328 Community Clinic Report Card on Utilization of Screening Colonoscopies: How Well Are We Doing?

Abstract

INTRODUCTION: Screening colonoscopy is an integral but underutilized diagnostic tool in preventing colorectal cancer (CRC). Reasons for delays in CRC screening include incorrect referrals, shortage of physician availability and endoscopy capacity, and limited access to care for uninsured and minority patients. The aims of our study were to measure the time from referral to screening colonoscopy and to define predictors of noncompliance to CRC screening. METHODS: A retrospective chart review of patients referred to our clinic for screening colonoscopy was conducted from 7/2017 to 9/2018. Inclusion criteria were age appropriate CRC screening; patients with positive FOBT/FIT for purely screening reasons were also included. Patients younger than 45 or older than 85 years, or those referred for a diagnostic (evaluation of anemia, hematochezia, weight loss) or surveillance colonoscopy (prior adenomatous polyps or adenocarcinoma) were excluded. Patient demographics, referral data, and medical histories were reviewed. RESULTS: 180 patients met inclusion criteria. Follow-up throughput is shown in Figure 1. 63% patients were deemed non-compliant (not making an appointment, missing scheduled appointment, or not completing recommended colonoscopy). Appointments for 60% of patients were canceled because of missed pre-GI visit registration or patient no showed. 52% of referrals came from outside the health system. 53% of all patients referred were never seen by GI. 71% of patients ordered to have a screening colonoscopy completed their procedure. A final total of 28% of all patients referred eventually underwent colonoscopy.Non-compliant patients were more likely to be uninsured (P-value = 0.04), come from outside referral (P-value = 0.014), have more days from referral reviewed to appointment (81.8 vs 71 days, P value = 0.01), and have less medical problems (1.2 vs 1.5, P value = 0.04). There was no statistical difference between gender, age, race, Hispanic, language, marital status, tobacco use, Charlson Comorbidity Score, or days from clinic appointment to colonoscopy. CONCLUSION: Our study identified outside referrals, lack of insurance, and more days from referral received to appointment as predictors of non-compliance to screening colonoscopy.Further interventions should address optimization of utilization of screening colonoscopies, such as targeted navigational resources for uninsured patients from outside referrals, minimizing steps to GI clinic visit, and educating patients on the value of CRC screening.