Screening programs using the fecal occult blood test (FOBT) have demonstrated a significant reduction in colorectal cancer mortality, although only when accompanied by a complete diagnostic evaluation of the colon in the setting of a positive result. Only 52% of patients with a positive FOBT result have completed a subsequent colonoscopy within Harvard Vanguard Medical Associates. This project uses a randomized, controlled study design to increase the rate of follow-up colonoscopy in the setting of positive FOBT results.

Patients in the intervention group will receive a personalized mailing highlighting their positive result and need for colonoscopy, followed by telephone outreach from a centralized gastroenterology scheduling office. A cross-over study design will be implemented to ensure that patients in the control group also receive centralized outreach.  The study has two specific aims:

• determine predictors of inadequate follow-up of positive FOBT results;
  
  
• determine if rates of colonoscopy following a positive FOBT result can be substantially increased through centralized patient mailings followed by telephone outreach.