title: Patient-Reported Attributions for Missed Colonoscopy Appointments in Two Large Healthcare Systems.
abstract: Missed colonoscopy appointments (no-shows) can lead to wasted resources and delays in colorectal cancer diagnosis, an area of special concern in public health systems that often provide care for vulnerable patients. Our objective was to identify reasons for missed colonoscopy appointments in patients seeking care at two large public health systems in Houston, TX.
  
  
  
  We conducted a telephone survey of patients who missed their colonoscopy appointments at two tertiary care health systems. Using a structured survey instrument, we collected information on patient-specific and health services barriers. Patient-specific barriers included perceived procedural-related factors (e.g., difficulty in preparation), cognitive-emotional factors (e.g., fear or concern about modesty), and changes in health status (e.g., improvement or worsening of health). Health services barriers included logistical factors (e.g., travel-related difficulties) and appointment scheduling problems (inconvenient date or time). We examined differences in attributions for missed appointments between the two study sites.
  
  
  
  Of 160 unique patients (102 Site A and 58 Site B) who missed their appointment during the study period, 153 (95.6 %) attributed their no-show to at least one of the listed barriers. Most respondents (125; 78.1 %) cited travel-related issues or scheduling problems as reasons for their missed appointment. Not having a ride or a travel companion was the most commonly reported travel-related issue. We also found significant differences for barriers between the two sites.
  
  
  
  Most missed colonoscopy appointments resulted from potentially preventable travel- and scheduling-related issues. Because barriers to keeping colonoscopy appointments are different across health systems, each health system might need to develop unique interventions to reduce missed colonoscopy appointments.
authors.affiliation: Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.|Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|University of Texas School of Public Health, Houston, TX, USA.
authors.forename: Viraj
authors.initials: V
authors.lastname: Bhise
authors.affiliation: Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.|Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Varsha
authors.initials: V
authors.lastname: Modi
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
authors.forename: Anisha
authors.initials: A
authors.lastname: Kalavar
authors.affiliation: Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.|Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Espadas
authors.affiliation: Harris Health System, Houston, TX, USA.
authors.forename: Loretta
authors.initials: L
authors.lastname: Hanser
authors.affiliation: Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Milena
authors.initials: M
authors.lastname: Gould
authors.affiliation: Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.|Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|Section of Gastroenterology and Hepatology, Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.affiliation: Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA. hardeeps@bcm.edu.|Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA. hardeeps@bcm.edu.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D001071:Appointments and Schedules; D003113:Colonoscopy; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D011795:Surveys and Questionnaires
keywords: Colonoscopy no-show; Colorectal cancer; Diagnostic delays; Patient adherence