Increasing timely colonoscopy surveillance for patients with high-risk colorectal polyps: Protocol for a cluster randomized trial.

May FP, McEwan JA, Tuan JJ, Crespi CM, Maehara CK, Yang JO, Uy A, Gupta S, Kang Y, Myint A, Naini BV, Elmore JG, Kadiyala S, Ong MK, Bui AAT, Hamilton AB, Chang LC, Gelvezon A, Hsu W, Bastani R. Increasing timely colonoscopy surveillance for patients with high-risk colorectal polyps: Protocol for a cluster randomized trial. Contemporary clinical trials. 2025 Nov 17; 160:108147, DOI: 10.1016/j.cct.2025.108147.

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Abstract:

INTRODUCTION: Colorectal cancer (CRC) is largely preventable through the removal of precancerous polyps from the colon and rectum. Polyp surveillance guidelines recommend that individuals with polyps categorized as high-risk neoplasia (HRN) undergo surveillance colonoscopy 3 years after HRN diagnosis. However, over half of patients fail to receive their surveillance colonoscopy within this recommended timeframe, highlighting the need for effective interventions to improve 3-year colonoscopy surveillance rates. METHODS: A hybrid type 1 effectiveness-implementation, 2-group cluster-randomized trial is being conducted at 30 primary health care clinics in a large, urban academic health center in Southern California. The study includes two arms: (1) a multilevel intervention arm in which a natural language processing (NLP) algorithm processes electronic health record (EHR) data to facilitate the identification of patients with HRN and providers and patients receive electronic notification when surveillance colonoscopy is due; and (2) a usual care arm, where no intervention is applied. RESULTS: The primary outcome will be completion of surveillance colonoscopy within 3.5 years of the HRN diagnosis. The secondary outcome will be time from the HRN diagnosis to completion of surveillance colonoscopy. CONCLUSIONS: This study evaluates the effectiveness of a multilevel health system intervention designed to improve adherence to surveillance colonoscopy guidelines for patients with a history of high-risk colorectal polyps. The findings are expected to offer valuable insights into strategies for leveraging EHR-informed algorithms to increase surveillance rates and improve CRC outcomes. TRIAL REGISTRATION: NCT06376565.