Electronic trigger-based interventions appear to be effective in reducing time to diagnostic evaluation of colorectal and prostate cancers as well as improving the proportion of patients who receive follow-up, according to a study published online ahead of print in the Journal of Clinical Oncology.

Researchers evaluated whether prospective use of electronic health record-based trigger algorithms would identify patients at risk of diagnostic delays and could prevent delays in diagnostic evaluation for cancer.

A cluster of randomized controlled trial of primary care providers (PCPs) at two sites was performed to test whether triggers that prospectively identify patients with potential delays in diagnostic evaluation for lung, colorectal, or prostate cancer can reduce time to follow-up diagnostic evaluation.

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Researchers compared times to diagnostic evaluation and proportions of patients followed up between intervention and control cohorts based on final review at 7 months.

A total of 72 PCPs were recruited (36 in the intervention group and 36 in the control group) and applied the trigger to all patients under their care from April 20, 2011, to July 19, 2012.

Of 10,673 patients with abnormal findings, the trigger flagged 1,256 patients (11.8%) as high risk for delayed diagnostic evaluation.

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Times to diagnostic evaluation were significantly lower in intervention patients compared with control patients flagged by the colorectal trigger (median 104 versus 200 days, respectively; n = 557; P<0.001) and prostate trigger (40% received evaluation at 144 versus 192 days, respectively, n = 19; P = 0.59). 

More intervention patients than control patients received diagnostic evaluation by final review (73.4% versus 52.2%, respectively; relative risk, 1.41; 95% CI, 1.25, 1.58).

The researchers concluded that similar interventions could improve timeliness of diagnosis of other serious conditions.


  1. Murphy DR, Wu L, Thomas EJ, at al. Electronic trigger-based intervention to reduce delays in diagnostic evaluation for cancer: a cluster randomized controlled trial. J Clin Oncol. 2015. [epub ahead of print]. doi:10.1200/JCO.2015.61.1301.