A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic
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 cen...
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| Veröffentlicht in: | Clinical and translational gastroenterology 2024-09, Vol.15 (9), p.e1 |
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| creator | Shim, Hong Gi Gupta, Anuj Fu, Andrew Flores, Jr, Ricardo Simmons, Robert Steinberg, Jonathan Guerson-Gil, Arcelia Liao, Yunhan Yang, Jie LaComb, Joseph F D'Souza, Lionel S Monzur, Farah Li, Ellen Guillaume, Alexandra |
| description | 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.
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.
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.
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. |
| doi_str_mv | 10.14309/ctg.0000000000000730 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 2155-384X</identifier><identifier>EISSN: 2155-384X</identifier><identifier>DOI: 10.14309/ctg.0000000000000730</identifier><identifier>PMID: 38916225</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Colon ; Colonoscopy ; Colonoscopy - economics ; Colonoscopy - statistics & numerical data ; Colorectal Neoplasms - diagnosis ; Coronaviruses ; COVID-19 ; COVID-19 - diagnosis ; COVID-19 - epidemiology ; Early Detection of Cancer - economics ; Female ; Health disparities ; Health Services Accessibility - statistics & numerical data ; Humans ; Intervention ; Male ; Mann-Whitney U test ; Medicaid ; Medical screening ; Medically Uninsured - statistics & numerical data ; Middle Aged ; Pandemics ; Patients ; Quality Improvement ; Retrospective Studies ; SARS-CoV-2 ; Statistical analysis ; Time Factors ; United States ; Variables ; Waiting Lists</subject><ispartof>Clinical and translational gastroenterology, 2024-09, Vol.15 (9), p.e1</ispartof><rights>Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.</rights><rights>2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c318t-638d3c67d4f8527dd3882f0cdca56a59025b7ef6abbc63b10f06c5a564c1d2203</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421721/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421721/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38916225$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shim, Hong Gi</creatorcontrib><creatorcontrib>Gupta, Anuj</creatorcontrib><creatorcontrib>Fu, Andrew</creatorcontrib><creatorcontrib>Flores, Jr, Ricardo</creatorcontrib><creatorcontrib>Simmons, Robert</creatorcontrib><creatorcontrib>Steinberg, Jonathan</creatorcontrib><creatorcontrib>Guerson-Gil, Arcelia</creatorcontrib><creatorcontrib>Liao, Yunhan</creatorcontrib><creatorcontrib>Yang, Jie</creatorcontrib><creatorcontrib>LaComb, Joseph F</creatorcontrib><creatorcontrib>D'Souza, Lionel S</creatorcontrib><creatorcontrib>Monzur, Farah</creatorcontrib><creatorcontrib>Li, Ellen</creatorcontrib><creatorcontrib>Guillaume, Alexandra</creatorcontrib><title>A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic</title><title>Clinical and translational gastroenterology</title><addtitle>Clin Transl Gastroenterol</addtitle><description>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.
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.
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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Colon</subject><subject>Colonoscopy</subject><subject>Colonoscopy - economics</subject><subject>Colonoscopy - statistics & numerical data</subject><subject>Colorectal Neoplasms - diagnosis</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - diagnosis</subject><subject>COVID-19 - epidemiology</subject><subject>Early Detection of Cancer - economics</subject><subject>Female</subject><subject>Health disparities</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Humans</subject><subject>Intervention</subject><subject>Male</subject><subject>Mann-Whitney U test</subject><subject>Medicaid</subject><subject>Medical screening</subject><subject>Medically Uninsured - statistics & numerical data</subject><subject>Middle Aged</subject><subject>Pandemics</subject><subject>Patients</subject><subject>Quality Improvement</subject><subject>Retrospective Studies</subject><subject>SARS-CoV-2</subject><subject>Statistical analysis</subject><subject>Time Factors</subject><subject>United States</subject><subject>Variables</subject><subject>Waiting Lists</subject><issn>2155-384X</issn><issn>2155-384X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkd1LHDEUxUNRqqh_QkugL76M3iST-XgqstZ2QVBR276FTJJZIzPJmmQs-9839WPZbl5u4PzO4V4OQp8InJCSQXuq0uIENl_N4APap4TzgjXl752N_x46ivHxH1QCbdr2I9pjTUsqSvk-cmf4ZpKDTSs8H5fBP5vRuIRv06RX2Ds884N3Piq_XOFf0iZ8Z0cTsXX43mkTrItTMBpfy2SzL-ILPwz-j3ULnB4Mnl39nJ8XpM16pkerDtFuL4dojt7mAbq_-HY3-1FcXn2fz84uC8VIk4qKNZqpqtZl33Baa82ahvagtJK8krwFyrva9JXsOlWxjkAPleJZKxXRlAI7QF9fc5dTNxqt8m5BDmIZ7CjDSnhpxf-Ksw9i4Z8FISUlNSU54fgtIfinycQkRhuVGQbpjJ-iYFBTAAplldEvW-ijn4LL9wlGoAVe87LOFH-lVPAxBtOvtyEgXloVuVWx3Wr2fd48Ze1675D9Bc3gnio</recordid><startdate>20240901</startdate><enddate>20240901</enddate><creator>Shim, Hong