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White M, Israilevich R, Lam S, McCarthy M, Mico V, Chipkin B, Abrams E, Moore K, Kastenberg D. Timely Completion of Direct Access Colonoscopy Is Noninferior to Office Scheduled for Screening and Surveillance. J Clin Gastroenterol 2024:00004836-990000000-00287. [PMID: 38630852 DOI: 10.1097/mcg.0000000000002000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/27/2024] [Indexed: 04/19/2024]
Abstract
GOALS We aimed to evaluate whether direct access colonoscopy (DAC) is noninferior to office-scheduled colonoscopy (OSC) for achieving successful colonoscopy. BACKGROUND DAC may improve access to colonoscopy. We developed an algorithm assessing eligibility, risk for inadequate preparation, and need for nursing/navigator assistance. STUDY This was a retrospective, single-center study of DAC and OSC patients from June 5, 2018, to July 31, 2019. Patients were 45 to 75 years old with an indication of screening or surveillance. A successful colonoscopy met 3 criteria: complete colonoscopy (cecum, anastomosis, or ileum), adequate preparation (Boston Score ≥2/segment), and performed <90 days from initial patient contact. Unsuccessful colonoscopy did not meet ≥1 criteria. Secondary end points included days to successful colonoscopy, preparation quality, polyp detection, and 10-year recall rate. Noninferiority against risk ratio value of 0.85 was tested using 1-sided alpha of 0.05. RESULTS A total of 1823 DAC and 828 OSC patients were eligible. DAC patients were younger, with a greater proportion of black patients and screening indications. For the outcome of successful colonoscopy, DAC was noninferior to OSC (DAC vs. OSC: 62.7% vs. 57.1%, RR 1.16, 95% LCL 1.09, P=0.001). For DAC, days to colonoscopy were fewer, and likelihood of 10-year recall after negative screening greater. Boston Score and polyp detection were similar for groups. Black patients were less likely to achieve successful colonoscopy; otherwise, groups were similar. For unsuccessful colonoscopies, proportionally more DAC patients canceled or no-showed while more OSC patients scheduled >90 days. DAC remained noninferior to OSC at 180 days. CONCLUSIONS DAC was noninferior to OSC for achieving successful colonoscopy, comparing similarly in quality and efficiency outcomes.
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Affiliation(s)
- Mary White
- Sidney Kimmel Medical College
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT
| | - Rachel Israilevich
- Sidney Kimmel Medical College
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Sophia Lam
- Sidney Kimmel Medical College
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York City, NY
| | - Michael McCarthy
- Sidney Kimmel Medical College
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vasil Mico
- Sidney Kimmel Medical College
- Department of Medicine, Tufts Medical Center, Boston
| | - Benjamin Chipkin
- Sidney Kimmel Medical College
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, CT
| | - Eric Abrams
- Department of Biology, University of Massachusetts-Amherst, Amherst, MA
| | - Kelly Moore
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA
| | - David Kastenberg
- Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA
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2
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Alturbag M. Factors and Reasons Associated With Appointment Non-attendance in Hospitals: A Narrative Review. Cureus 2024; 16:e58594. [PMID: 38765331 PMCID: PMC11102763 DOI: 10.7759/cureus.58594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
Non-attendance at hospital appointments is an extremely prevalent issue impacting healthcare systems on a daily basis. This phenomenon adversely affects patient health and healthcare providers, leading to delays in diagnosis and treatment, inefficient resource utilization, and increased healthcare expenses. The detrimental impact of non-attendance is not limited to patients who miss appointments, the knock-on effects of extended waiting times and reduced appointment availability are felt throughout healthcare systems. The purpose of this narrative review is to explore the factors underlying appointment non-attendance in hospital settings, to improve healthcare delivery and patient adherence. An extensive review of the existing global literature was conducted. Quantitative studies that explored the relationship between appointment non-attendance and patient characteristics, such as age, gender, marital status, education level, distance from the hospital, and source of referral, were included. Younger patients, males, individuals with lower levels of education, and those living farther from hospitals were more likely to miss appointments. Marital status was significant, with married patients showing better attendance, as was referral source, with general practitioner referrals associated with higher non-attendance. Qualitative studies identifying both patient-centered and hospital-specific reasons, such as forgetfulness, appointment time, protracted waiting times, patient-physician relationship, and patients' knowledge and perception of their health condition, were also included in the review. Lack of appointment reminders, difficulties in managing appointments, and inadequate patient-physician communication were significant hospital-specific reasons given for non-attendance. Patients' lack of awareness regarding the importance of attending appointments and limited understanding of their health conditions were also identified as patient-centered contributors. Non-attendance at hospital appointments is a multifaceted issue influenced by a range of socioeconomic, personal, and systemic factors. Addressing these factors requires a holistic approach that includes patient education, improved communication, and tailored healthcare delivery strategies, especially for vulnerable populations in rural areas. Enhanced reminder systems and streamlined appointment management could serve as pivotal interventions to reduce non-attendance rates, ultimately improving healthcare outcomes and resource utilization.
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Affiliation(s)
- Majed Alturbag
- School of Nursing & Midwifery, University of Dublin, Trinity College, Dublin, IRL
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3
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Steiner JF, Nguyen AP, Schuster KS, Goodrich G, Barrow J, Steiner CA, Zeng C. Associations between Missed Colonoscopy Appointments and Multiple Prior Adherence Behaviors in an Integrated Healthcare System: An Observational Study. J Gen Intern Med 2024; 39:36-44. [PMID: 37550443 PMCID: PMC10817878 DOI: 10.1007/s11606-023-08355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Missed colonoscopy appointments delay screening and treatment for gastrointestinal disorders. Prior nonadherence with other care components may be associated with missed colonoscopy appointments. OBJECTIVE To assess variability in prior adherence behaviors and their association with missed colonoscopy appointments. DESIGN Retrospective cohort study. PARTICIPANTS Patients scheduled for colonoscopy in an integrated healthcare system between January 2016 and December 2018. MAIN MEASURES Prior adherence behaviors included: any missed outpatient appointment in the previous year; any missed gastroenterology clinic or colonoscopy appointment in the previous 2 years; and not obtaining a bowel preparation kit pre-colonoscopy. Other sociodemographic, clinical, and system characteristics were included in a multivariable model to identify independent associations between prior adherence behaviors and missed colonoscopy appointments. KEY RESULTS The median age of the 57,590 participants was 61 years; 52.8% were female and 73.4% were white. Of 77,684 colonoscopy appointments, 3,237 (4.2%) were missed. Individuals who missed colonoscopy appointments were more likely to have missed a previous primary care appointment (62.5% vs. 38.4%), a prior gastroenterology appointment (18.4% vs. 4.7%) or not to have picked up a bowel preparation kit (42.4% vs. 17.2%), all p < 0.001. Correlations between the three adherence measures were weak (phi < 0.26). The rate of missed colonoscopy appointments increased from 1.8/100 among individuals who were adherent with all three prior care components to 24.6/100 among those who were nonadherent with all three care components. All adherence variables remained independently associated with nonadherence with colonoscopy in a multivariable model that included other covariates; adjusted odds ratios (with 95% confidence intervals) were 1.6 (1.5-1.8) for outpatient appointments, 1.9 (1.7-2.1) for gastroenterology appointments, and 3.1 (2.9-3.4) for adherence with bowel preparation kits, respectively. CONCLUSIONS Three prior adherence behaviors were independently associated with missed colonoscopy appointments. Studies to predict adherence should use multiple, complementary measures of prior adherence when available.
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Affiliation(s)
- John F Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA.
- Colorado Permanente Medical Group, Denver, CO, USA.
| | - Anh P Nguyen
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Kelly S Schuster
- Department of Gastroenterology, Kaiser Permanente Colorado, Denver, CO, USA
| | - Glenn Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Jennifer Barrow
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Claudia A Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
- Colorado Permanente Medical Group, Denver, CO, USA
| | - Chan Zeng
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
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4
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Dadlez NM, Le Clair AM, Wasima S, Mayer N, Harvey WF, Roberts K, Mazzullo J, Lominac E, Koethe BC, Weingart SN. Preventing lost-to-follow up diagnostic imaging in ambulatory care: evaluation of an electronic notification tool. BMJ Open Qual 2023; 12:e002334. [PMID: 37463784 PMCID: PMC10357715 DOI: 10.1136/bmjoq-2023-002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/24/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVE Missed or cancelled imaging tests may be invisible to the ordering clinician and result in diagnostic delay. We developed an outpatient results notification tool (ORNT) to alert physicians of patients' missed radiology studies. DESIGN Randomised controlled evaluation of a quality improvement intervention. SETTING 23 primary care and subspecialty ambulatory clinics at an urban academic medical centre. PARTICIPANTS 276 physicians randomised to intervention or usual care. MAIN OUTCOME MEASURE 90-day test completion of missed imaging tests. RESULTS We included 3675 radiology tests in our analysis: 1769 ordered in the intervention group and 1906 in the usual care group. A higher per cent of studies were completed for intervention compared with usual care groups in CT (20.7% vs 15.3%, p=0.06), general radiology (19.6% vs 12.0%, p=0.02) and, in aggregate, across all modalities (18.1% vs 16.1%, p=0.03). In the multivariable regression model adjusting for sex, age and insurance type and accounting for clustering with random effects at the level of the physician, the intervention group had a 36% greater odds of test completion than the usual care group (OR: 1.36 (1.097-1.682), p=0.005). In the Cox regression model, patients in the intervention group were 1.32 times more likely to complete their test in a timely fashion (HR: 1.32 (1.10-1.58), p=0.003). CONCLUSIONS An electronic alert that notified the responsible clinician of a missed imaging test ordered in an ambulatory clinic reduced the number of incomplete tests at 90 days. Further study of the obstacles to completing recommended diagnostic testing may allow for the development of better tools to support busy clinicians and their patients and reduce the risk of diagnostic delays.
