Predictive overbooking and active recruitment increases uptake of endoscopy appointments among African American patients

Abstract

Background and Aims Utilization of GI endoscopy is historically lower in non-white ethnic and racial groups compared with whites. These disparities are multifactorial but likely contribute to differences in GI clinical outcomes. We sought to improve endoscopy uptake overall and in minorities by predictive overbooking and active recruitment in a hospital-based GI clinic. Methods From January to October 2014, we alternated between traditional booking for Veterans Affairs Healthcare Network (VA) patients with a physician recommendation for endoscopy and active recruitment of patients to fill projected open endoscopy appointment slots. On intervention weeks, patients attending GI clinic were given the opportunity to “fast-track” to an endoscopy appointment on short notice. During control weeks, patients were not actively recruited. We compared uptake of endoscopy appointments in both groups and performed logistic regression to determine predictors of participation in “fast-track” active recruitment. Results During “fast-track” active recruitment for endoscopy, the clinic recruited an additional 111 patients for endoscopy over passive recruitment, including 46 African Americans (41.4%). In a logistic regression model controlling for demographic and clinical characteristics, African Americans were twice as likely (adjusted OR, 1.99; 95% CI, 1.26-3.17) than whites to participate in the “fast-track” option for recommended endoscopy. Conclusion Interventions to actively recruit patients for endoscopy increased the overall percentage of GI clinic patients undergoing endoscopy and disproportionately improved endoscopy appointment uptake in African Americans.

Predictive model-based interventions to reduce outpatient no-shows: a rapid systematic review

“… 37 In 1 RCT, African Americans were twice as likely as whites to take up “fast track” appointments made available by overbooking (adjusted odds ratio 1.99, 95% CI, 1.26–3.17). 41 , 44 …”

Factors associated with non-attendance at appointments in the gastroenterology endoscopy unit: a retrospective cohort study

“…The non-attendance rate was as high as 67% in non-urgent endoscopies and for screening colonoscopies. When appointments are not honored, the overall waiting time increases and patient satisfaction is likely to decrease ( May et al, 2017 ). Additionally, non-attendance at scheduled appointments has been reported to increase emergency department admissions and hospitalizations ( Hwang et al, 2015 ; Nuti et al, 2012 ).…”