Precision Patient Navigation to Improve Rates of Follow-up Colonoscopy, An Individual Randomized Effectiveness Trial.
Precision Patient Navigation to Improve Rates of Follow-up Colonoscopy, An Individual Randomized Effectiveness Trial.
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DOI：
10.1158/1055-9965.epi-20-1793
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发表时间：
2021-12
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通过年度粪便免疫化学试验（FIT）筛查结直肠癌并随访异常结果是降低结直肠癌发病率和死亡率的一种经济有效的策略。不幸的是，许多结果异常的患者没有完成后续的结肠镜检查。我们测试了针对不太可能完成手术的患者的导航是否可以改善依从性和长期结果。研究参与者是来自大型综合医疗系统（Kaiser Permanente Northwest）的患者，年龄在50至75岁之间，近期FIT结果异常后应进行结肠镜检查。在基线时使用预测风险模型估计随访依从性的概率。概率为70%及以下的患者随机分为患者导航组或常规护理组，随机分组按概率分类（<50%、50% < 60%、60% < 65%、65%≤70%）进行分层。我们使用Cox比例风险回归比较导航组和常规护理组6个月内结肠镜检查完成情况。参与者（n = 415； 200人被分配到患者导航组，215人被分配到常规护理组）的平均年龄为62岁，54%为女性，87%为非西班牙裔白人。6个月时，导航组76%的患者完成了结肠镜检查，而常规护理组的这一比例为65% （HR = 1.35； 95%可信区间为1.07-1.72；log-rank P值= 0.027）。在这个随机试验中，患者导航导致后续结肠镜检查依从性的改善。需要更多的研究来评估精确定向导航程序的价值。
Colorectal cancer screening by annual fecal immunochemical test (FIT) with follow-up on abnormal results is a cost-effective strategy to reduce colorectal cancer incidence and mortality. Unfortunately, many patients with abnormal results do not complete a follow-up colonoscopy. We tested whether navigation targeted to patients who are unlikely to complete the procedure may improve adherence and long-term outcomes. Study participants were patients at a large, integrated health system (Kaiser Permanente Northwest) who were ages 50 to 75 and were due for a follow-up colonoscopy after a recent abnormal FIT result. Probability of adherence to follow-up was estimated at baseline using a predictive risk model. Patients whose probability was 70% or lower were randomized to receive patient navigation or usual care, with randomization stratified by probability category (<50%, 50% < 60%, 60% < 65%, 65% ≤ 70%). We compared colonoscopy completion within 6 months between the navigation and usual care groups using Cox proportional hazards regression. Participants (n = 415; 200 assigned to patient navigation, 215 to usual care) had a mean age of 62 years, 54% were female, and 87% were non-Hispanic white. By 6 months, 76% of the patient navigation group had completed a colonoscopy, compared with 65% of the usual care group (HR = 1.35; 95% confidence interval, 1.07–1.72; log-rank P value = 0.027). In this randomized trial, patient navigation led to improvements in follow-up colonoscopy adherence. More research is needed to assess the value of precision-directed navigation programs.