Electronic Health Record (EHR) Review of Prior Appointment Adherence Provides a Simple Easily Available Predictor of Completion of Screening Colonoscopy

Abstract

Introduction: Failure to complete an ordered screening colonoscopy limits its benefit for CRC screening and leads to significant health care inefficiency. A simple methodology to predict patients more likely to be noncompliant to their colonoscopy could improve colonoscopy resource utilization and target navigational resources. Here, we assess if patient level EHR review of adherence to appointments prior to scheduled colonoscopy predicted noncompliance to ultimate completion of colonoscopy.Figure 1Methods: Our cohort included patients for whom screening colonoscopies were ordered and scheduled from 1/2011 to 12/2012. Patients were deemed failures to screen when no colonoscopy was performed within 12 months of scheduling. Colonoscopies were performed at two endoscopy centers. Exclusion criteria included history of CRC, colon resection, IBD, age greater than 80. Patient demographic, medical, and adherence to prior appointments was collected by review of the EHR EPIC (Verona, WI). Patient adherence to past appointments was defined by failure to attend an appointment in the last two years. Screening completion rates were compared by a two-sided Fisher's exact test or student T-test with p value =0.05 considered significant. Results: Of 504 cases scheduled for screening, 418 cases met inclusion criteria. Overall failure to screen rate (FTS) was 16.9% (70/418). Average age was 60.5 and 60% were female; age and gender were not associated with lower rates of completion. Blacks had a statistically significant higher FTS rate of 22.4% (37/165) compared to Whites 11.4% (23/201, p=0.007) (see Table 1). 91% of patients had a reviewable EHR history of prior appointments within the last two years. Those with any failed attendance of prior appointments had a FTS rate of 20.1% (49/244), significantly higher than those with perfect attendance, 12.1% (21/174, p =0.03). Those with greater than 50% nonattendance to prior appointments had a colonoscopy FTS rate of 34.2% (12/35) while those with less than 50% past nonattendance had a FTS rate of 15.4% (43/280, p =0.01). Conclusion: Patient EHR appointment adherence can serve as a simple method to predict patients more likely to miss and complete scheduled colonoscopy for CRC screening. Those who have missed the majority of past appointments had a FTS rate double that of the entire cohort. This provides colonoscopy schedulers information to consider when allocating endoscopy lab time to reduce inefficiencies from noncompliance to colonoscopy in screening programs.