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Affiliation(s)
- Nina M Dadlez
- Department of Pediatrics, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Amy M Le Clair
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Syeda Wasima
- Tufts Medical Center, Boston, Massachusetts, USA
| | - Nicole Mayer
- Tufts Medical Center, Boston, Massachusetts, USA
| | - William F Harvey
- Department of Medicine, Tufts Medicine, Burlington, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kari Roberts
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - John Mazzullo
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Eric Lominac
- Department of Informatics, Tufts Medical Center, Boston, Massachusetts, USA
| | - Benjamin C Koethe
- Biostatistics, Epidemiology, and Research Design (BERD) Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Saul N Weingart
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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5
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Wongtangman K, Azimaraghi O, Freda J, Ganz-Lord F, Shamamian P, Bastien A, Mirhaji P, Himes CP, Rupp S, Green-Lorenzen S, Smith RV, Medrano EM, Anand P, Rego S, Velji S, Eikermann M. Incidence and predictors of case cancellation within 24 h in patients scheduled for elective surgical procedures. J Clin Anesth 2022; 83:110987. [PMID: 36308990 DOI: 10.1016/j.jclinane.2022.110987] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/22/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Avoidable case cancellations within 24 h reduce operating room (OR) efficiency, add unnecessary costs, and may have physical and emotional consequences for patients and their families. We developed and validated a prediction tool that can be used to guide same day case cancellation reduction initiatives. DESIGN Retrospective hospital registry study. SETTING University-affiliated hospitals network (NY, USA). PATIENTS 246,612 (1/2016-6/2021) and 58,662 (7/2021-6/2022) scheduled elective procedures were included in the development and validation cohort. MEASUREMENTS Case cancellation within 24 h was defined as cancelling a surgical procedure within 24 h of the scheduled date and time. Our candidate predictors were defined a priori and included patient-, procedural-, and appointment-related factors. We created a prediction tool using backward stepwise logistic regression to predict case cancellation within 24 h. The model was subsequently recalibrated and validated in a cohort of patients who were recently scheduled for surgery. MAIN RESULTS 8.6% and 8.7% scheduled procedures were cancelled within 24 h of the intended procedure in the development and validation cohort, respectively. The final weighted score contains 29 predictors. A cutoff value of 15 score points predicted a 10.3% case cancellation rate with a negative predictive value of 0.96, and a positive predictive value of 0.21. The prediction model showed good discrimination in the development and validation cohort with an area under the receiver operating characteristic curve (AUC) of 0.79 (95% confidence interval 0.79-0. 80) and an AUC of 0.73 (95% confidence interval 0.72-0.73), respectively. CONCLUSIONS We present a validated preoperative prediction tool for case cancellation within 24 h of surgery. We utilize the instrument in our institution to identify patients with high risk of case cancellation. We describe a process for recalibration such that other institutions can also use the score to guide same day case cancellation reduction initiatives.
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Affiliation(s)
- Karuna Wongtangman
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Omid Azimaraghi
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Jeffrey Freda
- Vice President, Surgical Services, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Fran Ganz-Lord
- Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Peter Shamamian
- Department of Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Alexandra Bastien
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Parsa Mirhaji
- Center for Health Data Innovations, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Carina P Himes
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Samuel Rupp
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | | | - Richard V Smith
- Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Elilary Montilla Medrano
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Preeti Anand
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Simon Rego
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Salimah Velji
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA; Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.
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6
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Moving the Needle on Patient Cancellations Through Mobile Integration. Gastroenterol Nurs 2022; 45:419-427. [DOI: 10.1097/sga.0000000000000682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
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7
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Yılmaz H, Kocyigit B. Factors associated with non-attendance at appointments in the gastroenterology endoscopy unit: a retrospective cohort study. PeerJ 2022; 10:e13518. [PMID: 35910767 PMCID: PMC9332409 DOI: 10.7717/peerj.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/09/2022] [Indexed: 01/17/2023] Open
Abstract
Background and Aims Gastrointestinal (GI) endoscopy is a limited health resource because of a scarcity of qualified personnel and limited availability of equipment. Non-adherence to endoscopy appointments therefore wastes healthcare resources and may compromise the early detection and treatment of GI diseases. We aimed to identify factors affecting non-attendance at scheduled appointments for GI endoscopy and thus improve GI healthcare outcomes. Methods This was a single-center retrospective cohort study performed at a tertiary hospital gastroenterology endoscopy unit, 12 months before and 12 months after the start of the COVID-19 pandemic. We used multiple logistic regression analysis to identify variables associated with non-attendance at scheduled appointments. Results Overall, 5,938 appointments were analyzed, and the non-attendance rate was 18.3% (1,088). The non-attendance rate fell significantly during the pandemic (22.6% vs. 11.6%, p < 0.001). Multivariable regression analysis identified the absence of deep sedation (OR: 3.253, 95% CI [2.386-4.435]; p < 0.001), a referral from a physician other than a gastroenterologist (OR: 1.891, 95% CI [1.630-2.193]; p < 0.001), a longer lead time (OR: 1.006, 95% CI [1.004-1.008]; p < 0.001), and female gender (OR: 1.187, 95% CI [1.033-1.363]; p = 0.015) as associated with appointment non-attendance. Conclusions Female patients, those undergoing endoscopic procedures without deep sedation, those referred by physicians other than gastroenterologists, and with longer lead time were less likely to adhere to appointments. Precautions should be directed at patients with one or more of these risk factors, and for those scheduled for screening procedures during the COVID-19 pandemic.
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Affiliation(s)
- Hasan Yılmaz
- Department of Gastroenterology, Kocaeli University, İzmit, Kocaceli, Turkey,Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
| | - Burcu Kocyigit
- Department of Internal Medicine, Kocaeli University, İzmit, Kocaceli, Turkey
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Hua Y, Che T, Yang C, Hu M. Customer no-show reduction in web-based appointment service: investigations of non-attendance behaviors. SERVICE INDUSTRIES JOURNAL 2022. [DOI: 10.1080/02642069.2022.2045963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ye Hua
- School of Management, Zhejiang University of Technology, Hangzhou, People’s Republic of China
| | - Tong Che
- Research Center for Smarter Supply Chain & Dongwu Business School, Soochow University, Suzhou, People’s Republic of China
| | - Cheng Yang
- School of Management, Zijingang Campus, Zhejiang University, Hangzhou, People’s Republic of China
| | - Miao Hu
- School of Political Science and Public Administration, Soochow University, Suzhou, People’s Republic of China
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9
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Chou EY, Moore K, Zhao Y, Melly S, Payvandi L, Buehler JW. Neighborhood Effects on Missed Appointments in a Large Urban Academic Multispecialty Practice. J Gen Intern Med 2022; 37:785-792. [PMID: 34159548 PMCID: PMC8904676 DOI: 10.1007/s11606-021-06935-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Missed appointments diminish the continuity and quality of care. OBJECTIVE To determine whether missing scheduled appointments is associated with characteristics of the populations in places where patients reside. DESIGN Retrospective cross-sectional study using data extracted from electronic health records linked to population descriptors for each patient's census tract of residence. PATIENTS A total of 58,981 patients ≥18 years of age with 275,682 scheduled appointments during 2014-2015 at a multispecialty outpatient practice. MAIN MEASURES We used multinomial generalized linear mixed models to examine associations between the outcomes of scheduled appointments (arrived, canceled, or missed) and selected characteristics of the populations in patients' census tracts of residence (racial/ethnic segregation based on population composition, levels of poverty, violent crime, and perceived safety and social capital), controlling for patients' age, gender, type of insurance, and type of clinic service. KEY RESULTS Overall, 17.5% of appointments were missed. For appointments among patients residing in census tracts in the highest versus lowest quartile for each population metric, adjusted odds ratios (aORs) for missed appointments were 1.27 (CI 1.19, 1.35) for the rate of violent crime, 1.27 (CI 1.20, 1.34) for the proportion Hispanic, 1.19 (CI 1.12, 1.27) for the proportion living in poverty, 1.13 (CI 1.05, 1.20) for the proportion of the census tract population that was Black, and 1.06 (CI 1.01, 1.11 for perceived neighborhood safety. CONCLUSIONS Characteristics of the places where patients reside are associated with missing scheduled appointments, including high levels of racial/ethnic segregation, poverty, and violent crime and low levels of perceived neighborhood safety. As such, targeting efforts to improve access for patients living in such neighborhoods will be particularly important to address underlying social determinants of access to health care.
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Affiliation(s)
- Edgar Y Chou
- Drexel University College of Medicine and Drexel University Physicians Practice Plan, Philadelphia, PA, USA.,Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Yuzhe Zhao
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Steven Melly
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Lily Payvandi
- Drexel University College of Medicine/Tower Health, Philadelphia, PA, USA.,Boston Children's Hospital, Boston, MA, USA
| | - James W Buehler
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA. .,Department of Health Management & Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
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10
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Solonowicz O, Stier M, Kim K, Kupfer S, Tapper E, Sengupta N. Digital Navigation Improves No-Show Rates and Bowel Preparation Quality for Patients Undergoing Colonoscopy: A Randomized Controlled Quality Improvement Study. J Clin Gastroenterol 2022; 56:166-172. [PMID: 33471486 PMCID: PMC10065085 DOI: 10.1097/mcg.0000000000001497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/13/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Because of high historical no-show rates and poor bowel preparation quality in our unit, we sought to evaluate whether text message navigation for patients scheduled for colonoscopy would reduce no-show rates and improve bowel preparation quality compared with usual care. METHODS We performed a randomized controlled quality improvement study from April to August 2019 in an urban academic endoscopy unit. All patients scheduled for colonoscopy were randomly assigned to a control group that received usual care (paper instructions/nursing precalls) or to the intervention group that received usual care plus the text message program [short message service (SMS)]. The program provided timed-release instructions on dietary modifications and bowel preparation before colonoscopy. The primary outcome was no-shows. Secondary outcomes were no-show/same-day cancellations, no-show/cancellations within 7 days of the procedure, and bowel preparation quality. RESULTS A total of 1625 patients were randomized (SMS=833, control=792). No-show rates were significantly lower in the SMS group compared with the control group (8% vs. 14%; P<0.0001). Similar results were found for no-show/same-day cancellations (10% vs. 16%; P=0.0003), and no-show/cancellations within 7 days (18% vs. 26%; P=0.0008). There was no difference in adequate bowel preparation for all colonoscopies between the groups (89% vs. 87%; P=0.47). However, rates of adequate bowel preparation for screening/surveillance colonoscopies were significantly higher in SMS versus control groups (93% vs. 88%; P=0.04). CONCLUSIONS Text message navigation for patients scheduled for colonoscopy improved the quality of colorectal cancer screening by decreasing no-show rates and increasing adequate bowel preparation rates in patients undergoing screening colonoscopy compared with usual care.
