Improvements in Colonoscopy Bowel Preparation Quality and Procedure Completions Following Introduction of a Full-Time Patient Navigator

Introduction: Timely colonoscopy is essential in preventing colorectal cancer (CRC) mortality. Inadequate bowel preparation can result in procedure cancellations and thereby pose a major barrier to screening and diagnosis of CRC. In this study, we sought to characterize the impact of hiring a full-time patient navigator on bowel prep quality and colonoscopy completion rates. Methods: We reviewed a total of 2250 screening and diagnostic colonoscopies, consisting of 453 cases from January to December 2021 before the intervention and 1797 cases from May to October 2022 after the intervention. These procedures were performed at our tertiary academic medical center. Our study population was divided into two panels: “insured” (45% Commercial, 29% Medicare, 12% Managed Medicaid, and 14% Other) and “underinsured” (34% Self-Pay, 28% Medicaid, 19% Emergency Medicaid, and 19% Other). The patient navigator performed reminder calls before all colonoscopies and reviewed pre-procedure instructions in the underinsured patient panel only, as part of a quality improvement initiative. Bowel prep quality was assessed using the Boston Bowel Preparation Scale (BBPS) or, if missing, subjective reporting by the endoscopist. Prep quality was classified as “adequate” (BBPS ≥ 6 and all segmental BBPS ≥ 2) or “inadequate” (BBPS < 6 or any segmental BBPS score < 2). Procedures were marked as complete if the colonoscope was advanced to the cecum. Chi-square analyses were conducted across study groups. Results: Before the intervention, patients on the underinsured panel had significantly lower rates of adequate bowel prep compared to the insured panel (79.4% vs. 93.5%, P< 0.0001). This also resulted in significantly lower rates of colonoscopy completion on the underinsured panel compared to insured (92.8% vs. 97.2%, P< 0.05). In the post-intervention period, the rate of adequate bowel prep improved on the underinsured panel and was no longer significantly different from the insured panel (84.5% vs. 90.3%). Subsequently, the completion rate also improved on the underinsured panel and approached a rate similar to the insured panel (95.2% vs. 98%) (Figure 1, Table 1). Conclusion: Implementation of a full-time patient navigator resulted in adequate bowel preparations reaching 85% and procedure completions exceeding 90%, in line with nationally established quality metrics. Utilization of a patient navigator emphasizes direct and effective communication with patients, with the goal of improving healthcare quality and outcomes.Figure 1.: Colonoscopy Bowel Preparation Quality and Procedure Completions by Patient Panel and Year. Table 1. - Statistical significance for comparisons of Adequate Bowel Preparations and Procedure Completions by Patient Panel and Year Adequate Bowel Prep 2021 2022 P-value Procedure Completions 2021 2022 P-value Insured 93.5% 90.3% NS Insured 97.2% 98.0% NS Underinsured 79.4% 84.5% NS Underinsured 92.8% 95.2% NS P-value < 0.0001 NS P-value < 0.05 NS