A0629 - Reducing Health Care Disparities: Assessing Quality of Bowel Preparation and Rates of Colonoscopy Completion in the Underserved

Sunday, October 23, 2022

5:00 PM – 7:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Arcelia Guerson-Gil, MD

Stony Brook University Hospital
Stony Brook, NY

Arcelia Guerson-Gil, MD¹, Anuj Gupta, BA², Andrew Fu, ³, Hong Gi Shim, MD¹, Joseph LaComb, BS¹, Ricardo Flores Jr., BS¹, Ellen Li, MD, PhD¹, Alexandra Guillaume, MD¹, Farah Monzur, MD³
¹Stony Brook University Hospital, Stony Brook, NY; ²Renaissance School of Medicine at Stony Brook University, Stony Brook, NY; ³Stony Brook, Stony Brook, NY

Introduction: Inadequate bowel preparation is a major barrier to the successful completion of colonoscopies, particularly in disadvantaged populations. In our GI fellows’ clinic, we care for underinsured patients with low socioeconomic status, most of whom (56%) are Hispanic and Spanish-speaking only. We aimed to compare the quality of bowel preparation and rates of colonoscopy completion in the fellows and faculty panels and to identify whether the implementation of a patient navigator bridges the gap in health care disparities.

Methods: We conducted a retrospective chart review of 547 colonoscopies performed on a subset of the GI faculty panel from January 1, 2019 to December 31, 2021 and on all the patients from the fellows’ panel from January 1, 2019 to date. Data was collected on patient demographics, bowel preparation quality, and completion of procedure. Preparation quality was classified as adequate or inadequate based on the endoscopist’s report. Completion of procedure was defined as advancement of the colonoscope into the cecum. Chi-square analyses were conducted to identify statistically significant differences.

Results: A total of 297 and 250 colonoscopies were performed on the GI faculty and GI fellows’ panels, respectively. The number of inadequate bowel preparations was significantly higher in the fellows’ panel (58/250; 23%) compared to the faculty panel (35/297; 12%) (p< 0.001, OR=2.261, 1.438-3.589) (Figure 1). The number of procedure completions was significantly lower in the fellows’ panel (225/250; 90%) compared to the faculty panel (288/297; 97%) (p< 0.001, OR=3.556, 1.651-7.840) (Figure 1). As a pilot program to eliminate this disparity, we implemented a bilingual patient navigator in March 2022 (Table 1). Preliminary data of this intervention shows an improvement of bowel preparation quality, from 23% to 10%, and colonoscopy completion rates, from 90% to 97% (Figure 1).

Discussion: There is a major difference between the GI fellows’ and GI faculty panel in the rate of adequate bowel preparation and incomplete procedures due to poor bowel prep. These differences impact time to diagnosis which leads to increased morbidity and mortality. The implementation of a dedicated Spanish-speaking patient navigator in the GI fellows’ clinic has improved the rate of adequate bowel preparation, thereby improving colonoscopy completion rates. By inference, this has improved the quality of the care we deliver and will ultimately reduce healthcare disparities within our community.

Figure: Figure 1. Bowel preparation quality and colonoscopy completion

Calls patients (in Spanish if preferred language) 2 weeks prior to their scheduled procedure to:

Confirm procedure and appointment time
Review bowel preparation instructions and level of comprehension
Ensure clarity of COVID-19 testing instructions
Verify if patients are on any antiplatelet/anticoagulant agents and timing of periprocedural cessation
Give his contact information for any more questions

Sends an email to the patient with the procedure information and bowel preparation instructions (in Spanish if preferred language)

Calls patients to ensure they have started the financial aid process to avoid cancellations and financial burdens

Calls patients 5 days before the procedure to verify they will be starting the prep

Present during the procedure day and procedure itself to assist with patient translation, if needed

Table: Table 1. Patient navigator role and responsibilities. (Main role: Provides individualized education of the pre-procedural testing and bowel preparation instructions in Spanish).

Disclosures:

Arcelia Guerson-Gil indicated no relevant financial relationships.

Anuj Gupta indicated no relevant financial relationships.

Andrew Fu indicated no relevant financial relationships.

Hong Gi Shim indicated no relevant financial relationships.

Joseph LaComb indicated no relevant financial relationships.

Ricardo Flores Jr. indicated no relevant financial relationships.

Ellen Li indicated no relevant financial relationships.

Alexandra Guillaume indicated no relevant financial relationships.

Farah Monzur: Medtronic (Covidien) – Consultant.

Arcelia Guerson-Gil, MD¹, Anuj Gupta, BA², Andrew Fu, ³, Hong Gi Shim, MD¹, Joseph LaComb, BS¹, Ricardo Flores Jr., BS¹, Ellen Li, MD, PhD¹, Alexandra Guillaume, MD¹, Farah Monzur, MD³. A0629 - Reducing Health Care Disparities: Assessing Quality of Bowel Preparation and Rates of Colonoscopy Completion in the Underserved, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.