eP602 - Should Colorectal Screening Strategies Be Optimized in Patients in Socioeconomically Disadvantaged Areas? Experience from a Safety-Net Hospital

Purpose/Background: Colonoscopy is the main 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, caring for patients in low socioeconomic areas and those with limited healthcare access, screening colonoscopies are performed at an even lower rate. We implemented a quality improvement project (QIP) at a safety-net hospital with the goal of increasing colonoscopy completion rates and identifying trends based on who provided the intervention and Area Deprivation index (ADI), an index that ranks neighborhoods by income, education, employment, and housing quality.Methods/Interventions: We identified patients that underwent a colonoscopy before and after QIP. The QIP was defined as a combination of pre-procedural telephone reminders by staff with review and education on pre-procedural diet and bowel preparation. Standardized instructions were available in patients’ preferred languages for non-English speaking patients using certified interpreters. We analyzed patient demographics, no show rates, reasons for cancellation and quality of bowel preparation. Subgroup analysis was performed based on who provided intervention and ADI.Results/Outcomes: A total of 311 patients in the pre-QIP group and 455 patients in post-QIP group were identified. Colonoscopy completion rates were 60.1% in pre-QIP group and 81.3% in post-QIP group (p < 0.001). When the intervention was performed by a provider, colonoscopy completion rates increased 3 fold (OR=3.01, p < 0.001) compared to non-clinical staff (OR=2.52, p < 0.036). By ADI, patients in the first and second quartile (highest socioeconomic status) showed a benefit from the QIP (p < 0.001); whereas those that were in the highest quartiles (socioeconomically disadvantaged) did not benefit from the QIP. (Table 1)Conclusion/

Discussion: This study demonstrates that telephone reminders and education, especially when performed by providers, are essential components for increasing colonoscopy completion rates at a safety-net hospital. This data also suggests that targeted efforts should be made for patients with high ADI’s, as telephone reminders and education alone did not improve their colonoscopy completion rates in this QIP.Table 1: Impact of QIP on colonoscopy completion by ADI quartile