Factors Associated With Colonoscopy Completion Rates in an Inner-City Community Health Clinic

Abstract

Introduction: Colorectal cancer (CRC) is the 2nd leading cause of cancer death in the US and the 4th worldwide. In the US, incidence has declined as a result of screening strategies, since early diagnosis is the most important prognostic factor. CRC screening with colonoscopy provides visualization of precancerous polyps and the opportunity for immediate removal. However, screening rates have remained particularly low in areas of poverty and among minorities. Our goal is to determine patient factors associated with completion of CRC screening with colonoscopy in our inner-city community health clinic. Methods: A retrospective review of our medical records (E-Clinical Works) was done to identify patients >50 years old who had a colonoscopy referral from June 2015 to September 2016. Patients who had CRC screening colonoscopy ordered were included. Completion colonoscopy status was based on availability of colonoscopy report. Patients were excluded if colonoscopy was performed for purely diagnostic purposes. Associations between patients' characteristics as age, BMI, smoking status, and comorbidities, and colonoscopy completion were analyzed. Results: We identified 313 patients referred for CRC screening or surveillance colonoscopy, 60% (N=188) had colonoscopy performed. Baseline characteristics are shown in Table 1. Among those who had colonoscopy performed, having history of liver disease and surveillance as indication for colonoscopy were identified as significant factors associated with odds of completing colonoscopy. Similarly, active smoking status made completion of colonoscopy less likely. These associations remained significant on multivariate analysis.Figure: Baseline characteristics.Figure: Univariate and multivariate analysis for odds of colonoscopy completion.Conclusion: This study is part of the quality improvement endeavors undertaken at our clinic to improve our CRC screening rate. Identifying specific characteristics on our patient population to improve adherence to CRC screening guidelines and completion of screening colonoscopy will aid in targeting our population. Further studies are needed to evaluate these results in larger sample populations and their impact in improving CRC screening rates.