(HealthDay News) — For asymptomatic adults with positive fecal blood test results, patient navigators and provider reminders or performance data may help improve colonoscopy rates; however, current evidence about useful system-level interventions is insufficient, according to a review published online Oct. 9 in the Annals of Internal Medicine.

Kevin Selby, MD, from the Kaiser Permanente Division of Research in Oakland, California, and colleagues conducted a systematic review of studies to examine interventions designed to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test. Twenty-three studies were eligible for analysis: 7 randomized and 16 nonrandomized.

The researchers found that 11 studies described patient-level interventions (changes to invitation, giving results or follow-up appointments, and patient navigators), 5 described provider-level interventions (reminders or performance data), and 7 described system-level interventions (automated referral, telephone calls before colonoscopy, patient registries, and efforts for quality improvement). There was moderate evidence to support patient navigators and provider reminders or performance data, while low evidence was seen for system-level interventions. The proportion of test-positive patients who completed colonoscopy was compared with a control population in 17 studies, with absolute differences of −7.4 to 25 percentage points. More than half of the studies were at high or very high risk of bias.

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“Current evidence about useful system-level interventions is scant and insufficient,” the authors write.


Selby K, Baumgartner C, Levin TR, et al. Interventions to improve follow-up of positive results on fecal blood tests: A systematic review.  Ann Intern Med. 10 Oct 2017. doi: 10.7326/M17-1361