Randomized Trial of Patient Outreach Approaches to De-implement Outdated Colonoscopy Surveillance Intervals.

Area of Science:

• Gastroenterology
• Preventive Medicine
• Health Services Research

Background:

• Current guidelines recommend 7-10 year colonoscopy surveillance for low-risk adenomas, replacing older 5-year intervals.
• Transitioning patients to updated surveillance recommendations is crucial for optimizing healthcare resource allocation and patient management.
• This study addresses the need to evaluate effective outreach strategies for de-implementing outdated surveillance protocols.

Purpose of the Study:

• To compare the effectiveness of three outreach methods (telephone, secure messaging, mailed letter) for transitioning patients to the recommended 10-year colonoscopy surveillance interval.
• To assess patient adoption rates of the updated surveillance interval across different outreach modalities.
• To identify optimal communication strategies for de-implementing outdated medical guidelines in a large healthcare system.

Main Methods:

• A pragmatic randomized trial was conducted with 604 patients aged 54-70 with low-risk adenomas.
• Participants were assigned to receive outreach via telephone, secure message, or mailed letter, with one reminder attempt.
• The study measured 60-day response rates and the adoption of the 10-year surveillance interval.

Main Results:

• Telephone outreach yielded a 64.5% response rate, followed by secure messaging (51.7%) and mailed letters (31.3%).
• Adoption of the 10-year surveillance interval was significantly higher with telephone (37.0%) and secure messaging (32.0%) compared to mailed letters (18.9%).
• Telephone and secure messaging demonstrated statistically significant improvements in de-implementing outdated 5-year surveillance recommendations.

Conclusions:

• Telephone and secure messaging are more effective than mailed letters for de-implementing outdated colonoscopy surveillance recommendations.
• These findings support the use of direct communication methods for guideline implementation in integrated healthcare settings.
• Optimizing patient outreach strategies can improve adherence to evidence-based medical guidelines and enhance preventive care.