Patient Navigation to Improve Colonoscopy Completion After an Abnormal Stool Test Result : A Randomized Controlled Trial.

IF 19.6 1区医学 Q1 MEDICINE, GENERAL & INTERNAL

Annals of Internal Medicine Pub Date : 2025-05-01 Epub Date: 2025-04-01 DOI:10.7326/ANNALS-24-01885

Gloria D Coronado, Amanda F Petrik, Jamie H Thompson, Michael C Leo, Matthew Slaughter, Priyanka Gautom, Syed A Hussain, Leslie Mosso, Jeffrey Gibbs, Neha Yadav, Rajasekhara R Mummadi, Eric S Johnson, Ricardo Jimenez

{"title":"Patient Navigation to Improve Colonoscopy Completion After an Abnormal Stool Test Result : A Randomized Controlled Trial.","authors":"Gloria D Coronado, Amanda F Petrik, Jamie H Thompson, Michael C Leo, Matthew Slaughter, Priyanka Gautom, Syed A Hussain, Leslie Mosso, Jeffrey Gibbs, Neha Yadav, Rajasekhara R Mummadi, Eric S Johnson, Ricardo Jimenez","doi":"10.7326/ANNALS-24-01885","DOIUrl":null,"url":null,"abstract":"Background: Patient navigation is a recommended practice of the Guide to Community Preventive Services; little is known about whether it improves colonoscopy completion for adults who have received an abnormal stool test result.Objective: To determine whether patient navigation delivered to persons with an abnormal stool test result increased follow-up colonoscopy completion (primary) at 1 year.Design: Randomized controlled trial. (ClinicalTrials.gov: NCT03925883).Setting: A federally qualified health center (n = 32 clinics) in Washington state.Patients: Persons aged 50 to 75 years with an abnormal fecal test result in the prior month.Intervention: A 6-topic, telephone-based patient navigation program delivered by bilingual (English and Spanish) clinical staff.Measurements: Receipt of follow-up colonoscopy at 1 year (primary); time to colonoscopy receipt (secondary); and program effectiveness by patient characteristics, including patients' probability of obtaining a colonoscopy without navigation, derived using health record data (secondary).Results: Of 985 participants enrolled (mean age, 61 years [SD, 6.8]; 170 [18%] had a Spanish-language preference listed in the medical record), 967 were included in the primary intention-to-treat analysis (479 in patient navigation, 488 in usual care). Receipt of follow-up colonoscopy was higher in the patient navigation group than in the usual care group (55.1% vs. 42.1%; risk difference, 13.0 percentage points [95% CI, 6.5 to 19.4 percentage points]). The intervention effect was not moderated by patients' probability of obtaining a colonoscopy without navigation.Limitation: The study was primarily done during the height of the COVID-19 pandemic, which created additional barriers to colonoscopy at the health system and patient levels.Conclusion: These findings support the effectiveness of patient navigation for follow-up colonoscopy completion.Primary funding source: National Cancer Institute.","PeriodicalId":7932,"journal":{"name":"Annals of Internal Medicine","volume":" ","pages":"645-654"},"PeriodicalIF":19.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Internal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.7326/ANNALS-24-01885","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/1 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Patient navigation is a recommended practice of the Guide to Community Preventive Services; little is known about whether it improves colonoscopy completion for adults who have received an abnormal stool test result.

Objective: To determine whether patient navigation delivered to persons with an abnormal stool test result increased follow-up colonoscopy completion (primary) at 1 year.

Design: Randomized controlled trial. (ClinicalTrials.gov: NCT03925883).

Setting: A federally qualified health center (n = 32 clinics) in Washington state.

Patients: Persons aged 50 to 75 years with an abnormal fecal test result in the prior month.

Intervention: A 6-topic, telephone-based patient navigation program delivered by bilingual (English and Spanish) clinical staff.

Measurements: Receipt of follow-up colonoscopy at 1 year (primary); time to colonoscopy receipt (secondary); and program effectiveness by patient characteristics, including patients' probability of obtaining a colonoscopy without navigation, derived using health record data (secondary).

Results: Of 985 participants enrolled (mean age, 61 years [SD, 6.8]; 170 [18%] had a Spanish-language preference listed in the medical record), 967 were included in the primary intention-to-treat analysis (479 in patient navigation, 488 in usual care). Receipt of follow-up colonoscopy was higher in the patient navigation group than in the usual care group (55.1% vs. 42.1%; risk difference, 13.0 percentage points [95% CI, 6.5 to 19.4 percentage points]). The intervention effect was not moderated by patients' probability of obtaining a colonoscopy without navigation.

Limitation: The study was primarily done during the height of the COVID-19 pandemic, which created additional barriers to colonoscopy at the health system and patient levels.

Conclusion: These findings support the effectiveness of patient navigation for follow-up colonoscopy completion.

Primary funding source: National Cancer Institute.

查看原文本刊更多论文

患者导航改善异常大便检查结果后结肠镜检查完成：一项随机对照试验。

背景：病人导航是社区预防服务指南的推荐做法；对于大便检查结果异常的成年人，它是否能提高结肠镜检查的完成度，我们知之甚少。目的：确定对大便检查结果异常的患者进行导航是否会增加随访1年结肠镜检查的完成度（主要）。设计：随机对照试验。(ClinicalTrials.gov: NCT03925883)。环境：华盛顿州一家联邦认证的健康中心（n = 32个诊所）。患者：年龄50 - 75岁，前一个月大便检查结果异常者。干预：由双语（英语和西班牙语）临床工作人员提供的6个主题，基于电话的患者导航程序。测量方法：1年后接受结肠镜检查（主要）；结肠镜检查收据时间（次要）；根据患者特征（包括患者在没有导航的情况下获得结肠镜检查的概率）得出的项目有效性（次要）。结果：985名参与者入组(平均年龄61岁[SD， 6.8]；170例（18%）在医疗记录中有西班牙语偏好)，967例被纳入主要意向治疗分析（479例患者导航，488例常规护理）。导航组患者结肠镜随访率高于常规护理组(55.1%比42.1%；风险差异，13.0个百分点[95% CI， 6.5 ~ 19.4个百分点])。干预效果不受患者在没有导航的情况下获得结肠镜检查的可能性的影响。局限性：该研究主要是在COVID-19大流行高峰期进行的，这给卫生系统和患者层面的结肠镜检查带来了额外的障碍。结论：这些发现支持患者导航在结肠镜随访中的有效性。主要资金来源：美国国家癌症研究所。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of Internal Medicine 医学-医学：内科

CiteScore

23.90

自引率

1.80%

发文量

1136

审稿时长

3-8 weeks

期刊介绍： Established in 1927 by the American College of Physicians (ACP), Annals of Internal Medicine is the premier internal medicine journal. Annals of Internal Medicine’s mission is to promote excellence in medicine, enable physicians and other health care professionals to be well informed members of the medical community and society, advance standards in the conduct and reporting of medical research, and contribute to improving the health of people worldwide. To achieve this mission, the journal publishes a wide variety of original research, review articles, practice guidelines, and commentary relevant to clinical practice, health care delivery, public health, health care policy, medical education, ethics, and research methodology. In addition, the journal publishes personal narratives that convey the feeling and the art of medicine.