Gautam Mankaney1, Maged Rizk2, Shashank Sarvepalli3, Jeannie Bongorno2, Ari Garber2, Rocio Lopez4, John McMichael5, Carol A Burke2. 1. Department of Gastroenterology and Hepatology, Digestive Disease and Surgical Institute, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA. mankang@ccf.org. 2. Department of Gastroenterology and Hepatology, Digestive Disease and Surgical Institute, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA. 3. Department of Medicine, Digestive Disease and Surgical Institute, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA. 4. Department of Biostatistics, and Quantitative Health Sciences, Digestive Disease and Surgical Institute, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA. 5. Department of General Surgery, Digestive Disease and Surgical Institute, The Cleveland Clinic, 9500 Euclid Avenue/A30, Cleveland, OH, 44195, USA.
Abstract
BACKGROUND AND AIM: We identified patients without medical record evidence of up-to-date colorectal cancer (CRC) screening and sent an invitation letter to self-schedule a colonoscopy without requiring prior primary care or gastroenterologist consultation. The aim of the study was to evaluate the response rate to the letter and factors associated with colonoscopy completion. METHODS: A computer algorithm invited patients not up to date with CRC screening, with an INR < 1.5, and living within 300 miles of the Cleveland Clinic main campus through a letter. Patients scheduled a colonoscopy through a dedicated phone line without any prior physician consultation. Clinical, demographic, and socioeconomic variables were extracted from the EMR through natural language algorithms. We analyzed the percentage of patients who completed a colonoscopy within 6 months of sending the letter and factors associated with colonoscopy completion. RESULTS: A total of 145,717 letters were sent. 1451 patients were deceased and excluded from analysis. 3.8% (5442) of letter recipients completed a colonoscopy. The strongest factors associated with colonoscopy completion on multivariate analysis included family history of polyps (OR 3.1, 95% CI 2.3, 4.2) or CRC (OR 2.1, 95% CI 1.7, 2.5). Other factors included younger age, male gender, married status, closer distance to endoscopy center, number of visits in the year prior, statin use, and diabetes. There were no immediate procedural complications. CONCLUSIONS: Patient-initiated colonoscopy in response to letter invitation for CRC screening is effective and safe with safeguards established a priori. Consultation with a gastroenterologist or primary care physician is not necessary prior to colonoscopy. To our knowledge, this is the first study to evaluate patient-initiated colonoscopy for CRC cancer screening.
BACKGROUND AND AIM: We identified patients without medical record evidence of up-to-date colorectal cancer (CRC) screening and sent an invitation letter to self-schedule a colonoscopy without requiring prior primary care or gastroenterologist consultation. The aim of the study was to evaluate the response rate to the letter and factors associated with colonoscopy completion. METHODS: A computer algorithm invited patients not up to date with CRC screening, with an INR < 1.5, and living within 300 miles of the Cleveland Clinic main campus through a letter. Patients scheduled a colonoscopy through a dedicated phone line without any prior physician consultation. Clinical, demographic, and socioeconomic variables were extracted from the EMR through natural language algorithms. We analyzed the percentage of patients who completed a colonoscopy within 6 months of sending the letter and factors associated with colonoscopy completion. RESULTS: A total of 145,717 letters were sent. 1451 patients were deceased and excluded from analysis. 3.8% (5442) of letter recipients completed a colonoscopy. The strongest factors associated with colonoscopy completion on multivariate analysis included family history of polyps (OR 3.1, 95% CI 2.3, 4.2) or CRC (OR 2.1, 95% CI 1.7, 2.5). Other factors included younger age, male gender, married status, closer distance to endoscopy center, number of visits in the year prior, statin use, and diabetes. There were no immediate procedural complications. CONCLUSIONS:Patient-initiated colonoscopy in response to letter invitation for CRC screening is effective and safe with safeguards established a priori. Consultation with a gastroenterologist or primary care physician is not necessary prior to colonoscopy. To our knowledge, this is the first study to evaluate patient-initiated colonoscopy for CRC cancer screening.
Entities:
Keywords:
Colon cancer screening; Letter invitation for colorectal cancer screening; Patient-initiated colonoscopy; Population-based screening
Authors: Stephen S Grubbs; Blase N Polite; John Carney; William Bowser; Jill Rogers; Nora Katurakes; Paula Hess; Electra D Paskett Journal: J Clin Oncol Date: 2013-04-15 Impact factor: 44.544
Authors: Debra J Holden; Daniel E Jonas; Deborah S Porterfield; Daniel Reuland; Russell Harris Journal: Ann Intern Med Date: 2010-04-13 Impact factor: 25.391
Authors: John M Inadomi; Sandeep Vijan; Nancy K Janz; Angela Fagerlin; Jennifer P Thomas; Yunghui V Lin; Roxana Muñoz; Chim Lau; Ma Somsouk; Najwa El-Nachef; Rodney A Hayward Journal: Arch Intern Med Date: 2012-04-09
Authors: Idris Guessous; Chiranjeev Dash; Pauline Lapin; Mary Doroshenk; Robert A Smith; Carrie N Klabunde Journal: Prev Med Date: 2009-12-16 Impact factor: 4.018
Authors: Laura C Seeff; Amy DeGroff; Djenaba A Joseph; Janet Royalty; Florence K L Tangka; Marion R Nadel; Marcus Plescia Journal: Cancer Date: 2013-08-01 Impact factor: 6.860
Authors: Brenda K Edwards; Anne-Michelle Noone; Angela B Mariotto; Edgar P Simard; Francis P Boscoe; S Jane Henley; Ahmedin Jemal; Hyunsoon Cho; Robert N Anderson; Betsy A Kohler; Christie R Eheman; Elizabeth M Ward Journal: Cancer Date: 2013-12-16 Impact factor: 6.860