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Affiliation(s)
- Olga Solonowicz
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Matt Stier
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Karen Kim
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Sonia Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Elliot Tapper
- Section of Gastroenterology, Department of Medicine, University of Michigan Medicine, Ann Arbor, MI 48109
| | - Neil Sengupta
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
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11
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Mog AC, Liang PS, Donovan LM, Sayre GG, Shaukat A, May FP, Glorioso TJ, Jorgenson MA, Wood GB, Mueller C, Dominitz JA. Timely Colonoscopy After Positive Fecal Immunochemical Tests in the Veterans Health Administration: A Qualitative Assessment of Current Practice and Perceived Barriers. Clin Transl Gastroenterol 2022; 13:e00438. [PMID: 35060937 PMCID: PMC8865517 DOI: 10.14309/ctg.0000000000000438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/04/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The Veterans Health Administration introduced a clinical reminder system in 2018 to help address process gaps in colorectal cancer screening, including the diagnostic evaluation of positive fecal immunochemical test (FIT) results. We conducted a qualitative study to explore the differences between facilities who performed in the top vs bottom decile for follow-up colonoscopy. METHODS Seventeen semistructured interviews with gastroenterology (GI) providers and staff were conducted at 9 high-performing and 8 low-performing sites. RESULTS We identified 2 domains, current practices and perceived barriers, and most findings were described by both high- and low-performing sites. Findings exclusive to 1 group mainly pertained to current practices, especially arranging colonoscopy for FIT-positive patients. We observed only 1 difference in the perceived barriers domain, which pertained to primary care providers. DISCUSSION These results suggest that what primarily distinguishes high- and low-performing sites is not a difference in barriers but rather in the GI clinical care process. Developing and disseminating patient education materials about the importance of diagnostic colonoscopy, eliminating in-person precolonoscopy visits when clinically appropriate, and involving GI in missed colonoscopy appointments and outside referrals should all be considered to increase follow-up colonoscopy rates. Our study illustrates the challenges of performing a timely colonoscopy after a positive FIT result and provides insights on improving the clinical care process for patients who are at substantially increased risk for colorectal cancer.
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Affiliation(s)
- Ashley C. Mog
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Peter S. Liang
- Veteran Affairs New York Harbor Healthcare System, New York, New York, USA
- NYU Langone Health, New York, New York, USA
| | - Lucas M. Donovan
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - George G. Sayre
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Aasma Shaukat
- Minneapolis Veteran Affairs Healthcare System, Minneapolis, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Folasade P. May
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- University of California, Los Angeles, California, USA
| | - Thomas J. Glorioso
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA
| | | | - Gordon Blake Wood
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
| | - Candice Mueller
- CART Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC, USA
| | - Jason A. Dominitz
- Veteran Affairs Puget Sound Healthcare System, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
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12
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Alawadhi A, Palin V, van Staa T. Prevalence and factors associated with missed hospital appointments: a retrospective review of multiple clinics at Royal Hospital, Sultanate of Oman. BMJ Open 2021; 11:e046596. [PMID: 34408035 PMCID: PMC8375741 DOI: 10.1136/bmjopen-2020-046596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Missed hospital appointments pose a major challenge for healthcare systems. There is a lack of information about drivers of missed hospital appointments in non-Western countries and extent of variability between different types of clinics. The aim was to evaluate the rate and predictors of missed hospital appointments and variability in drivers between multiple outpatient clinics. SETTING Outpatient clinics in the Royal hospital (tertiary referral hospital in Oman) between 2014 and 2018. PARTICIPANTS All patients with a scheduled outpatient clinic appointment (N=7 69 118). STUDY DESIGN Retrospective cross-sectional analysis. PRIMARY AND SECONDARY OUTCOME MEASURES A missed appointment was defined as a patient who did not show up for the scheduled hospital appointment without notifying or asking for the appointment to be cancelled or rescheduled. The outcomes were the rate and predictors of missed hospital appointments overall and variations by clinic. Conditional logistic regression compared patients who attended and those who missed their appointment. RESULTS The overall rate of missed hospital appointments was 22.3%, which varied between clinics (14.0% for Oncology and 30.3% for Urology). Important predictors were age, sex, service costs, patient's residence distance from hospital, waiting time and appointment day and season. Substantive variability between clinics in ORs for a missed appointment was present for predictors such as service costs and waiting time. Patients aged 81-90 in the Diabetes and Endocrine clinic had an adjusted OR of 0.53 for missed appointments (95% CI 0.37 to 0.74) while those in Obstetrics and Gynaecology had OR of 1.70 (95% CI 1.11 to 2.59). Adjusted ORs for longer waiting times (>120 days) were 2.22 (95% CI 2.10 to 2.34) in Urology but 1.26 (95% CI 1.18 to 1.36) in Oncology. CONCLUSION Predictors of a missed appointment varied between clinics in their effects. Interventions to reduce the rate of missed appointments should consider these factors and be tailored to clinic.
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Affiliation(s)
- Ahmed Alawadhi
- Health Informatics, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Victoria Palin
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tjeerd van Staa
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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13
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Bhavsar NA, Doerfler SM, Giczewska A, Alhanti B, Lutz A, Thigpen CA, George SZ. Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions. PLoS One 2021; 16:e0251336. [PMID: 34048440 PMCID: PMC8162651 DOI: 10.1371/journal.pone.0251336] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/23/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Chronic pain affects 50 million Americans and is often treated with non-pharmacologic approaches like physical therapy. Developing a no-show prediction model for individuals seeking physical therapy care for musculoskeletal conditions has several benefits including enhancement of workforce efficiency without growing the existing provider pool, delivering guideline adherent care, and identifying those that may benefit from telehealth. The objective of this paper was to quantify the national prevalence of no-shows for patients seeking physical therapy care and to identify individual and organizational factors predicting whether a patient will be a no-show when seeking physical therapy care. DESIGN Retrospective cohort study. SETTING Commercial provider of physical therapy within the United States with 828 clinics across 26 states. PARTICIPANTS Adolescent and adult patients (age cutoffs: 14-117 years) seeking non-pharmacological treatment for musculoskeletal conditions from January 1, 2016, to December 31, 2017 (n = 542,685). Exclusion criteria were a primary complaint not considered an MSK condition or improbable values for height, weight, or body mass index values. The study included 444,995 individuals. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of no-shows for musculoskeletal conditions and predictors of patient no-show. RESULTS In our population, 73% missed at least 1 appointment for a given physical therapy care episode. Our model had moderate discrimination for no-shows (c-statistic:0.72, all appointments; 0.73, first 7 appointments) and was well calibrated, with predicted and observed no-shows in good agreement. Variables predicting higher no-show rates included insurance type; smoking-status; higher BMI; and more prior cancellations, time between visit and scheduling date, and between current and previous visit. CONCLUSIONS The high prevalence of no-shows when seeking care for musculoskeletal conditions from physical therapists highlights an inefficiency that, unaddressed, could limit delivery of guideline-adherent care that advocates for earlier use of non-pharmacological treatments for musculoskeletal conditions and result in missed opportunities for using telehealth to deliver physical therapy.
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Affiliation(s)
- Nrupen A. Bhavsar
- Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC, United Stated of America
| | - Shannon M. Doerfler
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Anna Giczewska
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Brooke Alhanti
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
| | - Adam Lutz
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Charles A. Thigpen
- ATI Physical Therapy, Greenville, SC, United Stated of America
- Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
- Center for Effectiveness Research in Orthopaedics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United Stated of America
| | - Steven Z. George
- Duke Clinical Research Institute, Duke University, Durham, NC, United Stated of America
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, United Stated of America
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14
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Briggs MS, Ulses C, VanEtten L, Mansfield C, Ganim A, Hand BN, Quatman-Yates CC. Predictive Factors for Patients' Failure to Show for Initial Outpatient Physical Therapist Evaluation. Phys Ther 2021; 101:6124132. [PMID: 33528021 DOI: 10.1093/ptj/pzab047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/19/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of this study was to examine primary factors that may predict patients' failure to show at initial physical therapist evaluation in an orthopedic and sports outpatient setting. METHODS A retrospective analysis of patients' demographic data for physical therapist evaluations between January 2013 and April 2015 was performed. A binary logistic regression model was used to evaluate the odds of a no-show at evaluation. Demographic variables of age, employment status, days waited for the appointment, payer source, and distance traveled to the clinic were analyzed. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. RESULTS A total of 6971 patients were included in the final analysis, with 10% (n = 698) of the scheduled patients having a no-show event for their initial evaluation. The following factors increased the odds of patients having a no-show event: days to appointment (OR = 1.058; 95% CI = 1.042-1.074), unemployment status (OR = 1.96; 95% CI = 1.41-2.73), unknown employment status (OR = 3.22; 95% CI = 1.12-8.69), Medicaid insurance (OR = 4.87; 95% CI = 3.43-6.93), Medicare insurance (OR = 2.22; 95% CI = 1.10-4.49), unknown payer source (OR = 262.84; 95% CI = 188.72-366.08), and distance traveled 8 or more kilometers (OR = 1.31; 95% CI = 1.01-1.70). Female sex (OR = 0.73; 95% CI = 0.57-0.95) and age 40 years or older (OR = 0.44; 95% CI = 0.33-0.60) decreased the odds of a no-show event. CONCLUSIONS Results from this study indicate there may be some demographic factors that are predictive of patients failing to attend their first physical therapist visit. IMPACT Understanding the predictive factors and identifying potential opportunities for improvements in scheduling processes might help decrease the number of patients failing to show for their initial physical therapy appointment, with the ultimate goal of positively influencing patient outcomes.
