title: Factors Associated With Missed and Cancelled Colonoscopy Appointments at Veterans Health Administration Facilities.
abstract: OBJECTIVE
  Cancelled and missed colonoscopy appointments waste resources, increase colonoscopy delays, and can adversely affect patient outcomes. We examined individual and organizational factors associated with missed and cancelled colonoscopy appointments in Veteran Health Administration facilities.
  
  
  METHODS
  From 69 facilities meeting inclusion criteria, we identified 27,994 patients with colonoscopy appointments scheduled for follow-up, on the basis of positive fecal occult blood test results, between August 16, 2009 and September 30, 2011. We identified factors associated with colonoscopy appointment status (completed, cancelled, or missed) by using hierarchical multinomial regression. Individual factors examined included age, race, sex, marital status, residence, drive time to nearest specialty care facility, limited life expectancy, comorbidities, colonoscopy in the past decade, referring facility type, referral month, and appointment lead time. Organizational factors included facility region, complexity, appointment reminders, scheduling, and prep education practices.
  
  
  RESULTS
  Missed appointments were associated with limited life expectancy (odds ratio [OR], 2.74; P = .0004), no personal history of polyps (OR, 2.74; P < .0001), high facility complexity (OR, 2.69; P = .007), dual diagnosis of psychiatric disorders and substance abuse (OR, 1.82; P < .0001), and opt-out scheduling (OR, 1.57; P = .02). Cancelled appointments were associated with age (OR, 1.61; P = .0005 for 85 years or older and OR, 1.44; P < .0001 for 65-84 years old), no history of polyps (OR, 1.51; P < .0001), and opt-out scheduling (OR, 1.26; P = .04). Additional predictors of both outcomes included race, marital status, and lead time.
  
  
  CONCLUSIONS
  Several factors within Veterans Health Administration clinic control can be targeted to reduce missed and cancelled colonoscopy appointments. Specifically, developing systems to minimize referrals for patients with limited life expectancy could reduce missed appointments, and use of opt-in scheduling and reductions in appointment lead time could improve both outcomes.
authors: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: Melissa.partin@va.gov.
authors: Melissa R
authors: MR
authors: Partin
authors: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
authors: Amy
authors: A
authors: Gravely
authors: Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Ziad F
authors: ZF
authors: Gellad
authors: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
authors: Sean
authors: S
authors: Nugent
authors: Center for Healthcare Organization and Implementation Research, Boston Veterans Affairs Health Care System, Boston, Massachusetts; Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
authors: James F
authors: JF
authors: Burgess
authors: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors: Aasma
authors: A
authors: Shaukat
authors: Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors: David B
authors: DB
authors: Nelson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003113:Colonoscopy; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
keywords: Appointments and Schedules; Colonoscopy; Health Services Accessibility; Observational Study; Organizational Efficiency; Veterans Health