Abstract B88: Comparing screening colonoscopy bowel preparation quality in navigated uninsured and insured patient populations
Authors: Naylor Keith , Fritz Cassandra , Lam Helen , Kim Karen 
Published: May 2015

Background: Racial and ethnic minority patients, as well as those with lower incomes and inadequate insurance, are less likely to complete preventative colorectal cancer (CRC) screening. Patient navigation is known to be an effective method for increasing the rates of CRC screening among minority groups and the medically underserved. The University of Chicago Medicine (UCM) is an active participant in the American Cancer Society's Colorectal Cancer Screening Initiative (ACS CCSI). The ACS CCSI began in August, 2012 with a goal of increasing access to and utilization of CRC screening among uninsured Illinois residents. In support of the CCSI, the UCM has partnered with Federally Qualified Healthcare Centers located on Chicago's South Side. Patients who participate in the CCSI at these healthcare sites receive: in-clinic patient navigation provided by an ACS trained navigator; they are provided GoLYTELY for bowel irrigation; and they are referred to UCM for screening colonoscopy. Prior to the day of their scheduled endoscopy, CCSI participants have no interaction or communication with the performing Gastroenterologist and they are responsible for adhering to the appropriate diet and completing the bowel preparation medications. Adequate bowel preparation is a quality measure for colonoscopy. Standard descriptors of bowel preparation include: “excellent”, no or minimal stool and small amounts of clear fluid; “Good”, no or minimal stool with large amounts of clear fluid; “Fair”, semisolid debris that are cleared with difficulty; and “Poor”, solid or semisolid debris that cannot be effectively cleared. Inadequate, “Fair” or “Poor”, bowel preparation is known to: lower rates of polyp detection; increase colonoscopy procedure duration; and contribute to earlier than recommended intervals for surveillance examination. Published studies have noted that uninsured patient populations are more likely to have an inadequate bowel preparation when compared with insured patient populations. The aim of this study was to assess bowel preparation among an insured university hospital population and an uninsured patient population who received navigation through the ACS CCSI.

Methods: This is a retrospective chart review of colonoscopies performed between 08/01/2012 and 07/01/2013. Inclusion criteria: adults age 50 and above who were eligible for guideline consistent CRC screening. Exclusion criteria: Patients referred for screening colonoscopy by a gastroenterologist. These patients are excluded as they may have received additional patient education and/or procedure related instructions that would likely impact the quality of their bowel preparation. Endoscopy procedure reports were reviewed for bowel preparation quality. Bowel preparation was summarized as Excellent/Good or Fair/Poor. Chi-Square and paired T-tests where used for statistical analysis.

Results: 228 outpatient colonoscopies were included in the review. 86 colonoscopies were performed as part of the ACS CCSI and 142 colonoscopies were performed as usual care. There was no difference in male gender comparing ACS CCSI and usual care (30% vs. 35%, p &gt; 0.50). The average age of ACS CCSI patients was younger than usual care (56.3 vs. 61.9 years, p &lt; 0.001). ACS CCSI patients were more likely to have an Excellent/Good bowel preparation compared to usual care (68.6% vs. 47.9%, p &lt; 0.005).

Conclusion: There are many barriers to effective CRC screening. Through the ACS CCSI, access to screening colonoscopies for the underserved in Illinois will increase. However, even with increased access, the quality of examination during colonoscopy can be impaired by inadequate bowel preparation thereby limiting its benefits and efficacy in preventing CRC. Our study found that an uninsured patient population that receives navigation through programs such as the ACS CCSI may achieve comparable, or in this population superior, rates of adequate quality of bowel preparation.

Citation Format: Keith Naylor, Cassandra Fritz, Helen Lam, Karen Kim. Comparing screening colonoscopy bowel preparation quality in navigated uninsured and insured patient populations. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B88. doi:10.1158/1538-7755.DISP13-B88