A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic.

IF 3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Clinical and Translational Gastroenterology Pub Date : 2024-09-01 DOI:10.14309/ctg.0000000000000730

Hong Gi Shim, Anuj Gupta, Andrew Fu, Ricardo Flores, Robert Simmons, Jonathan Steinberg, Arcelia Guerson-Gil, Yunhan Liao, Jie Yang, Joseph F LaComb, Lionel S D'Souza, Farah Monzur, Ellen Li, Alexandra Guillaume

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Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic limited access to colonoscopy. To advance colorectal cancer health equity, we conducted a quality improvement study on colonoscopy wait times in 2019-2023 for underinsured (Medicaid, uninsured) compared with insured patients at an academic medical center providing colonoscopy for surrounding Federally Qualified Health Centers.

Methods: Retrospective chart reviews were performed on adult outpatient colonoscopies in the preintervention period (2019-2021). In 2022, an institutional grant funded bilingual patient navigation to reduce colonoscopy wait times. Postintervention data were collected prospectively from May 2022 to May 2023 in 2 phases. Multivariable regression analyses were conducted for colonoscopy wait times as a primary outcome.

Results: Analysis of 3,403 screening/surveillance and 1,896 diagnostic colonoscopies revealed significantly longer colonoscopy wait times for underinsured compared with insured patients after 2019. For screening/surveillance colonoscopies, wait time differences between underinsured and insured patients in the second postintervention phase were reduced by 34.21 days (95% confidence interval [CI]: 11.07-57.35) compared with the postpandemic period and by 56.36 days (95% CI: 34.16-78.55) compared with the first postintervention phase. For diagnostic colonoscopies, wait time differences in the second postintervention phase were reduced by 27.57 days (95% CI: 9.96-45.19) compared with the postpandemic period and by 20.40 days (95% CI: 1.02-39.77) compared with the first postintervention phase.

Discussion: Colonoscopy wait times were significantly longer for underinsured compared with insured patients following the COVID-19 pandemic. This disparity was partially ameliorated by patient navigation. Monitoring outpatient colonoscopy wait times in underinsured patients is important for advancing health equity.

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关于 COVID-19 大流行后医保不足患者结肠镜检查等待时间的质量改进研究。

导言：2019年冠状病毒病（COVID-19）大流行限制了结肠镜检查的普及。为了促进结直肠癌健康公平，我们在一家为周边联邦合格医疗中心提供结肠镜检查服务的学术医疗中心开展了一项质量改进研究，研究对象是 2019-2023 年未充分参保（医疗补助、未参保）的结肠镜检查等待时间与参保患者的等待时间：对干预前（2019-2021 年）的成人门诊结肠镜检查进行回顾性病历审查。2022 年，一项机构拨款资助了双语患者导航，以减少结肠镜检查的等待时间。从 2022 年 5 月到 2023 年 5 月，分两个阶段对干预后的数据进行了前瞻性收集。将结肠镜检查等待时间作为主要结果进行了多变量回归分析：结果：对 3403 例筛查/监测和 1896 例诊断性结肠镜检查的分析表明，2019 年后，保险不足患者的结肠镜检查等待时间明显长于保险患者。在筛查/监测结肠镜检查方面，干预后第二阶段未充分参保患者与参保患者的等待时间差异与大流行后相比减少了 34.21 天（95% CI：11.07 - 57.35），与干预后第一阶段相比减少了 56.36 天（95% CI：34.16 - 78.55）。就诊断性结肠镜检查而言，干预后第二阶段的等待时间与大流行后相比减少了 27.57 天（95% CI：9.96 - 45.19），与干预后第一阶段相比减少了 20.40 天（95% CI：1.02 - 39.77）：结论：COVID-19 大流行后，保险不足的患者结肠镜检查等待时间明显长于保险患者。结论：COVID-19 大流行后，投保不足的患者的结肠镜检查等待时间明显长于投保患者，而患者导航则部分改善了这种差异。监测保险不足患者的门诊结肠镜检查等待时间对于促进健康公平非常重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Translational Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

7.00

自引率

0.00%

发文量

114

审稿时长

16 weeks

期刊介绍： Clinical and Translational Gastroenterology (CTG), published on behalf of the American College of Gastroenterology (ACG), is a peer-reviewed open access online journal dedicated to innovative clinical work in the field of gastroenterology and hepatology. CTG hopes to fulfill an unmet need for clinicians and scientists by welcoming novel cohort studies, early-phase clinical trials, qualitative and quantitative epidemiologic research, hypothesis-generating research, studies of novel mechanisms and methodologies including public health interventions, and integration of approaches across organs and disciplines. CTG also welcomes hypothesis-generating small studies, methods papers, and translational research with clear applications to human physiology or disease. Colon and small bowel Endoscopy and novel diagnostics Esophagus Functional GI disorders Immunology of the GI tract Microbiology of the GI tract Inflammatory bowel disease Pancreas and biliary tract Liver Pathology Pediatrics Preventative medicine Nutrition/obesity Stomach.