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A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic
Hong Gi Shim1, Anuj Gupta1, Andrew Fu1
1Division of Gastroenterology and Hepatology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA.
Insights
Patient navigation reduced colonoscopy wait times for underinsured patients, addressing health disparities exacerbated by the COVID-19 pandemic. This quality improvement initiative highlights the need for ongoing monitoring to ensure equitable access to colorectal cancer screening.
Area of Science:
- Health Services Research
- Colorectal Cancer Screening
- Health Equity
Background:
- The COVID-19 pandemic significantly disrupted access to essential medical procedures, including colonoscopies.
- Disparities in colonoscopy wait times existed between underinsured (Medicaid, uninsured) and insured patients at an academic medical center.
- This study aimed to address colorectal cancer health equity by examining colonoscopy wait times.
Purpose of the Study:
- To evaluate the impact of patient navigation on reducing colonoscopy wait times for underinsured patients.
- To compare colonoscopy wait times between underinsured and insured populations before and after intervention.
- To advance health equity in colorectal cancer screening access.
Main Methods:
- Retrospective chart reviews of adult outpatient colonoscopies from 2019-2021 (preintervention).
- Implementation of bilingual patient navigation funded by an institutional grant in 2022.
- Prospective data collection from May 2022 to May 2023 (postintervention) with multivariable regression analyses.
Main Results:
- Colonoscopy wait times were significantly longer for underinsured compared to insured patients post-2019.
- In the second postintervention phase, screening/surveillance colonoscopy wait times for underinsured patients decreased by 34.21 days compared to the postpandemic period.
- Diagnostic colonoscopy wait times for underinsured patients decreased by 27.57 days in the second postintervention phase compared to the postpandemic period.
Conclusions:
- Colonoscopy wait times for underinsured patients significantly increased following the COVID-19 pandemic.
- Patient navigation partially reduced these disparities, demonstrating its effectiveness in improving access.
- Continuous monitoring of colonoscopy wait times for underinsured populations is crucial for achieving health equity in cancer care.
Introduction:
The coronavirus disease 2019 (COVID-19) pandemic limited access to colonoscopy. To advance colorectal cancer health equity, we conducted a quality improvement study on colonoscopy wait times in 2019-2023 for underinsured (Medicaid, uninsured) compared with insured patients at an academic medical center providing colonoscopy for surrounding Federally Qualified Health Centers.
Methods:
Retrospective chart reviews were performed on adult outpatient colonoscopies in the preintervention period (2019-2021). In 2022, an institutional grant funded bilingual patient navigation to reduce colonoscopy wait times. Postintervention data were collected prospectively from May 2022 to May 2023 in 2 phases. Multivariable regression analyses were conducted for colonoscopy wait times as a primary outcome.
Results:
Analysis of 3,403 screening/surveillance and 1,896 diagnostic colonoscopies revealed significantly longer colonoscopy wait times for underinsured compared with insured patients after 2019. For screening/surveillance colonoscopies, wait time differences between underinsured and insured patients in the second postintervention phase were reduced by 34.21 days (95% confidence interval [CI]: 11.07-57.35) compared with the postpandemic period and by 56.36 days (95% CI: 34.16-78.55) compared with the first postintervention phase. For diagnostic colonoscopies, wait time differences in the second postintervention phase were reduced by 27.57 days (95% CI: 9.96-45.19) compared with the postpandemic period and by 20.40 days (95% CI: 1.02-39.77) compared with the first postintervention phase.
Discussion:
Colonoscopy wait times were significantly longer for underinsured compared with insured patients following the COVID-19 pandemic. This disparity was partially ameliorated by patient navigation. Monitoring outpatient colonoscopy wait times in underinsured patients is important for advancing health equity.
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