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Affiliation(s)
- Matthew S Briggs
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christine Ulses
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Lucas VanEtten
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Cody Mansfield
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Anthony Ganim
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brittany N Hand
- School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Catherine C Quatman-Yates
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.,School of Health & Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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15
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Lam TYT, Hui AJ, Sia F, Wong MY, Lee CCP, Chung KW, Lau JYW, Wu PI, Sung JJY. Short Message Service reminders reduce outpatient colonoscopy nonattendance rate: A randomized controlled study. J Gastroenterol Hepatol 2021; 36:1044-1050. [PMID: 32803820 DOI: 10.1111/jgh.15218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/22/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIM Nonattendance of outpatient colonoscopy leads to inefficient use of health-care resources. We aimed to study the effectiveness of using Short Message Service (SMS) reminder prior in patients scheduled for outpatient colonoscopy on their nonattendance rate. METHODS Patients who scheduled for an outpatient colonoscopy and had access of SMS were recruited from three clinics in Hong Kong. Patients were randomized to SMS group and standard care (SC) group. All patients were given a written appointment slip on the booking date. In addition, patients in the SMS group received an SMS reminder 7-10 days before their colonoscopy appointment. Patients' demographics, attendance, colonoscopy completion, and bowel preparation quality were recorded. Logistic regression was performed to identify predictors of nonattendance. RESULTS From November 2013 to October 2019, a total of 2225 eligible patients were recruited. A total of 1079 patients were allocated to the SMS group and 1146 to the SC group. The nonattendance rate of patients in the SMS group was significantly lower than that in the SC group (8.9% vs 11.9%, P = 0.022). There were no significant differences in their baseline characteristics and colonoscopy completion rate and bowel preparation quality. A trend towards a higher rate of adequate bowel preparation was observed in the SMS group when compared with the SC group (69.9% vs 65.8%, P = 0.053). Independent predictors for nonattendance included younger age, underprivilege, and existing diabetes. CONCLUSIONS An SMS reminder for outpatient colonoscopy is effective in reducing the nonattendance rate and may potentially improve the bowel preparation quality.
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Affiliation(s)
- Thomas Y T Lam
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Aric J Hui
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Felix Sia
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Mei Y Wong
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | | | - Ka W Chung
- Wong Siu Ching Family Medicine Centre, Hong Kong
| | - James Y W Lau
- Department of Surgery, Prince of Wales Hospital, Hong Kong
| | - Peter I Wu
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.,Department of Gastroenterology and Hepatology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph J Y Sung
- Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
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16
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Zhao L, Zhang X, Chen Y, Wang Y, Zhang W, Lu W. Does self-reported symptom questionnaire play a role in nonadherence to colonoscopy for risk-increased population in the Tianjin colorectal cancer screening programme? BMC Gastroenterol 2021; 21:117. [PMID: 33750307 PMCID: PMC7944887 DOI: 10.1186/s12876-021-01701-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 02/28/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A colorectal cancer screening programme (CCSP) was implemented from 2012 to 2017 in Tianjin, China. Residents with a positive faecal immunochemical test (FIT) or positive self-reported symptom questionnaire (SRSQ) were recommended to undergo colonoscopy. The objective was to investigate the potential factors associated with nonadherence to colonoscopy among a risk-increased population. METHODS Data were obtained from the CCSP database, and 199,522 residents with positive FIT or positive SRSQ during two screening rounds (2012-2017) were included in the analysis. Logistic regression analysis was performed to assess the association between nonadherence to colonoscopy and potential predictors. RESULTS A total of 152,870 (76.6%) individuals did not undergo colonoscopy after positive FIT or positive SRSQ. Residents with positive SRSQ but without positive FIT were more likely not to undergo colonoscopy (negative FIT: OR, 2.35; 95% CI, 2.29-2.41, no FIT: OR, 1.27; 95% CI, 1.24-1.31). Patients without a cancer history were less likely to undergo colonoscopy even if they received risk-increased reports based on the SRSQ. CONCLUSION In the CCSP, seventy-seven percent of the risk-increased population did not undergo colonoscopy. FIT should be recommended since positive FIT results are related to improved adherence to colonoscopy. Residents with negative FIT but positive SRSQ should be informed of the potential cancer risk to ensure adherence to colonoscopy.
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Affiliation(s)
- Lizhong Zhao
- Department of Gastroenterology, Tianjin Union Medical Center, Tianjin, China
| | - Xiaorui Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yongjie Chen
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Weihua Zhang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.
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17
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Weber K, DaSilva AF, Dault JT, Eber R, Huner K, Jones D, Kornman K, Ramaswamy V, Snyder M, Ward BB, Nalliah RP. Using business intelligence and data visualization to understand the characteristics of failed appointments in dental school clinics. J Dent Educ 2021; 85:521-530. [PMID: 33508149 DOI: 10.1002/jdd.12538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVES Broken appointments are an important cause of waste in health care. Patients who fail to attend incur costs to providers, deny trainees learning opportunities, and impact their own health as well as that of other patients who are waiting for care. METHODS A total of 410,000 appointment records over 3 years were extracted from our electronic health record. We conducted exploratory data analysis and assessed correlations between appointment no-shows and other attributes of the appointment and the patient. The University of Michigan Medical School's Committee on Human Research reviewed the study and deemed that no Institutional Review Board oversight was necessary for this quality improvement project that was, retrospectively, turned into a study with previously de-identified data. RESULTS The patient's previous attendance record is the single most significant correlation with attendance. We found that patients who said they are "scared" of dental visits were 62% as likely to attend as someone reporting "no problem." Patients over 65 years of age have better attendance rates. There was a positive association between receiving email/text confirmation and attendance. A total of 94.9% of those emailed a reminder and 92.2% of those who were texted attended their appointment. CONCLUSION(S) We were able to identify relationships of several variables to failed and attended appointments that we were previously unknown to us. This knowledge enabled us to implement interventions to support better attendance at Dental Clinics at the University of Michigan, improving patient health, student training, and efficient use of resources.
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Affiliation(s)
- Kate Weber
- Health Infrastructures and Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandre F DaSilva
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Jean T Dault
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Robert Eber
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kim Huner
- University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Darlene Jones
- Dental Hygiene, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Kenneth Kornman
- Dental, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Vidya Ramaswamy
- Assessment, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Mark Snyder
- Vertically Integrated Clinic, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Brent B Ward
- Oral Maxillofacial Surgery, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Romesh P Nalliah
- Patient Services, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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18
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O'Neil J, Winter E, Hemond C, Fass R. Will They Show? Predictors of Nonattendance for Scheduled Screening Colonoscopies at a Safety Net Hospital. J Clin Gastroenterol 2021; 55:52-58. [PMID: 32149821 DOI: 10.1097/mcg.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Colonoscopy can reduce colorectal cancer-related mortality by up to 90% through early detection and polyp removal. Despite this, nonattendance rates for scheduled colonoscopies have been reported ranging from 4.1% to as high as 67% depending on the population studied. AIM The aim of the study was to measure the nonattendance rate for scheduled screening colonoscopy at a large safety net hospital and identify predictors of nonattendance within this patient population. MATERIALS AND METHODS This was a population-based study of 1186 adults who were scheduled to undergo screening colonoscopy at a safety net hospital as part of their routine preventative health program. Health systems variables were assessed including procedure time and scheduling patterns as well as patient-centered variables such as socioeconomic indicators and specific comorbid diagnoses. Associations with nonattendance were examined by univariate and multivariate logistic regression. RESULTS The overall rate of nonattendance for scheduled screening colonoscopy was 33%. A multivariate model was constructed to predict nonattendance revealing that private payer status [odds ratio (OR)=0.368, 95% confidence interval (CI): 0.225, 0.602] and prior colonoscopy (OR=0.371, 95% CI: 0.209, 0.656) were associated with greater attendance rates. Chronic obstructive pulmonary disease (OR=2.034, 95% CI: 1.239, 3.341), afternoon procedure time (OR=1.807, 95% CI: 1.137, 2.871), and a greater interval time between the date the colonoscopy was ordered and the date the colonoscopy was scheduled to occur (OR=1.005, 95% CI: 1.001, 1.009) were independently associated with nonattendance when controlling for age, sex, and race. CONCLUSIONS Specific predictors for scheduled screening colonoscopy nonattendance at a safety net hospital can be identified. These findings can be used to tailor community-based interventions to improve colorectal cancer screening rates.
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Affiliation(s)
- Jessica O'Neil
- Digestive Health Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH
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19
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Rogers BD, Shy C, Rampgopal R, Hengehold T, Almuhaidb A, Weaver M, Quader F, Roediger R, Walker T, Gyawali CP, Sayuk GS. Patient Engagement with Interactive Text Message System Improves Successful Colonoscopy Rates in an Outpatient Endoscopy Center. Dig Dis 2020; 39:399-406. [PMID: 32961537 DOI: 10.1159/000511767] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/21/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Text message-based interventions reduce colonoscopy no-show rates and improve bowel preparation scores. In this non-randomized study, we assessed whether an interactive text messaging system could improve colonoscopy outcomes. METHODS Colonoscopy pre-procedural instructions were programmed into a dedicated software platform created for this study. In the intervention arm, text messages were sent to veterans during a 4-week study period. Validated pre-procedural satisfaction questionnaires were completed by patients during standard protocol and intervention periods. Demographics and colonoscopy outcomes data were compared between the standard protocol and intervention arms, including procedure completion rate on scheduled date, Boston bowel preparation score (BPPS), adenoma detection rate, and satisfaction. RESULTS Of 241 patients, 128 were in the standard protocol arm and 113 in the intervention arm. Higher proportions of patients receiving text messages underwent colonoscopy on their scheduled date (69.9%) compared to the ones in the standard protocol (50.8%, p = 0.015). Patients with ≥3 interactions with the system had 80.6% likelihood of completing colonoscopy on the scheduled date compared to 56.9% with <3 interactions and 50.8% with standard protocol (p < 0.001). Frequency of interaction with the system was similar between older (>65 years) and younger patients (p = 1.0). Among older patients, colonoscopy was completed successfully in 84.2% when alert-based human interactions occurred compared to 65.6% in those without and 47.9% with standard protocol (p = 0.018). More than 90% indicated they would recommend the system to patients undergoing future colonoscopy. CONCLUSION An interactive text messaging system improves successful colonoscopy rates in a VA setting, with greatest impact in older patients.
