S630 Characterizing Racial Disparities in Follow-Up Care in an Open-Access Endoscopy Cohort

Abstract

Introduction: Open-access endoscopy (OAE) describes access to endoscopic procedures for patients who are not office-established patients of a gastroenterologist. OAE has expanded access to endoscopy and can decrease healthcare disparities. Previous studies have explored factors associated with non-attendance to OAE. However, disparities in follow-up care after OAE have not been described. Methods: Barnes-Jewish Hospital (BJH) is a large nonprofit hospital in St. Louis, MO. BJH offers OAE to the St. Louis community. Utilizing the procedure list for open-access esophagogastroduodenoscopies (EGD), we completed a retrospective analysis of all patients who received an open-access EGD during 2019. During this time, 677 open-access EGDs were scheduled. Demographic and clinical variables, EGD indication, EGD findings, recommended follow-up, and completed follow-up care were collected from the electronic health record. Means ± standard deviations (SD) were used to express continuous variables. Student’s t-tests were utilized to compare means. Chi-square test or Fisher Exact Test were used to determine the unadjusted odds ratio (OR) and 95% confidence interval. A two-sided p-value of < 0.05 was considered statistically significant. Results: Of the 677 open-access EGDs, 294 (43.4%) were male, 414 (61.2%) identified as white, and 259 (38.3%) identified as minority. Within minority patients, 223/259 (86.1%) identified as Black. Some type of follow-up care was recommended in 176/677 patients (26.0%). Of the 176 patients who were recommended for follow-up, 130/176 (73.9%) were able to obtain the recommended follow-up. Of the 176 patients who were recommended for follow-up care, 37 (21.0%) were found to have HP. When stratifying the population who required some type of follow-up care by race, minority patients with HP were more likely than minority patients without HP to receive appropriate follow-up (OR=2.3; 95% CI 1.2 – 3.9). For white patients, those with HP were just as likely as those with a differing diagnosis to receive proper follow-up (OR 0.85, 95% CI 0.2 - 3.9). Conclusion: OAE has the potential to decrease healthcare disparities by providing access to endoscopies for patients who do not have a primary gastroenterologist. Minority patients with HP were more likely to receive the appropriate follow-up care than minority patients who required follow-up care without HP. Implementing strategies to ensure that all patients receive follow-up care after OAE, regardless of the findings made during OAE, is necessary.