Increasing Screening Colonoscopy in an Urban Public Hospital

This hospital-based intervention used patient navigators to eliminate health care system barriers to timely colorectal cancer screening at a large, urban public hospital. Patient navigators were hired to assist patients obtain screening by helping complete paperwork, schedule appointments, provide reminders, and facilitate referrals. A direct referral system was created to allow health care providers to refer patients directly, bypassing many of the normal barriers to screening, and reducing waiting time for a screening appointment. The gastrointestinal suite was remodeled to improve efficiency by bringing in additional screening devices and video processors, and moving the instrument cleaning area closer to the suite. Recovery areas were redesigned to allow more patients to be monitored by one provider, leaving more doctors available to assist in procedures.

The goal of this program is to increase access to colorectal cancer screening by improving the efficiency in health care clinics.

Following the introduction of patient navigators, there was a dramatic decline in broken appointment rates for screening and diagnostic colonoscopy (from 67% to 5%). The likelihood of keeping an appointment for colonoscopy after the patient navigator intervention increased by nearly 3-fold (relative risk = 2.6; 95% CI = 2.2-3.0). The rate of screening colonoscopies more than doubled from 58.6 per month to 119 per month. Screening colonoscopy coverage provided by the facility among people over age 50 in surrounding zip codes increased from 5.2% to 15.6% (relative risk 3.0; 95% CI = 1.9-4.7).