THE IMPACT OF DIGITAL NAVIGATION PATHWAYS ON NO-SHOW RATES FOR PATIENTS UNDERGOING COLONOSCOPY: A QUALITY IMPROVEMENT STUDY

ABSTRACT

Background: High no-show rates for colonoscopy have been previously associated with poor clinical outcomes, decreased operational efficiency, and diminished utilization of resources. Studies have suggested that addressing barriers like poor health literacy, logistical challenges, and psycho-emotional issues could reduce no-show rates for colonoscopies. Recently, digital navigation tools designed to eliminate such barriers are an emerging trend with promising results leading to better outcomes for patients undergoing colonoscopy. Objective: The goal of this study was to examine the feasibility of an automated, text message-based digital navigation program and determine the impact on no-show rates for patients undergoing colonoscopies. Methods: Rx.Health developed a Digital Navigation Pathway (DNP) that consisted of bowel-prep instructions, appointment reminders, driving instructions, microlearning videos, and educational messaging. Providers at the Gastroenterology (GI) clinic of NYC Health + Hospitals/Lincoln Medical Center prescribed this pathway through RxUniverse, a digital medicine unification platform, to the patients' smartphones. The sample included patients scheduled for colonoscopy between October 2019 to March 2020 (pre-intervention) and October 2020 to March 2021 (post-intervention). Through a year over year analysis, the mean no-show rates and the number of scheduled colonoscopies at the GI clinic were compared between the pre-intervention and post-intervention groups. Furthermore, as a part of the pre/post program implementation analysis, the colonoscopy utilization patterns at the GI clinic were compared. Results: There were 567 colonoscopies scheduled during the pre-intervention period and 381 scheduled colonoscopies in the post-intervention period. The average no-show rate in the pre-intervention group was 27.81 percent compared to 4.46 percent (p<0.00001)* in the post-intervention group, which translated into an 83.9 percent reduction in no-show rates at the GI clinic. Furthermore, this resulted in 23.7 colonoscopies saved per 100 scheduled colonoscopies in the post-intervention group. Conclusion: Patients that were enrolled in the digital navigation program were more likely to show up to their scheduled colonoscopy appointment compared to patients in the preintervention group. Given the pre-/post implementation study design and COVID-19 pandemic that occurred during the intervention period, future cluster randomized controlled trials should be conducted to examine if there is an association between digital navigation programs and no-show rates for patients undergoing colonoscopies. (Figure Presented) Figure 1. Colonoscopy Bowel Preparation Digital Navigation Pathway (Figure Presented) Figure 2. The Effect of DNPs on No-Show Rates during the Pre- and Post-intervention Period (p < 0.00001) *