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Evaluation of an Intervention to Increase Screening Colonoscopy in an Urban Public Hospital Setting

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An Erratum to this article was published on 21 July 2006

Abstract

Only 50% of New Yorkers aged 50 and over reported ever being screened for colorectal cancer by any modality according to a recent household survey. The objective of this investigation was to assess the impact of a hospital-based intervention aimed at eliminating health care system barriers to timely colorectal cancer screening at Lincoln Medical Center, a large, urban public hospital in one of the nation's poorest census tracts. We conducted a retrospective analysis of all colonoscopies performed over an 11-month period, during which a multi-pronged intervention to increase the number of screening colonoscopies took place. Two “patient navigators” were hired during the study period to provide continuity for colonoscopy patients. A Direct Endoscopic Referral System (DERS) was also implemented. Enhancements to the gastrointestinal (GI) suite were also made to improve operational efficiency. Immediately following the introduction of the patient navigators, there was a dramatic and sustained decline in the broken appointment rates for both screening and diagnostic colonoscopy (from 67% in May of 2003 to 5% in June of 2003). The likelihood of keeping the 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 increased from 56.8 per month to 119 per month. The screening colonoscopy coverage provided by this facility among persons aged 50 and over in surrounding Zip codes increased from 5.2 to 15.6% (RR 3.0, 95% CI 1.9–4.7). Efforts to increase the number of screening colonoscopies were highly successful, due in large part to the influence of patient navigators, a streamlined referral system, and GI suite enhancements. These findings suggest that there are significant health-care system barriers to colonoscopy that, when addressed, could have a significant impact on screening colonoscopy rates in the general population.

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Acknowledgement

This work was supported in part by a grant from the Fund for the City of New York and with funds from the City Council of New York.

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Authors and Affiliations

  1. Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA

    Denis Nash PhD, MPH

  2. Department of Epidemiology, International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, New York, NY, USA

    Denis Nash PhD, MPH

  3. Columbia University, 722 W. 168th St., Room 706,  , NY, USA

    Denis Nash PhD, MPH

Authors
  1. Denis Nash PhD, MPH
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  2. Sulaiman Azeez
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  3. David Vlahov
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  4. Melissa Schori
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Corresponding author

Correspondence to Denis Nash PhD, MPH.

Additional information

Nash is with the Center for Urban Epidemiologic Studies, The New York Academy of Medicine, New York, NY, USA, the Department of Epidemology, International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, New York, NY, USA; Azeez is with the Department of Gastroenterology, Lincoln Medical Center, Bronx, NY, USA; Vlahov is the Director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, New York, NY, USA; Schori is with the Office of the Medical Director, Lincoln Medical Center, Bronx, NY, USA.

An erratum to this article can be found at http://dx.doi.org/10.1007/s11524-006-9086-x

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Nash, D., Azeez, S., Vlahov, D. et al. Evaluation of an Intervention to Increase Screening Colonoscopy in an Urban Public Hospital Setting. JURH 83, 231–243 (2006). https://doi.org/10.1007/s11524-006-9029-6

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  • DOI: https://doi.org/10.1007/s11524-006-9029-6

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