Predictive overbooking and active recruitment increases uptake of endoscopy appointments among African American patients.
OBJECTIVE
Use of GI endoscopy is historically lower in nonwhite ethnic and racial groups compared with whites. These disparities are multifactorial but likely contribute to differences in GI clinical outcomes. We sought to improve endoscopy uptake overall and in minorities by predictive overbooking and active recruitment in a hospital-based GI clinic.


METHODS
From January to October 2014, we alternated between traditional booking for Veterans Affairs Healthcare Network patients with a physician recommendation for endoscopy and active recruitment of patients to fill projected open endoscopy appointment slots. On intervention weeks, patients attending a GI clinic were given the opportunity to "fast track" to an endoscopy appointment on short notice. During control weeks, patients were not actively recruited. We compared uptake of endoscopy appointments in both groups and performed logistic regression to determine predictors of participation in fast-track active recruitment.


RESULTS
During fast-track active recruitment for endoscopy, the clinic recruited an additional 111 patients for endoscopy over passive recruitment, including 46 African Americans (41.4%). In a logistic regression model controlling for demographic and clinical characteristics, African Americans were twice as likely (adjusted OR, 1.99; 95% CI, 1.26-3.17) than whites to participate in the fast-track option for recommended endoscopy.


CONCLUSIONS
Interventions to actively recruit patients for endoscopy increased the overall percentage of GI clinic patients undergoing endoscopy and disproportionately improved endoscopy appointment uptake in African Americans.
Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Division of Digestive Diseases, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.
Folasade P
FP
May
Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California, USA.
Mark W
MW
Reid
Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California, USA.
Samuel
S
Cohen
Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California, USA.
Francis
F
Dailey
Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA; Cedars-Sinai Center for Outcomes Research and Education, Los Angeles, California, USA; Department of Health Policy and Management, University of California, Los Angeles Fielding School of Public Health, Los Angeles, California, USA.
Brennan M R
BM
Spiegel
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001071:Appointments and Schedules; D001213:Asian / Q000706:statistics & numerical data; D003113:Colonoscopy / Q000706:statistics & numerical data*; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000706:statistics & numerical data; D018579:Patient Selection; D014481:United States; D014493:United States Department of Veterans Affairs; D044465:White People / Q000706:statistics & numerical data