Braschi Caitlyn, Pelto Debra J, Hennelly Marie O, Lee Kristen K, Shah Brijen, Montgomery Guy H, Itzkowitz Steven H, Jandorf Lina
Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1130, New York, NY, 10029, USA,
J Gastrointest Cancer. 2014 Dec;45(4):500-3. doi: 10.1007/s12029-014-9653-4.
Patients with a history of advanced adenomas are at increased risk of developing colorectal cancer (CRC), yet rates of adherence to current surveillance colonoscopy guidelines are poor. We determined rates of referral and adherence to 3-year interval surveillance colonoscopy in patients with advanced adenomas and identified modifiable factors as possible intervention targets to improve surveillance referral and adherence in these at-risk patients.
We reviewed electronic medical records (EMR) of patients (N = 103) who had pathology findings on screening colonoscopy that warranted a 3-year surveillance colonoscopy. We abstracted demographics, surveillance colonoscopy completion rate, documentation of initial pathology in the "Problem List" of the EMR, and timing and nature of visits to a primary care physician (PCP).
Only 22 (21.4 %) patients had a record of surveillance colonoscopy completion. Among non-completers, 50.6 % of patients had no PCP visit within a year of their surveillance due date, 19.8 % saw a PCP and were not referred, and 29.6 % saw a PCP and were referred to either a gastroenterology consultation or a surveillance colonoscopy. Pathology found on initial screening was noted in the Problem List of 77.3 % of completers but only 33.3 % of non-completers (p ≤ 0.001).
Possible targets for interventions include using EMRs to improve physician communication and encouraging patients to have timely PCP visits and follow-through after colonoscopy referral. Clinical studies in this area have the potential to improve outcomes for patients by reducing CRC mortality through early detection.
有进展性腺瘤病史的患者患结直肠癌（CRC）的风险增加，但目前对结肠镜监测指南的依从率较低。我们确定了进展性腺瘤患者接受3年间隔结肠镜监测的转诊率和依从率，并确定了可改变的因素作为可能的干预目标，以改善这些高危患者的监测转诊和依从性。
我们回顾了103例患者的电子病历（EMR），这些患者在筛查结肠镜检查中有病理结果，需要进行3年的监测结肠镜检查。我们提取了人口统计学信息、监测结肠镜检查完成率、EMR“问题列表”中初始病理的记录，以及到初级保健医生（PCP）处就诊的时间和性质。
只有22例（21.4%）患者有监测结肠镜检查完成的记录。在未完成检查的患者中，50.6%的患者在监测截止日期后一年内未去看PCP，19.8%的患者看了PCP但未被转诊，29.6%的患者看了PCP并被转诊至胃肠病咨询或监测结肠镜检查。77.3%的完成检查者的初始筛查病理结果记录在问题列表中，但未完成检查者中只有33.3%（p≤0.001）。
可能的干预目标包括利用电子病历改善医生之间的沟通，并鼓励患者及时就诊PCP并在结肠镜检查转诊后坚持后续治疗。该领域的临床研究有可能通过早期检测降低CRC死亡率，从而改善患者的预后。
