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2015 HSR&D/QUERI National Conference Abstract

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3088 — Individual and Organizational Predictors of Cancelled and Missed Colonoscopy Appointments: An Observational Study.

Partin MR, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System; University of Minnesota Department of Medicine; Gravely A, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System; Gellad ZF, Durham Veterans Affairs Health Care System; Department of Medicine, Duke University Medical Center; Nugent S, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System; Burgess JF, Center for Healthcare Organization and Implementation Research, Boston Veterans Affairs Health Care System; Shaukat A, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System; University of Minnesota Department of Medicine; Nelson DB, Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System; University of Minnesota Department of Medicine;

Objectives:
We assessed the contribution of individual and organizational-level factors to rates of cancelled and missed colonoscopy appointments in a national sample of Veterans Health Affairs (VHA) medical facilities and patients.

Methods:
From 69 VHA facilities meeting inclusion criteria, we identified 27,994 patients who had colonoscopy appointments scheduled to follow-up on positive fecal occult blood test results between 8/16/2009 and 9/30/2011. We identified predictors of colonoscopy appointment status (completed, cancelled, missed) in this cohort using hierarchical multinomial regression, incorporating random effects for facility, and fixed effects for individual factors assessed from VHA medical records (age, race, gender, marital status, residence, drive time to nearest specialty care facility, limited life expectancy, comorbidities, colonoscopy in the past 10 years, referring facility type, referral month, colonoscopy appointment lead time) and organizational factors assessed from administrative data and facility surveys (facility region, facility complexity, and colonoscopy appointment reminders, scheduling and prep education practices).

Results:
Among the 27,994 patients included, 17,294 (61.78%) completed, 9,197 (32.85%) cancelled, and 1,503 (5.37%) missed their first appointment scheduled in the colonoscopy clinic. The strongest unique predictor of cancelled appointments was patient age 85 and older (odds ratio (OR) 1.61, P = 0.0005). The strongest unique predictor of missed appointments was life expectancy < 6 months (OR 2.74, P = 0.0004). Strong predictors of both cancelled and missed appointments included no personal history of polyps (OR 1.51, P < 0.0001 for cancelled; 2.74, P < 0.0001 for missed), opt-out colonoscopy appointment scheduling (i.e., patient sent letter with specific colonoscopy appointment time, must call clinic to opt-out) (OR 1.26, P = 0.04 for cancelled; 1.57, P = 0.02 for missed) and colonoscopy appointment lead time (days between the colonoscopy procedure date and scheduling date) (OR 1.15, P < 0.0001 for cancelled; 1.12, P < 0.0001 for missed).

Implications:
Reducing appointment lead time and avoiding opt-out scheduling may reduce both cancelled and missed appointment rates for colonoscopy. Reducing missed colonoscopy appointment rates may also require developing systems to minimize the number of patients with limited life expectancy scheduled for colonoscopy.

Impacts:
The findings identify several factors within the control of clinics that could be targeted in future efforts to improve efficiency and patient access to colonoscopy in outpatient endoscopy clinics.