October 2008

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Colorectal cancer is the third most common cancer and the second most common cause of cancer death in the United States. Despite methods to improve early detection only 53% of the eligible population in the United States is current with these guidelines. Letter reminders have been shown effective in improving screening rates. Meanwhile computers and email usage have increased and even penetrated the field of medicine. This study looks at the effectiveness of using a secure email system linked to an electronic health record to send reminders to patients in an effort to increase colorectal cancer screening rates. METHODS. In a randomized prospective cohort study, 1409 subjects were randomly placed into one of three arms of the study: 1) usual care, 2) letter reminder or 3) email reminder. In the two intervention arms a letter or an email was sent inviting patients to pick up a fecal occult blood test at the lab for colorectal cancer screening. The number of completed colorectal cancer screenings was tallied after 3 months study period. RESULTS. Rates of colorectal cancer screening in the 3 groups were 8.7% in the usual care group, 24.2% in the letter reminder group and 23.2% in the email group. Significant statistical difference was seen better the usual care group and the letter reminders (p<0.0005) and between the usual care and email reminders (p<0.0005) but no statistical difference was seen between the letter reminders and the email reminders (p=7.11). CONCLUSION. Email reminders are as effective as letter reminders in increasing screening rates of colorectal cancer.




School of Medicine



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