{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T14:22:18Z","timestamp":1771942938031,"version":"3.50.1"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Missed test results, defined as test results not followed up within an appropriate time frame, are common and lead to delays in diagnosis and treatment.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the effect of a quality improvement collaborative, the Virtual Breakthrough Series (VBTS), on the follow-up rate of 2 types of test results prone to being missed: chest imaging suspicious for lung cancer and laboratory findings suggestive of colorectal cancer.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This stepped-wedge cluster-randomized clinical trial was conducted between February 2020 and March 2022 at 12 Department of Veterans Affairs (VA) medical centers, with a predefined 3-cohort roll-out. Each cohort was exposed to 3 phases: preintervention, action, and continuous improvement. Follow-up ranged from 0 to 12 months, depending on cohort. Teams at each site were led by a project leader and included diverse interdisciplinary representation, with a mix of clinical and technical experts, senior leaders, nursing champions, and other interdisciplinary team members. Analysis was conducted per protocol, and data were analyzed from April 2022 to March 2024.<\/jats:p><\/jats:sec>Intervention<\/jats:title>All teams participated in a VBTS, which included instruction on reducing rates of missed test results at their site.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was changes in the percentage of abnormal test result follow-up, comparing the preintervention phase with the action phase. Secondary outcomes were effects across cohorts and the intervention\u2019s effect on sites with the highest and lowest preintervention follow-up rates. Previously validated electronic algorithms measured abnormal imaging and laboratory test result follow-up rates.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 11 teams completed the VBTS and implemented 47 (mean, 4 per team; range, 3-8 per team; mode, 3 per team) unique interventions to improve missed test results. A total of 40\u202f027 colorectal cancer\u2013related tests were performed, with 5130 abnormal results, of which 1286 results were flagged by the electronic trigger (e-trigger) algorithm as being missed. For lung cancer\u2013related studies, 376\u202f765 tests were performed, with 7314 abnormal results and 2436 flagged by the e-trigger as being missed. There was no significant difference in the percentage of abnormal test results followed up by study phase, consistent across all 3 cohorts. The estimated mean difference between the preintervention and action phases was \u22120.78 (95% CI, \u22126.88 to 5.31) percentage points for the colorectal e-trigger and 0.36 (95% CI, \u22125.19 to 5.9) percentage points for the lung e-trigger. However, there was a significant effect of the intervention by site, with the site with the lowest follow-up rate at baseline increasing its follow-up rate from 27.8% in the preintervention phase to 55.6% in the action phase.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cluster-randomized clinical trial of the VBTS intervention, there was no improvement in the percentage of test results receiving follow-up. However, the VBTS may offer benefits for sites with low baseline performance.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT04166240<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.40269","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T15:39:14Z","timestamp":1730302754000},"page":"e2440269","source":"Crossref","is-referenced-by-count":1,"title":["A Virtual Breakthrough Series Collaborative for Missed Test Results"],"prefix":"10.1001","volume":"7","author":[{"given":"Lisa","family":"Zubkoff","sequence":"first","affiliation":[{"name":"Birmingham\/Atlanta Geriatric Research Education and Clinical Center, Birmingham VA Healthcare System, Birmingham, Alabama"},{"name":"Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Zimolzak","sequence":"additional","affiliation":[{"name":"Center for Innovations in Quality, Effectiveness and Safety, Michael E. 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