Gi</creator><creator>Gupta, Anuj</creator><creator>Fu, Andrew</creator><creator>Flores, Jr, Ricardo</creator><creator>Simmons, Robert</creator><creator>Steinberg, Jonathan</creator><creator>Guerson-Gil, Arcelia</creator><creator>Liao, Yunhan</creator><creator>Yang, Jie</creator><creator>LaComb, Joseph F</creator><creator>D'Souza, Lionel S</creator><creator>Monzur, Farah</creator><creator>Li, Ellen</creator><creator>Guillaume, Alexandra</creator><general>Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins</general><general>Wolters Kluwer</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20240901</creationdate><title>A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic</title><author>Shim, Hong Gi ; Gupta, Anuj ; Fu, Andrew ; Flores, Jr, Ricardo ; Simmons, Robert ; Steinberg, Jonathan ; Guerson-Gil, Arcelia ; Liao, Yunhan ; Yang, Jie ; LaComb, Joseph F ; D'Souza, Lionel S ; Monzur, Farah ; Li, Ellen ; Guillaume, Alexandra</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c318t-638d3c67d4f8527dd3882f0cdca56a59025b7ef6abbc63b10f06c5a564c1d2203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Colon</topic><topic>Colonoscopy</topic><topic>Colonoscopy - economics</topic><topic>Colonoscopy - statistics & numerical data</topic><topic>Colorectal Neoplasms - diagnosis</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - diagnosis</topic><topic>COVID-19 - epidemiology</topic><topic>Early Detection of Cancer - economics</topic><topic>Female</topic><topic>Health disparities</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Humans</topic><topic>Intervention</topic><topic>Male</topic><topic>Mann-Whitney U test</topic><topic>Medicaid</topic><topic>Medical screening</topic><topic>Medically Uninsured - statistics & numerical data</topic><topic>Middle Aged</topic><topic>Pandemics</topic><topic>Patients</topic><topic>Quality Improvement</topic><topic>Retrospective Studies</topic><topic>SARS-CoV-2</topic><topic>Statistical analysis</topic><topic>Time Factors</topic><topic>United States</topic><topic>Variables</topic><topic>Waiting Lists</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shim, Hong Gi</creatorcontrib><creatorcontrib>Gupta, Anuj</creatorcontrib><creatorcontrib>Fu, Andrew</creatorcontrib><creatorcontrib>Flores, Jr, Ricardo</creatorcontrib><creatorcontrib>Simmons, Robert</creatorcontrib><creatorcontrib>Steinberg, Jonathan</creatorcontrib><creatorcontrib>Guerson-Gil, Arcelia</creatorcontrib><creatorcontrib>Liao, Yunhan</creatorcontrib><creatorcontrib>Yang, Jie</creatorcontrib><creatorcontrib>LaComb, Joseph F</creatorcontrib><creatorcontrib>D'Souza, Lionel S</creatorcontrib><creatorcontrib>Monzur, Farah</creatorcontrib><creatorcontrib>Li, Ellen</creatorcontrib><creatorcontrib>Guillaume, Alexandra</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical and translational gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shim, Hong Gi</au><au>Gupta, Anuj</au><au>Fu, Andrew</au><au>Flores, Jr, Ricardo</au><au>Simmons, Robert</au><au>Steinberg, Jonathan</au><au>Guerson-Gil, Arcelia</au><au>Liao, Yunhan</au><au>Yang, Jie</au><au>LaComb, Joseph F</au><au>D'Souza, Lionel S</au><au>Monzur, Farah</au><au>Li, Ellen</au><au>Guillaume, Alexandra</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic</atitle><jtitle>Clinical and translational gastroenterology</jtitle><addtitle>Clin Transl Gastroenterol</addtitle><date>2024-09-01</date><risdate>2024</risdate><volume>15</volume><issue>9</issue><spage>e1</spage><pages>e1-</pages><issn>2155-384X</issn><eissn>2155-384X</eissn><abstract>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.
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.
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.
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.</abstract><cop>United States</cop><pub>Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins</pub><pmid>38916225</pmid><doi>10.14309/ctg.0000000000000730</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Adult Aged Colon Colonoscopy Colonoscopy - economics Colonoscopy - statistics & numerical data Colorectal Neoplasms - diagnosis Coronaviruses COVID-19 COVID-19 - diagnosis COVID-19 - epidemiology Early Detection of Cancer - economics Female Health disparities Health Services Accessibility - statistics & numerical data Humans Intervention Male Mann-Whitney U test Medicaid Medical screening Medically Uninsured - statistics & numerical data Middle Aged Pandemics Patients Quality Improvement Retrospective Studies SARS-CoV-2 Statistical analysis Time Factors United States Variables Waiting Lists |
| title | A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic |
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