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E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy

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CHOICE: A Comprehensive and Coordinated Colorectal Cancer Screening Program in a Large Urban Health System.

Emma Ghalili¹, Tsion Tmariam¹, Parth D Trivedi^1,2

¹Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Health Services Research

|April 28, 2025

Summary

The CHOICE Program improved colorectal cancer (CRC) screening by integrating patient navigation and EMR optimization. This initiative achieved a 79% colonoscopy completion rate, demonstrating its effectiveness in enhancing CRC screening rates.

Keywords:

colorectal neoplasms delivery of health care integrated early detection of cancer mass screening patient navigation

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Area of Science:

Public Health
Gastroenterology
Health Systems Management

Background:

Colorectal cancer (CRC) screening rates and completion of diagnostic colonoscopies remain suboptimal in many healthcare systems.
Effective strategies are needed to improve adherence to CRC screening protocols and reduce disparities in care.

Purpose of the Study:

To implement and evaluate a coordinated colorectal cancer (CRC) screening program within a large urban academic health system.
The primary goals were to increase system-wide screening rates, reduce patient no-shows, and improve colonoscopy completion.

Main Methods:

The CHOICE Program utilized a multi-faceted approach including patient navigation, electronic medical record (EMR) optimization, and standardized system-wide practice changes.
Key components involved provider and patient education, protocol standardization, enhanced navigator outreach, and streamlined scheduling processes.
The study targeted health system patients aged 45-75 at average risk for CRC, assessing colonoscopy completion rates.

Main Results:

Over a 2-year period (March 2022-February 2024), 18,119 patients were referred to the CHOICE Program.
The program achieved a 79% colonoscopy completion rate among scheduled patients.
The CHOICE Program successfully standardized and operationalized CRC screening efforts within a large health system.

Conclusions:

The CHOICE Program demonstrates a successful model for enhancing colorectal cancer screening completion rates through integrated interventions.
The program's standardized approach offers a scalable template for other health systems seeking to improve their CRC screening outcomes.
Implementing such coordinated programs is crucial for improving population health and reducing the burden of colorectal cancer.