John Z. Ayanian is the principal investigator on this project. Debby Collins is the project contact: 617-432-3467. 

Colorectal cancer is the second leading cause of cancer mortality in the United States. Most colorectal cancers arise in adenomatous polyps, and people who have had this type of polyp remain at increased risk of developing recurrent precancerous polyps and cancer. Regular surveillance colonoscopy with removal of all detected polyps has been shown to decrease the incidence of colorectal cancer. Therefore, recent national guidelines recommend that individuals with a history of adenomatous polyps undergo repeat colonoscopy every three to five years. Compliance with these guidelines, however, is less than optimal.

In this study, we are implementing and evaluating a randomized intervention to improve surveillance for colorectal polyps at primary care practices affiliated with Brigham and Women’s Hospital, a major academic medical center in Boston. These primary care practices include hospital-based practices, community-based practices, community health centers, and an integrated multispecialty group practice. The study has the following two specific aims:

• determining whether rates of surveillance colonoscopy can be substantially increased among patients with prior adenomatous polyps by linking computerized data from colonoscopy and pathology reports to identify patients with prior polyps who are due for repeat colonoscopy, and providing reminders to primary care physicians caring for these patients;
• evaluating whether the impact of the study intervention varies by patient demographic characteristics or site of primary care.

This study provides a model for evaluating ways that data from electronic medical records can be used to improve screening of patients with prior colorectal polyps who are at increased risk of developing recurrent polyps or cancer.