Gastroenterology visitation and reminders predict surveillance uptake for patients with adenomas with high-risk features

Abstract

Individuals diagnosed with colorectal adenomas with high-risk features during screening colonoscopy have increased risk for the development of subsequent adenomas and colorectal cancer. While US guidelines recommend surveillance colonoscopy at 3 years in this high-risk population, surveillance uptake is suboptimal. To inform future interventions to improve surveillance uptake, we sought to assess surveillance rates and identify facilitators of uptake in a large integrated health system. We utilized a cohort of patients with a diagnosis of ≥ 1 tubular adenoma (TA) with high-risk features (TA ≥ 1 cm, TA with villous features, TA with high-grade dysplasia, or ≥ 3 TA of any size) on colonoscopy between 2013 and 2016. Surveillance colonoscopy completion within 3.5 years of diagnosis of an adenoma with high-risk features was our primary outcome. We evaluated surveillance uptake over time and utilized logistic regression to detect factors associated with completion of surveillance colonoscopy. The final cohort was comprised of 405 patients. 172 (42.5%) patients successfully completed surveillance colonoscopy by 3.5 years. Use of a patient reminder (telephone, electronic message, or letter) for due surveillance (adjusted odds = 1.9; 95%CI = 1.2–2.8) and having ≥ 1 gastroenterology (GI) visit after diagnosis of an adenoma with high-risk features (adjusted odds = 2.6; 95%CI = 1.6–4.2) significantly predicted surveillance colonoscopy completion at 3.5 years. For patients diagnosed with adenomas with high-risk features, surveillance colonoscopy uptake is suboptimal and frequently occurs after the 3-year surveillance recommendation. Patient reminders and visitation with GI after index colonoscopy are associated with timely surveillance completion. Our findings highlight potential health system interventions to increase timely surveillance uptake for patients diagnosed with adenomas with high-risk features.

Implementasi Fitur Notifikasi Whatsapp API pada Sistem Manajemen Tugas Akhir

“…Dalam tahap ini akan menghasilkan antarmuka pengguna dari perancangan desain. (Myint, 2021) Peneliti menentukan desain atau rancangan yang dibutuhkan seperti halaman login, halaman dashboard, halaman bimbingan mahasiswa, tampilan input dosen pembimbing, tampilan mahasiswa bimbingan skripsi, tampilan form notifikasi (Novita & Andiarni, 2019) Hal ini juga dapat digunakan untuk mengevaluasi apakah proses sistem memenuhi persyaratan, karena ada sejumlah parameter tertentu yang dapat dimasukkan untuk eksekusi sistem secara optimal (Sabirin et al, 2020).…”

“…Seperti menentukan desain sistem yang akan digunakan agar kelayakan dalam pemakaiannya sesuai dengan yang dibutuhkan. Dalam tahap ini akan menghasilkan antarmuka pengguna dari perancangan desain (Myint, 2021). Peneliti menentukan desain atau rancangan yang dibutuhkan seperti halaman login, halaman dashboard, halaman bimbingan mahasiswa, tampilan input dosen pembimbing, tampilan mahasiswa bimbingan skripsi, tampilan form notifikasi(Novita & Andiarni, 2019).…”

Digital Health at Enterprise Scale: Evaluation Framework for Selecting Patient-Facing Software in a Digital-First Health System

“…Rather than relying on individuals of patients, providers, and staff members, an intelligent digital pathway unlocks the opportunities of what should be done rather than what can be done with the constrained resources of time (eg, phone reach out and panel management) and clinic capacity (eg, limited number of patient rooms and provider appointments). For example, in colorectal cancer surveillance, a multimodal engagement of electronic message, telephone, and letter significantly improved surveillance [ 12 ]. In a systematic review, SMS text messaging improved patient satisfaction with cancer care and supported medication adherence [ 13 ].…”