Underutilization of Follow-Up Imaging Among Incarcerated Patients: Retrospective Analysis of Adherence to Radiologic Recommendations.

Abstract

Objective: To evaluate adherence to radiology follow-up recommendations for incarcerated patients and characterize follow-up pathways.

Methods: This retrospective single-center study identified radiology reports for incarcerated individuals evaluated in emergency department (ED) or inpatient settings from January 2017 through November 2024. Incarceration status was based on correctional facility addresses, phone numbers, or incarceration-related discharge flags from Pennsylvania, New Jersey, and Delaware in the electronic medical record. Reports were initially screened with text-based query for "recommend" and/or "follow-up." Two radiologists manually reviewed candidate reports. Eligibility required a definitive recommendation for follow-up imaging, endoscopy, and/or biopsy. Analyses of adherence to recommended timing were restricted to recommendations with an interpretable follow-up interval. Adherence was defined as completion from 30 days before through 60 days after the recommended interval. Follow-up was categorized as outpatient follow-up, incidental follow-up during subsequent ED visits or readmissions, or completion during the index encounter.

Results: Among 15,680 accessions, initial text query identified 1,891 records, and manual review yielded 243 final eligible reports from 164 patients. Of these reports, 140 had interpretable follow-up intervals, and 12 (8.6%) had outpatient completion within the adherence window. Any follow-up was documented at our institution in 81 out of 243 (33.3%); 29 (11.9%) outpatient follow-up; 27 (11.1%) completed incidentally during later ED visits or readmissions; 25 (10.3%) during the initial encounter.

Conclusions: Successful outpatient follow-up of recommendations from radiology reports for incarcerated patients in ED/inpatient settings occurred in less than one in ten cases, lower than reported in broader populations. Dedicated closed-loop pathways may be needed to improve continuity for this vulnerable population.