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Affiliation(s)
- Benjamin D Rogers
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Corey Shy
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Rajeev Rampgopal
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Tricia Hengehold
- Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri, USA
| | - Aymen Almuhaidb
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Michael Weaver
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Farhan Quader
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Rebecca Roediger
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Ted Walker
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Gregory S Sayuk
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.,Division of Gastroenterology, John Cochran Veteran's Administration Medical Center, St Louis, Missouri, USA
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20
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Lee M, Khan MM, Brandt HM, Salloum RG, Chen B. Decomposing socioeconomic disparities in the use of colonoscopy among the insured elderly population before and after the Affordable Care Act. Cancer Causes Control 2020; 31:1039-1048. [PMID: 32862301 DOI: 10.1007/s10552-020-01343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/22/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Out-of-pocket costs may significantly dampen patients' willingness to adopt preventive procedures. This is especially true for colonoscopies, which typically involved relatively high cost-sharing requirements prior to the Affordable Care Act (ACA) implementation in 2011. PURPOSE We aim to examine the effects of income-related disparities in colonoscopy use in the years prior to and immediately after the implementation of the ACA. Further, we quantify the contributions of different factors in explaining the disparities in the use of colonoscopies among elderly population with health insurance coverage. METHODS Five cycles (2008, 2010, 2012, 2014, and 2016) of Behavioral Risk Factor Surveillance System data were utilized. To examine income-related disparities in the use of CRC, individuals aged 65-75 were included, and the concentration index (CI) was calculated before and after the implementation of ACA. To identify and quantify the contribution of different factors, a decomposition analysis of CI was conducted. RESULTS CIs decreased from 0.1935 in pre-ACA years to 0.1813 in the post-ACA years among the elderly, indicating that the disparities in the use of colonoscopy was relatively low and the disparities index declined after the implementation of ACA. Decomposition analyses showed that whereas decreases in disparities derived largely from income and educational level, higher level of income and educational attainment were major contributors to the observed disparities in colonoscopy use. CONCLUSIONS Our findings indicate that the ACA's removal of financial barriers may have contributed toward the reduction in disparities of colonoscopy use. More direct interventions, e.g., improved knowledge, better access and lower indirect cost will be helpful in improving screening among low-income and low-educational attainment households.
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Affiliation(s)
- Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA. .,Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - M Mahmud Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ramzi G Salloum
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Brain Chen
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Kiruparan P, Kiruparan N, Debnath D. Impact of pre-appointment contact and short message service alerts in reducing 'Did Not Attend' (DNA) rate on rapid access new patient breast clinics: a DGH perspective. BMC Health Serv Res 2020; 20:757. [PMID: 32807150 PMCID: PMC7429943 DOI: 10.1186/s12913-020-05627-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022] Open
Abstract
Background Failure to attend the clinic without prior intimation, known as “Did Not Attend” (DNA) is a significant global issue. There have been no published studies attempting to reduce DNA rates in breast clinics. We aimed to assess the impact of contacting patients prior to clinic attendance and Short Message Service (SMS) reminder on DNA rates in rapid access new patient breast clinics, evaluate ‘Could Not Attend’ (CNA) rate, and explore any correlation between age, sex, clinic days and sessions. Methods Initially, DNAs at the rapid access new patient breast clinic between 01/04/2018 and 31/03/2019 at a district general hospital in the North-West of England was assessed (Cycle 1). Changes were introduced in terms of contacting patients prior to offering appointments, followed by SMS reminders nearer the clinic dates. Subsequently, DNA was reassessed between 01/10/2019 and 31/03/2020 (Cycle 2). Results Following implementation of changes, DNA rate reduced from 8.2 to 4.1% (p < 0.00001). CNA rates were 0.9% (Cycle 1) and 1.1% (Cycle 2) [p = 0.36]. Evening clinics had the lowest DNA rates throughout. DNA patients in cycle 2 were significantly older than those in cycle 1 (p = 0.002). Conclusions Contacting patients prior to clinic appointments and sending SMS reminders helped reduce DNA rates significantly in rapid access new patient breast clinics. Scheduling clinic sessions with least DNA rates, such as evening clinics, should be contemplated. One should be cautious of mobile phone technology that conveys SMS, which can potentially disadvantage the older age group. This model could be considered across the board to improve DNA rates.
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Affiliation(s)
| | | | - Debasish Debnath
- Breast Unit, Blackpool Victoria Hospital, Blackpool, FY3 8NR, UK
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22
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Alnasser R, Alkhowaiter S, Alhusaini S, Aljarallah B. Factors Associated with Missed and Cancelled Appointments in the Endoscopy Unit: Descriptive Study. Cureus 2020; 12:e7264. [PMID: 32292676 PMCID: PMC7153807 DOI: 10.7759/cureus.7264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and aim Canceled and missed appointments at the endoscopy unit affect the quality of the provided services and can negatively impact patient outcomes. Assessing the association between the various factors relating to nonattendance will show whether the defective aspects are organizational or personal, which is essential to improve the quality of the healthcare system. Moreover, this study will be of value in our region due to the current scarcity of studies in the Middle East. Methods A descriptive study was conducted at King Khaled University Hospital in Riyadh, Saudi Arabia. A database of participants was established from those who missed/canceled their outpatient endoscopy clinic appointment; purposive sampling was applied, excluding those who are under 14 years old. Demographic data and organizational factors (e.g., referred clinic and the lead time) were collected from the patients' files and a structured interview done by phone within 7-14 days of the missed/canceled appointment. Results A total of 919 endoscopy procedures were scheduled in an eight-week period, and 179 procedures were missed/canceled (19.48%); 84% were missed, and 16% were canceled. The highest percentage of the population had a high-school diploma or less. The results showed that roughly half of the patients were unemployed. More than two-thirds of the patients had undergone an endoscopy within the past year or less. The majority stated that they underwent the procedure in a different facility, which might be due to various reasons, one of which could be justified as long lead time. Conclusion An annual update of patients' files is suggested. Text messages can help serve as a reminder in addition to clear appointment instructions that will aid in minimizing the absence rates. Overbooking is recommended to decrease the lead time and increase clinic efficiency. Raising patients' awareness regarding the effect of missing appointments as well as upgrading the communication methods will assist in decreasing the rate of missed appointments.
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Affiliation(s)
| | - Saad Alkhowaiter
- Gastroenterology, King Khalid University Hospital, Riyadh, SAU.,Medicine, King Saud University, Riyadh, SAU
| | | | - Badr Aljarallah
- Hepatology and Gastroenterology, Qassim University Medical City, Qassim, SAU
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23
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Keswani RN, Gregory DL, Wood M, Dolan NC, Chmiel R, Manka M, Cameron KA. Colonoscopy education delivered via the patient portal does not improve adherence to scheduled first-time screening colonoscopy. Endosc Int Open 2020; 8:E401-E406. [PMID: 32118113 PMCID: PMC7035025 DOI: 10.1055/a-1072-4556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 10/07/2019] [Indexed: 12/11/2022] Open
Abstract
Background and study aims Non-adherence to scheduled colonoscopy burdens endoscopic practices and innovative approaches to improve adherence are needed. We aimed to assess the effect of an educational video emphasizing colonoscopy importance delivered through the electronic health record patient portal upon "no-show" and late cancellation rates (non-adherence) in patients scheduled for first-time screening colonoscopy. Patients and methods We conducted a single center randomized controlled trial among patients scheduled for their first screening colonoscopy. Patients were randomized to routine care ("control") or video education ("video"). Control patients received a portal message 14 days prior to colonoscopy date; video patients additionally received a link to the educational video. Results In total, 830 patients (59 % female, median age 55 years) were randomized ("control": 406; "video": 424). Nearly all (88 %) opened the message; in the video arm, most (72 %) watched a majority of the video. Overall, 80 % attended their scheduled colonoscopy appointment (late cancel: 18 %, "no show": 1 %) and 90 % underwent colonoscopy within 3 months of appointment. Adherence rates did not differ between video and control arms for the scheduled appointment (OR 1.2, CI 0.9-1.8) or for colonoscopy within 3 months of scheduled appointment (OR 1.3, CI 0.8-2.1). Bowel preparation quality did not differ between the groups. Conclusion Most patients scheduled for colonoscopy will open a patient portal message and, when delivered, watch an educational video. However, delivery of an educational video two weeks prior to screening colonoscopy appointment did not improve adherence.
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Affiliation(s)
- Rajesh N. Keswani
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States,Corresponding author Rajesh N. Keswani MD MS 676 N. St. Clair, Suite 1400Chicago, IL 60611
| | - Dyanna L. Gregory
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Mariah Wood
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Nancy C. Dolan
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois, United States
| | - Ryan Chmiel
- Northwestern Memorial Hospital, Chicago, Illinois, United States
| | - Michael Manka
- Department of Gastroenterology and Hepatology, Northwestern University, Chicago, Illinois, United States
| | - Kenzie A. Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Chicago, Illinois, United States
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24
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A Theory-based Educational Pamphlet With Low-residue Diet Improves Colonoscopy Attendance and Bowel Preparation Quality. J Clin Gastroenterol 2020; 54:164-169. [PMID: 30439762 PMCID: PMC7879458 DOI: 10.1097/mcg.0000000000001151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
GOALS/BACKGROUND Patients who "no-show" for colonoscopy or present with poor bowel preparation waste endoscopic resources and do not receive adequate examinations for colorectal cancer (CRC) screening. Using the Health Belief Model, we modified an existing patient education pamphlet and evaluated its effect on nonattendance rates and bowel preparation quality. STUDY We implemented a color patient education pamphlet to target individual perceptions about CRC and changed bowel preparation instructions to include a low-residue diet instead of the previous clear liquid diet. We compared the nonattendance rate over a 2-month period before and after the introduction of the pamphlet, allowing for a washout period during which pamphlet use was inconsistent. We compared the Boston Bowel Preparation Scale (BBPS) in 100 consecutive patients who underwent colonoscopy during each of the 2 periods. RESULTS Baseline characteristics between the 2 groups were similar, although patients who received the pamphlet were younger (P=0.03). The nonattendance rate was significantly lower in patients who received the pamphlet (13% vs. 21%, P=0.01). The percentage of patients with adequate bowel preparation increased from 82% to 86% after introduction of the pamphlet, although this was not statistically significant (P=0.44). The proportion of patients with a BBPS score of 9 was significantly higher in the pamphlet group (41% vs. 27%, P=0.03). There was no difference in adenoma and sessile serrated adenoma detection rates before and after pamphlet implementation. CONCLUSIONS After implementing a theory-based patient education intervention with a low-residue diet, our absolute rate for colonoscopy nonattendance decreased by 8% and the proportion of patients with a BBPS score of 9 increased by 14%. The Health Belief Model appears to be a useful construct for CRC screening interventions.
