A University of Pennsylvania study found that fewer than 1 in 10 incarcerated patients complete recommended radiology follow-ups within the appropriate timeframe, revealing a significant gap in healthcare continuity that may contribute to delayed cancer detection in this vulnerable population.
- Only 8.6% of incarcerated patients completed outpatient radiology follow-ups within the American College of Radiology adherence window (30 days before to 60 days after recommended date)
- Among 243 radiology reports reviewed, 67% had no documented follow-up at the institution, indicating major care coordination failures
- When follow-up occurred, 36% happened incidentally during emergency department visits or readmissions rather than planned outpatient appointments
- Incarcerated patients present with later-stage cancers than non-incarcerated populations, suggesting early detection gaps from missed radiology follow-ups
- Recommended solutions include assigning follow-up ownership at discharge, routing recommendations to correctional health liaisons, and completing evaluations during initial encounters
Radiology follow-up recommendations for incarcerated patients result in timely completion in fewer than one in 10 cases, according to a group from the University of Pennsylvania in Philadelphia.
The researchers found that among 243 manually-reviewed reports, the majority of recommendations had no evidence of any follow-up and that the majority of completed follow-up events occurred incidentally through subsequent acute care rather than planned outpatient visits.
"Our findings suggest a potential gap in radiological continuity of care for incarcerated patients and support development of closed-loop follow-up workflows tailored to incarcerated and recently released individuals," noted lead author Yu Sakai, MD, and colleagues in a study published October 7 in the Journal of the American College of Radiology.
While data suggests that cancer is underdetected during incarceration and that incarcerated patients present with later-stage cancers than nonincarcerated patients, no prior study had systematically examined radiology follow-up adherence in this population, the researchers noted.
To bridge the gap, the group conducted a retrospective single-center analysis of radiology reports for incarcerated individuals evaluated in the emergency department or inpatient setting from January 2017 through November 2024. Incarceration status was identified from correctional facility identifiers in the electronic medical record. The primary outcome was outpatient completion within the American College of Radiology (ACR)-defined adherence window of 30 days before through 60 days after the recommended due date.
Among 15,680 accessions, initial text query identified 1,891 records, and manual review yielded 243 final eligible reports from 164 patients (mean age 47 years old, 57% male). Of these reports, 140 had interpretable follow-up intervals, and just 12 (8.6%) had outpatient completion within the adherence window.
Any follow-up was documented at the institution in 81 of 243 reports (33.3%); of these, 29 (11.9%) were completed as planned outpatient visits, 27 (11.1%) occurred incidentally during a subsequent ED visit or readmission, and 25 (10.3%) during the initial encounter.
"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," the group wrote.
The researchers suggested that routing recommendations directly to correctional health liaisons and responsible clinicians, with follow-up ownership assigned at discharge, and completing evaluation during the initial encounter could reduce dependence on later care coordination.
Multi-site research with broader follow-up ascertainment is needed to confirm these findings, they added.
The full study is available here.
