Provider-delivered phone reminders increase colonoscopy completion at a safety net hospital

Colonoscopy is the primary screening method for colorectal cancer. In the United States, only two-thirds of the population who qualify for screening undergo colonoscopies. At safety net hospitals that care for patients in low socioeconomic areas and those with limited healthcare access, screening colonoscopies are performed at an even lower rate. This study aimed to implement a quality improvement strategy (QIS) in a safety net hospital with the goal of increasing colonoscopy completion rates and identifying trends related to Area Deprivation Index (ADI) scores.

Patients who underwent a colonoscopy before and after a QIS were identified. The QIS was defined as a combination of preprocedural telephone reminders by providers with detailed review and education on preprocedural diet and bowel preparation. Standardized instructions were available in the patients' preferred languages for non-English-speaking patients using certified interpreters. Patient demographics, no-show rates, reasons for cancellation, and quality of bowel preparation were analyzed. Subgroup analysis was performed based on who provided the intervention and ADI.

A total of 165 patients received the QIS, and 511 did not. Colonoscopy completion rate was 81.8% among patients who received the QIS and 57.1% among those who did not (P <.001). When the intervention was performed by a provider, colonoscopy completion rates increased 3-fold (odds ratio [OR], 3.47 [95% CI, 1.99-6.07]) compared with nonclinical staff (OR, 2.43 [95% CI, 0.95-6.19]). Using ADI, patients in the first and second quartiles (the highest socioeconomic status) exhibited a benefit from the QIS (P <.001), whereas those who were in the highest quartiles (socioeconomically disadvantaged) did not benefit from the QIS.

Our study demonstrates that telephone reminders and education, especially when performed by clinical providers, are essential components for increasing colonoscopy completion rates in a safety net hospital. In addition, our data suggest that more targeted alternative efforts should be made for patients with high ADI scores, as telephone reminders and education alone did not improve their colonoscopy completion rates in the QIS.