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25
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Ding X, Gellad ZF, Mather C, Barth P, Poon EG, Newman M, Goldstein BA. Designing risk prediction models for ambulatory no-shows across different specialties and clinics. J Am Med Inform Assoc 2019; 25:924-930. [PMID: 29444283 PMCID: PMC6077778 DOI: 10.1093/jamia/ocy002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/07/2018] [Indexed: 12/31/2022] Open
Abstract
Objective As available data increases, so does the opportunity to develop risk scores on more refined patient populations. In this paper we assessed the ability to derive a risk score for a patient no-showing to a clinic visit. Methods Using data from 2 264 235 outpatient appointments we assessed the performance of models built across 14 different specialties and 55 clinics. We used regularized logistic regression models to fit and assess models built on the health system, specialty, and clinic levels. We evaluated fits based on their discrimination and calibration. Results Overall, the results suggest that a relatively robust risk score for patient no-shows could be derived with an average C-statistic of 0.83 across clinic level models and strong calibration. Moreover, the clinic specific models, even with lower training set sizes, often performed better than the more general models. Examination of the individual models showed that risk factors had different degrees of predictability across the different specialties. Implementation of optimal modeling strategies would lead to capturing an additional 4819 no-shows per-year. Conclusion Overall, this work highlights both the opportunity for and the importance of leveraging the available electronic health record data to develop more refined risk models.
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Affiliation(s)
- Xiruo Ding
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, 27710, USA
| | - Ziad F Gellad
- Department of Medicine, Duke University, Durham, North Carolina, 27703, USA.,Department of Medicine, Durham VA Medical Center, Durham, North Carolina, 27705, USA
| | - Chad Mather
- Department of Medicine, Duke University, Durham, North Carolina, 27703, USA
| | - Pamela Barth
- Duke Health Technology Solutions, Duke University, Durham, North Carolina, 27713, USA
| | - Eric G Poon
- Duke Health Technology Solutions, Duke University, Durham, North Carolina, 27713, USA
| | - Mark Newman
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, 40536, USA
| | - Benjamin A Goldstein
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, 27710, USA.,Center for Predictive Medicine, Duke Clinical Research Institute, Durham, North Carolina, 27705, USA
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26
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Hausmann J, Linke JP, Albert JG, Masseli J, Tal A, Kubesch A, Filmann N, Philipper M, Farnbacher M. Time-saving polyp detection in colon capsule endoscopy: evaluation of a novel software algorithm. Int J Colorectal Dis 2019; 34:1857-1863. [PMID: 31520200 DOI: 10.1007/s00384-019-03393-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colon capsule endoscopy (CCE) is a reliable method to detect colonic polyps in the well-prepared colon. As CCE evaluation can be time consuming, a new software algorithm might aid in reducing evaluation time. OBJECTIVES The aim of the study was to evaluate whether it is feasible to reliably detect colon polyps in CCE videos with a new software algorithm the "collage mode" (Rapid 8 Software, Covidien/Medtronic®). METHODS Twenty-nine CCE videos were randomly presented to three experienced and to three inexperienced investigators. Videos were evaluated by applying the collage mode. Investigation time was documented and the results (≥one polyp vs. no polyp) were compared with the findings of two highly experienced central readers who read the CCE videos in the standard mode beforehand. RESULTS It took a median time of 9.8, 3.5, and 7.5 vs. 4.3, 4.6 and 12.5 min for experienced vs. inexperienced investigators to review the CCE videos. For detecting ≥one polyp vs. no polyp, sensitivity of 93.3%, 73.3%, and 93.3% was observed for the experienced and sensitivity of 46.7%, 33.3%, and 93.3% for the inexperienced CCE readers. CONCLUSION Collage mode might allow for a quick review of CCE videos with a high polyp detection rate for experienced CCE readers. Future prospective studies should include CCE collage mode for rapid polyp detection to further prove the feasibility of practical colon polyp detection by CCE and possibly support the role of CCE as a screening tool in CRC prevention.
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Affiliation(s)
- Johannes Hausmann
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany.
| | - Jan-Peter Linke
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany.,Department of Internal Medicine, Heilig-Geist-Hospital, Bingen, Germany
| | - Jörg G Albert
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany.,Department of Internal Medicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Johannes Masseli
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Andrea Tal
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Alica Kubesch
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt, Germany
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Arias F, Riverso M, Levy SA, Armstrong R, Estores DS, Tighe P, Price CC. Pilot Study: Neurocognitive Disorders and Colonoscopy in Older Adults. Anesth Analg 2019; 129:e89-e93. [PMID: 31425226 PMCID: PMC6774261 DOI: 10.1213/ane.0000000000004212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In a preoperative anesthesia setting with integrated neuropsychology for individuals >64 years of age, we completed a pilot study examining the association between neurocognitive disorders with frequency of missed colonoscopies and quality of bowel preparation (prep). Gastroenterologists completed the Boston Bowel Preparation Scale (BBPS) for each patient. Of 47 older adults seen in our service, 68% met criteria for neurocognitive disorders. All individuals failing to attend the colonoscopy procedure had met criteria for major neurocognitive disorder. Poor bowel prep was also identified in 100% of individuals with major neurocognitive disorder and 28% of individuals with mild neurocognitive disorder. Our pilot data suggest that, in high-risk individuals, the presence of neurocognitive disorders is risk factors for missed appointments and inadequate bowel prep. These pilot data provide reference statistics for future intervention protocols.
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Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence, Gainesville, FL
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Michael Riverso
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Shellie-Anne Levy
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Rebecca Armstrong
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - David S. Estores
- Division of Gastroenterology, Hepatology, & Nutrition, Gainesville, FL
| | - Patrick Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL
| | - Catherine C. Price
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
- Department of Anesthesiology, University of Florida, Gainesville, FL
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28
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Mahmud N, Doshi SD, Coniglio MS, Clermont M, Bernard D, Reitz C, Khungar V, Asch DA, Mehta SJ. An Automated Text Message Navigation Program Improves the Show Rate for Outpatient Colonoscopy. HEALTH EDUCATION & BEHAVIOR 2019; 46:942-946. [PMID: 31431077 DOI: 10.1177/1090198119869964] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background. Numerous barriers to outpatient colonoscopy completion exist, causing undue procedure cancellations and poor bowel preparation. We piloted a text message navigation program to improve colonoscopy adherence. Method. We conducted a prospective study of patients aged 18 to 75 years scheduled for outpatient colonoscopy at an urban endoscopy center in April 2018. An intervention arm consisting of bidirectional, automated text messages prior to the procedure was compared with a usual care arm. We enrolled 21 intervention patients by phone and randomly selected 50 controls. Outcomes included colonoscopy appointment adherence, bowel preparation quality, and colonoscopy completion. Results. The arms had similar demographics and comorbidities. Intervention patients had higher colonoscopy appointment adherence (90% vs. 62%, p = 0.049). There were no significant differences in preparation quality or procedure completeness. Poststudy surveys indicated high patient satisfaction and perceived usefulness of the program. Conclusion. A bidirectional, automated texting navigation program improved colonoscopy adherence rates as compared with usual care.
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Affiliation(s)
- Nadim Mahmud
- University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | | | | | - David A Asch
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
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Finn RT, Lloyd B, Patel YA, Allen JT, Cornejo J, Davis A, McIntosh T, Ferguson S, Sims K, Sudaj S, Taheri J, Burr NA, Provenzale D, Gellad ZF. Decreasing Endoscopy No-Shows Using a Lean Improvement Framework. Clin Gastroenterol Hepatol 2019; 17:1224-1227.e3. [PMID: 30735786 DOI: 10.1016/j.cgh.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Raymond T Finn
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | - Benjamin Lloyd
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | - Yuval A Patel
- Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Andrea Davis
- Durham VA Medical Center, Durham, North Carolina
| | | | - Stephanie Ferguson
- Durham VA Medical Center, Durham, North Carolina; The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina
| | - Kellie Sims
- The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina
| | - Shawn Sudaj
- Durham VA Medical Center, Durham, North Carolina
| | - Javad Taheri
- Durham VA Medical Center, Durham, North Carolina; Department of Industrial Engineering, North Carolina State University, Raleigh, North Carolina
| | | | - Dawn Provenzale
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina; The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina
| | - Ziad F Gellad
- Durham VA Medical Center, Durham, North Carolina; Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina; The Cooperative Studies Program Epidemiology Center-Durham, Durham, North Carolina.
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30
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Timing Isn't Everything for Diagnostic Colonoscopy After Positive Results From a Fecal Immunohistochemical Test. Clin Gastroenterol Hepatol 2019; 17:1245-1247. [PMID: 30768964 DOI: 10.1016/j.cgh.2019.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
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31
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Flugelman AA, Stein N, Segol O, Lavi I, Keinan-Boker L. Delayed Colonoscopy Following a Positive Fecal Test Result and Cancer Mortality. JNCI Cancer Spectr 2019; 3:pkz024. [PMID: 31360901 PMCID: PMC6649710 DOI: 10.1093/jncics/pkz024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/12/2019] [Accepted: 03/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background A fecal test followed by diagnostic colonoscopy for a positive result is a widely endorsed screening strategy for colorectal cancer (CRC). However, the relationship between the time delay from the positive test to the follow-up colonoscopy and CRC mortality has not been established. Methods From a population-based screening program, we identified CRC patients newly diagnosed from 2005 through 2015 by a positive fecal occult test followed by a colonoscopy. The primary outcome measure was CRC-specific mortality according to four categories for the time elapsed between the positive result and the subsequent colonoscopy. Results The 1749 patients underwent colonoscopies within 0–3 months (n = 981, 56.1%), 4–6 months (n = 307, 17.5%), 7–12 months (n = 157, 9.0%), and later than 12 months (n = 304, 17.4%). CRC-specific deaths according to exposure groups were: 13.8% (135 of 981) for 0–3 months, 10.7% (33 of 307) for 4–6 months (crude hazards ratio [HR] = 0.74, 95% confidence interval [CI] = 0.51 to 1.14), 11.5% (18 of 157) for 7–12 months (crude HR = 0.83, 95% CI = 0.51 to 1.42), and 22.7% (69 of 304) for longer than 12 months (crude HR = 1.40, 95% CI = 1.04 to 1.90). The only variable that was associated with mortality risk was the number of positive slides (P = .003). High positivity was twice the value in the 0–3 as the longer-than-12 months group: 51.9% vs 25.0% and similar for the 4–6 and 7–12 months groups (38.1% and 36.5%), respectively. The adjusted HRs for CRC mortality were 0.81 (95% CI = 0.55 to 1.19); 0.83 (95% CI = 0.50 to 1.41), and 1.53 (95% CI = 1.13 to 2.12, P = .006) for the 4–12, 7–12, and longer-than-12-months groups, respectively, compared with the shortest delay group. Conclusions Among screen-diagnosed CRC patients, performance of colonoscopy more than 12 months after the initial positive fecal occult blood test was associated with more advanced disease and higher mortality due to CRC.
