Automated reminder improves colonoscopy surveillance

  • Magrath M & al.
  • J Natl Compr Canc Netw
  • 1 Nov 2018

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • An electronic medical record (EMR)-based clinical decision support system was associated with improved adherence to colonoscopy surveillance guidelines, with fewer overuse and underuse colonoscopy recommendations.
  • The system automatically generates guideline-adherent recommendations for the next surveillance colonoscopy after polypectomy, based on findings from colonoscopy and pathology reports.

Why this matters

  • Over- or underuse of colonoscopy surveillance is common after polypectomy.

Study design

  • Outcomes were compared between 1320 patients after the system was deployed and 1822 patients before it was deployed.
  • Funding: NIH/National Cancer Institute.

Key results

  • Guideline-adherent recommendations were more common after the system was implemented (84.6% vs 77.4%; P<.001 even after colonoscopies without surveillance recommendations were excluded vs p>
  • After implementation, there was a reduction in underuse (3.1% vs 4.7%) and overuse (10.8% vs 14.4%).
  • When the system was used, compared with cases when it was available but was not used, guideline-adherent recommendations were made more often (87.0% vs 63.4%; relative risk, 1.34; 95% CI, 1.24-1.42).

Limitations

  • Conducted at a single, safety net health system.
  • Quasi-experimental design is vulnerable to confounders.

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