures play a very large role in the rate of recall, and it's important that patients know that a recall is not suggestive of a definitive diagnosis. While radiologists aim to keep recall rates down, they also must put the patient's health first. If that means conducting a second mammogram to be confident about the results, then they will call the patient back in."
Lourenco cautions that recall rates are typically affected by factors out of the radiologist's control, and therefore cannot determine the quality of a radiologist or an institution.