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Affiliation(s)
- Anath A Flugelman
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.,Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clalit National Cancer Control Center, Haifa, Israel
| | - Nili Stein
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Clalit National Cancer Control Center, Haifa, Israel
| | - Ori Segol
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Idit Lavi
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel.,Clalit National Cancer Control Center, Haifa, Israel
| | - Lital Keinan-Boker
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel.,School of Public Health, University of Haifa, Haifa, Israel
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Abstract
BACKGROUND/OBJECTIVES Noncompliance with physician and procedure appointments is associated with poor disease control and worse disease outcomes. This also impacts the quality of care, decreases efficiency, and affects revenue. Studies have shown that no-show rates are higher in clinics caring for underserved populations and may contribute to poorer health outcomes in this group. METHODS We performed a 17-month retrospective observational cohort study of patients scheduled for outpatient procedures in the Gastroenterology endoscopy suite at the University of Florida Health, Jacksonville. Multivariate logistic regression analysis was performed to evaluate associations between attendance and predictors of no-show. RESULTS In total, 6157 patients were scheduled to undergo different GI procedures during the study period. A total of 4388 (71%) patients completed their procedure, whereas 2349 (29%) failed to attend their appointment and were considered "no-show". There was a significant relationship between the visit attendance and race, insurance, gender, and marital status. Males had a higher no-show rate compared with females (30% vs. 28%; P<0.05). African Americans had the highest no-show rate (32%; P<0.05) amongst different races. Patients scheduled for surveillance colonoscopy (ie, history of polyps, IBD, Colon cancer) were more likely to show (78%) than those obtaining initial colorectal cancer screening (74%) or other indications (71%) (P<0.05).In the logistic regression model, patients with commercial insurance are more likely to show for their appointments than those with noncommercial insurance (eg, Medicare, Medicaid, City contract etc) [odds ratio (OR), 2.6; 95% confidence interval (CI), 2.2-3.0]. The odds of showing up are 1.7 times higher for married men compared with single men (OR, 1.7; 95% CI, 1.3-2.0). Similarly, married females are more likely to show up for appointment than single females (OR, 1.1; 95% CI, 0.9-1.3). We did not find significant association between the type of GI procedure (eg, colonoscopy vs. esophagogastroduodenoscopy vs. advanced endoscopic procedures) (P>0.05). CONCLUSIONS Predictors of no-shows for endoscopic gastrointestinal procedures included unpartnered or single patients, African American race and noncommercial insurance providers. Patients scheduled for surveillance colonoscopy had better adherence than initial screening. Further studies are required to better characterize these factors and improve adherence to the outpatient appointments based on the identified predictors.
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Dantas LF, Fleck JL, Cyrino Oliveira FL, Hamacher S. No-shows in appointment scheduling - a systematic literature review. Health Policy 2018; 122:412-421. [PMID: 29482948 DOI: 10.1016/j.healthpol.2018.02.002] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 12/20/2017] [Accepted: 02/07/2018] [Indexed: 12/29/2022]
Abstract
No-show appointments significantly impact the functioning of healthcare institutions, and much research has been performed to uncover and analyze the factors that influence no-show behavior. In spite of the growing body of literature on this issue, no synthesis of the state-of-the-art is presently available and no systematic literature review (SLR) exists that encompasses all medical specialties. This paper provides a SLR of no-shows in appointment scheduling in which the characteristics of existing studies are analyzed, results regarding which factors have a higher impact on missed appointment rates are synthetized, and comparisons with previous findings are performed. A total of 727 articles and review papers were retrieved from the Scopus database (which includes MEDLINE), 105 of which were selected for identification and analysis. The results indicate that the average no-show rate is of the order of 23%, being highest in the African continent (43.0%) and lowest in Oceania (13.2%). Our analysis also identified patient characteristics that were more frequently associated with no-show behavior: adults of younger age; lower socioeconomic status; place of residence is distant from the clinic; no private insurance. Furthermore, the most commonly reported significant determinants of no-show were high lead time and prior no-show history.
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Affiliation(s)
- Leila F Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Julia L Fleck
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Fernando L Cyrino Oliveira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rua Marquês de São Vicente, 225, Rio de Janeiro, RJ, 22451-900, Brazil.
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Oluloro A, Petrik AF, Turner A, Kapka T, Rivelli J, Carney PA, Saha S, Coronado GD. Timeliness of Colonoscopy After Abnormal Fecal Test Results in a Safety Net Practice. J Community Health 2018; 41:864-70. [PMID: 26874943 DOI: 10.1007/s10900-016-0165-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fecal testing can only reduce colorectal cancer mortality if patients with an abnormal test result receive a follow-up colonoscopy. As part of the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project, we examined factors associated with adherence to follow-up colonoscopy among patients with abnormal fecal test results. As part of STOP CRC outreach, Virginia Garcia Memorial Health Center staff distributed 1753 fecal immunochemical tests (FIT), of which 677 (39 %) were completed, and 56 had an abnormal result (8 %). Project staff used logistic regression analyses to examine factors associated with colonoscopy referral and completion. Of the 56 patients with abnormal FIT results; 45 (80 %) had evidence of a referral for colonoscopy, 32 (57 %) had evidence of a completed colonoscopy within 18 months, and 14 (25 %) within 60 days of an abnormal fecal test result. In adjusted analysis, Hispanics had lower odds of completing follow-up colonoscopy within 60 days than non-Hispanic whites (adjusted OR 0.20; 95 % CI 0.04, 0.92). Colonoscopy within 60 days trended lower for women than for men (adjusted OR 0.25; 95 % CI 0.06-1.04). Among the 24 patients lacking medical record evidence of a colonoscopy, 19 (79 %) had a documented reason, including clinician did not pursue, patient refused, and colonoscopy not indicated. No reason was found for 21 %. Improvements are needed to increase rates of follow-up colonoscopy completion, especially among female and Hispanic patients.
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Affiliation(s)
- Ann Oluloro
- Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA. .,Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Amanda F Petrik
- Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Ann Turner
- Virginia Garcia Memorial Health Center, 226 SE 8th Ave, Hillsboro, OR, 97123, USA
| | - Tanya Kapka
- Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA.,Virginia Garcia Memorial Health Center, 226 SE 8th Ave, Hillsboro, OR, 97123, USA
| | - Jennifer Rivelli
- Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
| | - Patricia A Carney
- Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Somnath Saha
- Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA.,Section of General Internal Medicine, Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Rd. (P3HSRD), Portland, OR, 97239, USA
| | - Gloria D Coronado
- Kaiser Permanente Northwest, Center for Health Research, 3800 N. Interstate Ave., Portland, OR, 97227, USA
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Adams S, Scherer WT, White KP, Payne J, Hernandez O, Gerber MS, Whitehead NP. Dynamic Scheduling for Veterans Health Administration Patients using Geospatial Dynamic Overbooking. J Med Syst 2017; 41:182. [PMID: 29027078 DOI: 10.1007/s10916-017-0815-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
The Veterans Health Administration (VHA) is plagued by abnormally high no-show and cancellation rates that reduce the productivity and efficiency of its medical outpatient clinics. We address this issue by developing a dynamic scheduling system that utilizes mobile computing via geo-location data to estimate the likelihood of a patient arriving on time for a scheduled appointment. These likelihoods are used to update the clinic's schedule in real time. When a patient's arrival probability falls below a given threshold, the patient's appointment is canceled. This appointment is immediately reassigned to another patient drawn from a pool of patients who are actively seeking an appointment. The replacement patients are prioritized using their arrival probability. Real-world data were not available for this study, so synthetic patient data were generated to test the feasibility of the design. The method for predicting the arrival probability was verified on a real set of taxicab data. This study demonstrates that dynamic scheduling using geo-location data can reduce the number of unused appointments with minimal risk of double booking resulting from incorrect predictions. We acknowledge that there could be privacy concerns with regards to government possession of one's location and offer strategies for alleviating these concerns in our conclusion.
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Affiliation(s)
- Stephen Adams
- Department of Systems and Information Engineering, University of Virginia, 151 Engineer's Way, Charlottesville, VA, 22904, USA.
| | - William T Scherer
- Department of Systems and Information Engineering, University of Virginia, 151 Engineer's Way, Charlottesville, VA, 22904, USA
| | - K Preston White
- Department of Systems and Information Engineering, University of Virginia, 151 Engineer's Way, Charlottesville, VA, 22904, USA
| | - Jason Payne
- Department of Systems and Information Engineering, University of Virginia, 151 Engineer's Way, Charlottesville, VA, 22904, USA
| | - Oved Hernandez
- Department of Systems and Information Engineering, University of Virginia, 151 Engineer's Way, Charlottesville, VA, 22904, USA
| | - Mathew S Gerber
- Department of Systems and Information Engineering, University of Virginia, 151 Engineer's Way, Charlottesville, VA, 22904, USA
| | - N Peter Whitehead
- Systems Engineering Technical Center, The Mitre Corporation, McClean, VA, USA
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May FP, Reid MW, Cohen S, Dailey F, Spiegel BM. Predictive overbooking and active recruitment increases uptake of endoscopy appointments among African American patients. Gastrointest Endosc 2017; 85:700-705. [PMID: 27623103 PMCID: PMC5346055 DOI: 10.1016/j.gie.2016.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/01/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Use of GI endoscopy is historically lower in nonwhite ethnic and racial groups compared with whites. These disparities are multifactorial but likely contribute to differences in GI clinical outcomes. We sought to improve endoscopy uptake overall and in minorities by predictive overbooking and active recruitment in a hospital-based GI clinic. METHODS From January to October 2014, we alternated between traditional booking for Veterans Affairs Healthcare Network patients with a physician recommendation for endoscopy and active recruitment of patients to fill projected open endoscopy appointment slots. On intervention weeks, patients attending a GI clinic were given the opportunity to "fast track" to an endoscopy appointment on short notice. During control weeks, patients were not actively recruited. We compared uptake of endoscopy appointments in both groups and performed logistic regression to determine predictors of participation in fast-track active recruitment. RESULTS During fast-track active recruitment for endoscopy, the clinic recruited an additional 111 patients for endoscopy over passive recruitment, including 46 African Americans (41.4%). In a logistic regression model controlling for demographic and clinical characteristics, African Americans were twice as likely (adjusted OR, 1.99; 95% CI, 1.26-3.17) than whites to participate in the fast-track option for recommended endoscopy. CONCLUSIONS Interventions to actively recruit patients for endoscopy increased the overall percentage of GI clinic patients undergoing endoscopy and disproportionately improved endoscopy appointment uptake in African Americans.
