一项随机对照试验，旨在提高结肠镜检查用于结直肠癌筛查后电子健康记录中随访监测时间间隔的准确性。
A Randomized Controlled Trial to Improve the Accuracy of Follow-Up Surveillance Time Intervals in the Electronic Health Record After a Colonoscopy for Colorectal Cancer Screening.
作者信息
Atlas Steven J, Palchaudhuri Sonali, Harris Kimberly A, Gallagher Katherine L, He Wei, Rubins David, Chang Yuchiao, Haas Jennifer S, Richter James M
机构信息
Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Am J Gastroenterol. 2025 Apr 23. doi: 10.14309/ajg.0000000000003497.
INTRODUCTION
Electronic health records (EHRs) provide cancer screening reminders to patients and clinicians, but they are not always accurate. Updating the EHR after a colonoscopy for colorectal cancer screening is typically performed manually by the endoscopist when pathology results are available but may be error prone. We evaluated an electronic tool embedded in patient result letters that automatically updated the EHR follow-up time interval after a colonoscopy.
METHODS
A randomized controlled trial of endoscopists from 1 institution who performed colonoscopies on patients undergoing a screening or surveillance colonoscopy. Intervention endoscopists were trained to use the electronic tool in their result letters to patients. Control endoscopists continued with their usual care. The primary outcome was the accuracy of the follow-up surveillance colonoscopy time interval in the EHR compared with the time interval specified in the patient result letter.
RESULTS
Overall, 43 endoscopists were randomly assigned to intervention (n = 22) or control (n = 21) groups. Characteristics of patients in the intervention (n = 2,365) and control (n = 1,422) were similar. A result letter was sent to 1,498 (63.3%) intervention and 814 (57.2%) control patients ( P < 0.001). Among all patients sent a result letter, the accuracy of the follow-up colonoscopy surveillance time interval between the result letter and the EHR was significantly higher for the intervention (92.4% vs 76.2%, P < 0.001). Intervention endoscopists were more satisfied with the process of reporting results after a colonoscopy (88.2% vs 60.0%, P = 0.11).
DISCUSSION
For patients undergoing a colonoscopy for colorectal cancer screening, an electronic tool embedded in the result letter that automatically updated the EHR significantly improved the accuracy of the follow-up time interval compared with usual care.
引言
电子健康记录（EHRs）为患者和临床医生提供癌症筛查提醒，但它们并不总是准确的。在结肠镜检查用于结直肠癌筛查后，当病理结果可用时，内镜医生通常手动更新电子健康记录，但这可能容易出错。我们评估了嵌入患者结果信中的一种电子工具，该工具可在结肠镜检查后自动更新电子健康记录的随访时间间隔。
方法
对来自1家机构的内镜医生进行一项随机对照试验，这些内镜医生对接受筛查或监测性结肠镜检查的患者进行操作。干预组内镜医生接受培训，在给患者的结果信中使用该电子工具。对照组内镜医生继续常规操作。主要结局是电子健康记录中随访监测结肠镜检查时间间隔与患者结果信中规定的时间间隔相比的准确性。
结果
总体而言，43名内镜医生被随机分配到干预组（n = 22）或对照组（n = 21）。干预组（n = 2365）和对照组（n = 1422）患者的特征相似。向1498名（63.3%）干预组患者和814名（57.2%）对照组患者发送了结果信（P < 0.001）。在所有收到结果信的患者中，干预组结果信与电子健康记录之间随访结肠镜检查监测时间间隔的准确性显著更高（92.4%对76.2%，P < 0.001）。干预组内镜医生对结肠镜检查后报告结果的过程更满意（88.2%对60.0%，P = 0.11）。
讨论
对于接受结肠镜检查以进行结直肠癌筛查的患者，与常规操作相比，嵌入结果信中的自动更新电子健康记录的电子工具显著提高了随访时间间隔的准确性。
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