Clinical—Alimentary TractAn Alerting System Improves Adherence to Follow-up Recommendations From Colonoscopy Examinations
Section snippets
Development of Principles for an Automated Follow-up Reminder System
Interviews and meetings with primary care and gastroenterology physicians suggested overlapping but not identical requirements for a colonoscopy follow-up management system that included the following 7 principles: (1) both the specialist and primary care physician (PCP) should be able to place and alter the colonoscopy referral; (2) PCPs should be notified when the follow-up procedure is due, and before the patient is contacted so that, when appropriate, the order can be modified or canceled;
Results
Of 2609 patients identified from August 1, 2004, to February 28, 2005, there were 830 (31.8%) eligible for randomization. The most common reasons for lack of eligibility were that patients were not yet due for follow-up evaluation (32.5%) or had interval colonoscopies performed early for diagnostic purposes (18.7%) (Figure 2).
Of the 830 patients, 539 were randomized to the intervention arm and the remaining 291 were followed up without intervention. Demographics and index colonoscopic factors
Discussion
In this study we created and tested an EMR-based system that reminds patients and providers when follow-up examinations, in this case colonoscopies, are due and provides documentation in the medical record of this communication. Our study is notable for several important results. First, the low-cost intervention almost doubled the rate of recommended examinations during the time period of the study. Second, the intervention was even more effective in minority populations who typically receive
Acknowledgments
The authors greatly appreciate the assistance of Eileen Joyce and Sara O'Conner in the Division of Gastroenterology, Beth Israel Deaconess Medical Center, and Kenneth Sands, MD, Department of Medicine, Beth Israel Deaconess Medical Center.
Clinical Trials Registration: clinicaltrials.gov #NCT01172080.
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This article has an accompanying continuing medical education activity on page e13. Learning Objective: Upon completion of this CME module successful learners will be able to explain issues in follow-up colonoscopy adherence and identify potential solutions to improve follow up and reduce risk.
Conflicts of interest The authors disclose no conflicts.
Funding Supported by Controlled Risk Insurance Company (CRICO)-Risk Management Foundation. The study sponsor had no role in study design, data collection, analysis, or interpretation.