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39% Reduction in Cancellations - Study

ABSTRACT

Title:

EVALUATING THE IMPACT OF A NOVEL, TEXT MESSAGE REMINDER AND NAVIGATION TOOL ON THE “NO-SHOW” RATE FOR PATIENTS UNDERGOING OUTPATIENT COLONOSCOPY.

 

Introduction:

While colon cancer screening has seen recent improvements in preparation, access, and public awareness, an area of continued concern remains the tremendous number of patients who “no-show” for their procedure. Previous studies show the number of patients who fail to attend a colonoscopy averages between 4% and 23% but has been recorded as high as 42% in one large, safety net health system. This large group of patients directly contributes to the staggering 43% of adults, age 50 or older, who have never been endoscopically screened for colon cancer.

            Patients who fail to make their appointments decrease the efficiency of our healthcare system and negatively impact their own health.  Focused efforts to improve patient attendance have included reminder mailings, telephone calls, and automated systems with varying degrees of success. One 2016 study employed a nurse navigator whose sole responsibility was to call patients one week before their procedure to remind and educate them regarding proper bowel prep. This intervention greatly increased patient attendance and was financially sustainable. 

Methods:

In late 2017, The University of Louisville Division of Gastroenterology partnered with a team of computer programmers to develop a novel system that delivers personalized text messages to patients prior to their colonoscopy.  The system guides patients through their bowel preparation by texting them instructions at preset intervals.  Additionally, the system also helps patients anticipate barriers to completing their preparation and provides references and guidance if they are experiencing difficulties. Beginning in April of 2018, all patients undergoing outpatient colonoscopies were enrolled in the text message system. In the three months prior to and following implementation, the number of same day cancellations and “no-shows” were recorded. 

Results:

 In the three months preceding the launch of this system, 13.7% patients did not arrive for their colonoscopy or cancelled on the day of the procedure.  In the three months following the launch of this system, this percentage decreased to 8.3%.  This was found to be a statistically significant difference (p-value: 0.0012) using a two-proportion Z-test.

Conclusion:

While this texting system did not completely eliminate same day cancelations and “no-shows”, it dramatically decreased their prevalence. These results are comparable to employing a nurse navigator but the low cost of development and implementation make text messages a more economical solution.  This study is limited by its single-site design, which concurrently uses both mailings and voice calls to remind patients of their procedure.  In summary, this enhanced text messaging system improved patient compliance with colonoscopy preparation and increased their rate of attendance.

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