title: Appointment-keeping behaviors and procedure day are associated with colonoscopy attendance in a patient navigator population.
abstract: BACKGROUND
  Patient navigator programs (PNP) have been shown to improve colonoscopy completion with demonstrated cost-effectiveness. Despite additional resources available to these patients, many still do not attend their colonoscopies. The aim of this study was to determine factors associated with colonoscopy attendance amongst patients in whom logistical barriers to attendance have been minimized through enrollment in a PNP.
  
  
  METHODS
  Retrospective case-control study of patients enrolled in a PNP for colonoscopy performed at a tertiary endoscopy center from 2009 to 2014. Cases were defined as patients who did not attend their first scheduled colonoscopy after PNP enrollment. Age- and gender-matched controls completed their first scheduled colonoscopy after PNP enrollment.
  
  
  RESULTS
  514 subjects (257 cases, mean age 57.1years, 36.6% males) were included. Patients who attended their colonoscopy were less likely to be Spanish-speaking (64.6% vs 78.2%, p=0.0003) and uninsured (0.4% vs 3.9%, p=0.006). Attendance rates were significantly lower for screening colonoscopies compared to an indication of surveillance or diagnostic (45.5% vs 65.3%, p<0.0001). Fewer patients attended colonoscopies scheduled on Monday (39.2% vs 52.1%, p=0.04) and in December (10.7% vs 52.3%, p<0.0001). On multivariate analysis, poor appointment-keeping behaviors, including a prior missed colonoscopy (OR 0.20, 95% CI 0.10-0.39) or missed office visit (OR 0.44, 95% CI 0.26-0.73) and procedures scheduled on Mondays (OR 0.51, 95% CI 0.27-0.94) were negatively associated with attendance.
  
  
  CONCLUSIONS
  Appointment-keeping behaviors, in addition to insurance-status, language-barriers and medical comorbidities, influence colonoscopy attendance in a PNP population. Patients scheduled for colonoscopies on Mondays or in December may require more resources to ensure attendance.
authors.affiliation: Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA. Electronic address: jnayor@partners.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Nayor
authors.affiliation: Brigham and Women's Hospital, Division of General Internal Medicine, 801 Massachusetts Ave, Suite 610, Boston, MA 02118, USA. Electronic address: neil.maniar@gmail.com.
authors.forename: Swapnil
authors.initials: S
authors.lastname: Maniar
authors.affiliation: Brigham and Women's Hospital, Division of Gastroenterology, Hepatology and Endoscopy, 75 Francis Street, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA. Electronic address: wwchan@partners.org.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Chan
mesh_terms: D001071:Appointments and Schedules; D016022:Case-Control Studies; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance; D062526:Patient Navigation; D012189:Retrospective Studies
keywords: Attendance; Colonoscopy; Patient navigator; Scheduling