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Affiliation(s)
- Folasade P. May
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE),Division of Digestive Diseases, David Geffen School of Medicine at UCLA,Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Mark W. Reid
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Samuel Cohen
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Francis Dailey
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE)
| | - Brennan M.R. Spiegel
- Department of Gastroenterology, VA Greater Los Angeles Healthcare System,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE),Division of Digestive Diseases, David Geffen School of Medicine at UCLA,Department of Health Policy and Management, UCLA Fielding School of Public Health
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Goldberg DS, Taddei TH, Serper M, Mehta R, Dieperink E, Aytaman A, Baytarian M, Fox R, Hunt K, Pedrosa M, Pocha C, Valderrama A, Kaplan DE. Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis. Hepatology 2017; 65:864-874. [PMID: 27531119 DOI: 10.1002/hep.28765] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 08/10/2016] [Indexed: 12/11/2022]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) is a leading cause of morbidity and mortality in cirrhosis patients. This provides an opportunity to target the highest-risk population, yet surveillance rates in the United States and Europe range from 10% to 40%. The goal of this study was to identify barriers to HCC surveillance, using data from the Veterans Health Administration, the largest provider of liver-related health care in the United States. We included all patients 75 years of age or younger who were diagnosed with cirrhosis from January 1, 2008, until December 31, 2010. The primary outcome was a continuous measure of the percentage of time up-to-date with HCC surveillance (PTUDS) based on abdominal ultrasound (secondary outcomes included computed tomography and magnetic resonance imaging). Among 26,577 patients with cirrhosis (median follow-up = 4.7 years), the mean PTUDS was 17.8 ± 21.5% (ultrasounds) and 23.3 ± 24.1% when any liver imaging modality was included. The strongest predictor of increased PTUDS was the number of visits to a specialist (gastroenterologist/hepatologist and/or infectious diseases) in the first year after cirrhosis diagnosis; the association between visits to a primary care physician and increasing surveillance was very small. Increasing distance to the closest Veterans Administration center was associated with decreased PTUDS. There was an inverse association between ultrasound lead time (difference between the date an ultrasound was ordered and requested exam date) and the odds of it being performed: odds ratio = 0.77, 95% confidence interval 0.72-0.82 when ordered > 180 days ahead of time; odds ratio = 0.90, 95% confidence interval 0.85-0.94 if lead time 91-180 days. CONCLUSIONS The responsibility for suboptimal surveillance rests with patients, providers, and the overall health care system; several measures can be implemented to potentially increase HCC surveillance, including increasing patient-specialist visits and minimizing appointment lead time. (Hepatology 2017;65:864-874).
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Affiliation(s)
- David S Goldberg
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.,Department of Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | | | - Marina Serper
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Rajni Mehta
- VA Connecticut-Healthcare System, West Haven, CT
| | | | - Ayse Aytaman
- VA New York Harbor Health Care System, Brooklyn, NY
| | | | - Rena Fox
- San Francisco VA Medical Center, San Francisco, CA
| | | | | | | | | | - David E Kaplan
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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38
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Plumb AA, Ghanouni A, Rainbow S, Djedovic N, Marshall S, Stein J, Taylor SA, Halligan S, Lyratzopoulos G, von Wagner C. Patient factors associated with non-attendance at colonoscopy after a positive screening faecal occult blood test. J Med Screen 2017; 24:12-19. [PMID: 27216771 DOI: 10.1177/0969141316645629] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
Background Screening participants with abnormal faecal occult blood test results who do not attend further testing are at high risk of colorectal cancer, yet little is known about their reasons for non-attendance. Methods We conducted a medical record review of 170 patients from two English Bowel Cancer Screening Programme centres who had abnormal guaiac faecal occult blood test screening tests between November 2011 and April 2013 but did not undergo colonoscopy. Using information from patient records, we coded and categorized reasons for non-attendance. Results Of the 170 patients, 82 were eligible for review, of whom 66 had at least one recorded reason for lack of colonoscopy follow-up. Reasons fell into seven main categories: (i) other commitments, (ii) unwillingness to have the test, (iii) a feeling that the faecal occult blood test result was a false positive, (iv) another health issue taking priority, (v) failing to complete bowel preparation, (vi) practical barriers (e.g. lack of transport), and (vii) having had or planning colonoscopy elsewhere. The most common single reasons were unwillingness to have a colonoscopy and being away. Conclusions We identify a range of apparent reasons for colonoscopy non-attendance after a positive faecal occult blood test screening. Education regarding the interpretation of guaiac faecal occult blood test findings, offer of alternative confirmatory test options, and flexibility in the timing or location of subsequent testing might decrease non-attendance of diagnostic testing following positive faecal occult blood test.
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Affiliation(s)
- Andrew A Plumb
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Alex Ghanouni
- 2 Health Behaviour Research Centre, University College London, London, UK
| | - Sandra Rainbow
- 3 London Hub, Bowel Cancer Screening Programme, Northwick Park Hospital, Harrow, UK
| | - Natasha Djedovic
- 3 London Hub, Bowel Cancer Screening Programme, Northwick Park Hospital, Harrow, UK
| | - Sarah Marshall
- 4 St Marks Screening Centre, St Marks Hospital, Harrow, UK
| | - Judith Stein
- 5 University College Screening Centre, University College London Hospitals, London, UK
| | - Stuart A Taylor
- 1 Centre for Medical Imaging, University College London, London, UK
| | - Steve Halligan
- 1 Centre for Medical Imaging, University College London, London, UK
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39
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Dalton ARH. Incomplete diagnostic follow-up after a positive colorectal cancer screening test: a systematic review. J Public Health (Oxf) 2017; 40:e46-e58. [DOI: 10.1093/pubmed/fdw147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/20/2016] [Indexed: 12/19/2022] Open
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40
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McCarthy AM, Kim JJ, Beaber EF, Zheng Y, Burnett-Hartman A, Chubak J, Ghai NR, McLerran D, Breen N, Conant EF, Geller BM, Green BB, Klabunde CN, Inrig S, Skinner CS, Quinn VP, Haas JS, Schnall M, Rutter CM, Barlow WE, Corley DA, Armstrong K, Doubeni CA. Follow-Up of Abnormal Breast and Colorectal Cancer Screening by Race/Ethnicity. Am J Prev Med 2016; 51:507-12. [PMID: 27132628 PMCID: PMC5030116 DOI: 10.1016/j.amepre.2016.03.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Timely follow-up of abnormal tests is critical to the effectiveness of cancer screening, but may vary by screening test, healthcare system, and sociodemographic group. METHODS Timely follow-up of abnormal mammogram and fecal occult blood testing or fecal immunochemical tests (FOBT/FIT) were compared by race/ethnicity using Population-Based Research Optimizing Screening through Personalized Regimens consortium data. Participants were women with an abnormal mammogram (aged 40-75 years) or FOBT/FIT (aged 50-75 years) in 2010-2012. Analyses were performed in 2015. Timely follow-up was defined as colonoscopy ≤3 months following positive FOBT/FIT; additional imaging or biopsy ≤3 months following Breast Imaging Reporting and Data System Category 0, 4, or 5 mammograms; or ≤9 months following Category 3 mammograms. Logistic regression was used to model receipt of timely follow-up adjusting for study site, age, year, insurance, and income. RESULTS Among 166,602 mammograms, 10.7% were abnormal; among 566,781 FOBT/FITs, 4.3% were abnormal. Nearly 96% of patients with abnormal mammograms received timely follow-up versus 68% with abnormal FOBT/FIT. There was greater variability in receipt of follow-up across healthcare systems for positive FOBT/FIT than for abnormal mammograms. For mammography, black women were less likely than whites to receive timely follow-up (91.8% vs 96.0%, OR=0.71, 95% CI=0.51, 0.97). For FOBT/FIT, Hispanics were more likely than whites to receive timely follow-up than whites (70.0% vs 67.6%, OR=1.12, 95% CI=1.04, 1.21). CONCLUSIONS Timely follow-up among women was more likely for abnormal mammograms than FOBT/FITs, with small variations in follow-up rates by race/ethnicity and larger variation across healthcare systems.
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Affiliation(s)
- Anne Marie McCarthy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
| | - Jane J Kim
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Elisabeth F Beaber
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Yingye Zheng
- Department of Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Andrea Burnett-Hartman
- Division of Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, Washington; Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
| | | | - Nirupa R Ghai
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Dale McLerran
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nancy Breen
- Health Systems and Interventions Research Branch, National Cancer Institute, Bethesda, Maryland
| | - Emily F Conant
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Berta M Geller
- Department of Family Medicine, University of Vermont, Burlington, Vermont
| | | | | | - Stephen Inrig
- Department of Health Policy and History of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Health Policy and Management, Mount Saint Mary's University, Los Angeles, California
| | - Celette Sugg Skinner
- Department of Clinical Science and Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jennifer S Haas
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Mitchell Schnall
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - William E Barlow
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Douglas A Corley
- Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, California
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Chyke A Doubeni
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
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Sewitch MJ, Hosseina M. Cancelled and Missed Colonoscopy Appointments Not Easy to Measure. Clin Gastroenterol Hepatol 2016; 14:485-6. [PMID: 26435070 DOI: 10.1016/j.cgh.2015.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 09/17/2015] [Accepted: 09/28/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Maida J Sewitch
- Department of Medicine, McGill University, Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
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Liang PS, Dominitz JA. Striving for Efficient, Patient-centered Endoscopy. Clin Gastroenterol Hepatol 2016; 14:268-70. [PMID: 26484705 DOI: 10.1016/j.cgh.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/10/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Peter S Liang
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jason A Dominitz
- Gastroenterology Section, VA Puget Sound Health Care System, Seattle, Washington; Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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