Folasade P May1, Mark W Reid2, Samuel Cohen3, Francis Dailey3, Brennan M R Spiegel4. 1. Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA. 2. Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California, USA. 3. Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California, USA. 4. Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California, USA; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA.
Abstract
BACKGROUND AND AIMS: Use of GI endoscopy is historically lower in nonwhite 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 patients with a physician recommendation for endoscopy and active recruitment of patients to fill projected open endoscopy appointment slots. On intervention weeks, patients attending a 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. CONCLUSIONS: 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. Published by Elsevier Inc.
BACKGROUND AND AIMS: Use of GI endoscopy is historically lower in nonwhite 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 patients with a physician recommendation for endoscopy and active recruitment of patients to fill projected open endoscopy appointment slots. On intervention weeks, patients attending a 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. CONCLUSIONS: 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. Published by Elsevier Inc.
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