Factors associated with non-attendance at outpatient endoscopy

Sola-Vera, Javier; Sáez, J.; Laveda, R; Girona, Eva; García-Sepulcre, Mariana Fe; Cuesta, A; Vázquez, Nancy; Uceda, Francisco; Pérez, Estefanía; Sillero, C

doi:10.1080/00365520701562056

Cited by 41 publications

(55 citation statements)

References 13 publications

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“…Using a 20 % baseline non-adherence rate, as reported in previous studies, the model's estimated PPV improves significantly (50 %), with only a modest reduction in the NPV. 7,9,10,15,49 Moreover, the model is equally effective at predicting non-adherence by patients with no prior history of endoscopy, who may be at higher risk of colonoscopy nonadherence. 9 Changes in the model's NPVand PPV have implications for the allocation of resources, like patient navigators, that may improve colonoscopy adherence.…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have identified predictors of non-adherence with colonoscopy scheduling and completion. [9][10][11][13][14][15][16][17] However, no study has described a validated multivariable model for predicting non-adherence with scheduled colonoscopy. Furthermore, no automated method to assess a patient's prior record of nonadherence has been developed, an essential step for any implementation strategy involving large patient populations.…”

Section: Introductionmentioning

confidence: 99%

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Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

et al. 2015

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BACKGROUND: Accurately predicting the risk of no-show for a scheduled colonoscopy can help target interventions to improve compliance with colonoscopy, and thereby reduce the disease burden of colorectal cancer and enhance the utilization of resources within endoscopy units. OBJECTIVES: We aimed to utilize information available in an electronic medical record (EMR) and endoscopy scheduling system to create a predictive model for no-show risk, and to simultaneously evaluate the role for natural language processing (NLP) in developing such a model. DESIGN: This was a retrospective observational study using discovery and validation phases to design a colonoscopy non-adherence prediction model. An NLPderived variable called the Non-Adherence Ratio ("NAR") was developed, validated, and included in the model. PARTICIPANTS: Patients scheduled for outpatient colonoscopy at an Academic Medical Center (AMC) that is part of a multi-hospital health system, 2009 to 2011, were included in the study. MAIN MEASURES: Odds ratios for non-adherence were calculated for all variables in the discovery cohort, and an Area Under the Receiver Operating Curve (AUC) was calculated for the final non-adherence prediction model. KEY RESULTS: The non-adherence model included six variables: 1) gender; 2) history of psychiatric illness, 3) NAR; 4) wait time in months; 5) number of prior missed endoscopies; and 6) education level. The model achieved discrimination in the validation cohort (AUC= =70.2 %). At a threshold non-adherence score of 0.46, the model's sensitivity and specificity were 33 % and 92 %, respectively. Removing the NAR from the model significantly reduced its predictive power (AUC = 64.3 %, difference = 5.9 %, p<0.001). CONCLUSIONS: A six-variable model using readily available clinical and demographic information demonstrated accuracy for predicting colonoscopy non-adherence. The NAR, a novel variable developed using NLP technology, significantly strengthened this model's predictive power.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

et al. 2015

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“…Patients are also more likely to no-show when they have to wait longer from the time the appointment is scheduled until the time the procedure occurs (2,4,7). …”

Section: Introductionmentioning

confidence: 99%

Estimating the Cost of No-Shows and Evaluating the Effects of Mitigation Strategies

et al. 2013

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Objective To measure the cost of non-attendance (“no-shows”) and benefit of overbooking and interventions to reduce no-shows for an outpatient endoscopy suite. Methods We used a discrete event simulation model to determine improved overbooking scheduling policies and examine the effect of no-shows on procedure utilization and expected net gain, defined as the difference in expected revenue based on CMS reimbursement rates and variable costs based on the sum of patient waiting time and provider and staff overtime. No-show rates were estimated from historical attendance (18% on average, with a sensitivity range of 12 to 24%). We then evaluated the effectiveness of scheduling additional patients and the effect of no-show reduction interventions on the expected net gain. Results The base schedule booked 24 patients per day. The daily expected net gain with perfect attendance is $4,433.32. The daily loss attributed to the base case no-show rate of 18% is $725.42 (16.36% of net gain), ranging from $472.14 to $1,019.29 (10.7% to 23.0% of net gain). Implementing no-show interventions reduced net loss by $166.61 to $463.09 (3.8% to 10.5% of net gain). The overbooking policy of 9 additional patients per day resulted in no loss in expected net gain when compared to the reference scenario. Conclusions No-shows can significantly decrease the expected net gain of outpatient procedure centers. Overbooking can help mitigate the impact of no-shows on a suite’s expected net gain and has a lower expected cost of implementation to the provider than intervention strategies.

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“…Two studies claim a better outcome for patients with easier access to gastroscopy in case of gastric cancer [3] and peptic ulcer disease [4]. At the same time Sola-Vera et al [8] showed that patients' tendency to drop an appointment increases with the length of waiting time, which again might have impact on the patient's outcome.…”

Section: Introductionmentioning

confidence: 99%

"Drop in" gastroscopy outpatient clinic - experience after 9 months

et al. 2012

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BackgroundLogistics handling referrals for gastroscopy may be more time consuming than the examination itself. For the patient, "drop in" gastroscopy may reduce uncertainty, inadequate therapy and time off work.MethodsAfter an 8-9 month run-in period we asked patients, hospital staff and GPs to fill in a questionnaire to evaluate their experience with "drop in" gastroscopy and gastroscopy by appointment, respectively. The diagnostic gain was evaluated.Results112 patients had "drop in" gastroscopy and 101 gastroscopy by appointment. The number of "drop in" patients varied between 3 and 12 per day (mean 6.5). Mean time from first GP consultation to gastroscopy was 3.6 weeks in the "drop in" group and 14 weeks in the appointment group. The half-yearly number of outpatient gastroscopies increased from 696 before introducing "drop in" to 1022 after (47% increase) and the proportion of examinations with pathological findings increased from 42% to 58%. Patients and GPs expressed great satisfaction with "drop in". Hospital staff also acclaimed although it caused more unpredictable working days with no additional staff.Conclusions"Drop in" gastroscopy was introduced without increase in staff. The observed increase in gastroscopies was paralleled by a similar increase in pathological findings without any apparent disadvantages for other groups of patients. This should legitimise "drop in" outpatient gastroscopies, but it requires meticulous observation of possible unwanted effects when implemented.

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Factors associated with non-attendance at outpatient endoscopy

Abstract: A longer time on the waiting list and referral by a general practitioner are factors associated with patients failing to keep their endoscopy appointment.

Cited by 41 publications

References 13 publications

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

Predicting Non-Adherence with Outpatient Colonoscopy Using a Novel Electronic Tool that Measures Prior Non-Adherence

Estimating the Cost of No-Shows and Evaluating the Effects of Mitigation Strategies

"Drop in" gastroscopy outpatient clinic - experience after 9 months

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