BMC Gastroenterology | |
Prevalence and predictors of patient no-shows to outpatient endoscopic procedures scheduled with anesthesia | |
Lukejohn W. Day1  Justin L. Sewell1  Jennifer T. Chang2  | |
[1] Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, San Francisco, CA, USA;Division of Gastroenterology, Department of Medicine, University of California, San Francisco, CA, USA | |
关键词: Health disparities; Quality; Health outcomes; Endoscopy; | |
Others : 1234391 DOI : 10.1186/s12876-015-0358-3 |
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received in 2015-02-15, accepted in 2015-09-25, 发布年份 2015 | |
【 摘 要 】
Background
Demand for endoscopic procedures scheduled with anesthesia is increasing and no-show to appointments carries significant patient health and financial impact, yet little is known about predictors of no-show.
Methods
We performed a 16-month retrospective observational cohort study of patients scheduled for outpatient endoscopy with anesthesia at a county hospital serving the safety-net healthcare system of San Francisco. Multivariate logistic regression analysis was performed to evaluate associations between attendance and predictors of no-show.
Results
In total, 511 patients underwent endoscopy with anesthesia during the study period. Twenty-seven percent of patients failed to attend an appointment and were considered “no-show”. In multivariate analysis, higher no-show rates were associated with patients with a prior history of no-show (odds ratio [OR] 6.4; 95 % confidence interval [CI], 2.4- 17.5), those with active substance abuse within the past year (OR 2.2; 95 % CI 1.4-3.6), those with heavy prescription opioids/benzodiazepines use (OR 1.6; 95 % CI 1.0-2.6) and longer wait-times (OR 1.05; 95 % CI 1.00-1.09). Inversely associated with patient no-show were active employment (OR 0.38; 95 % CI 0.18-0.81), patients who attended a pre-operative appointment with an anesthesiologist (OR 0.52; CI 0.32-0.85), and those undergoing an advanced endoscopic procedure (OR 0.43; 95 % CI 0.19-0.94).
Conclusion
In a safety-net healthcare population, behavioral and social determinants of health, including missed appointments, active substance abuse, homelessness, and unemployment are associated with no-shows to endoscopy with anesthesia.
【 授权许可】
2015 Chang et al.
【 预 览 】
Files | Size | Format | View |
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20151129061759939.pdf | 513KB | download | |
Fig. 1. | 25KB | Image | download |
【 图 表 】
Fig. 1.
【 参考文献 】
- [1]Turner AG, Cooke H: Are patients’ attitudes the cause of long waiting lists? Br J Clin Pract 1991, 45:97-98.
- [2]Neal RD, Lawlor DA, Allgar V, Colledge M, Ali S, Hassey A, et al.: Missed appointments in general practice: retrospective data analysis from four practices. Br J Gen Pract 2001, 51(471):830-832.
- [3]Prentice JC, Pizer SD: Delayed access to health care and mortality. Health Serv Res 2007, 42:644-662.
- [4]Rhee MK, Slocum W, Ziemer DC, Culler SD, Cook CB, El-Kebbi IM, et al.: Patient adherence improves glycemic control. Diabetes Educ 2005, 31:240-250.
- [5]Sewell JL, Kushel MB, Inadomi JM, Yee HF Jr: Non-English speakers attend gastroenterology clinic appointments at higher rates than English speakers in a vulnerable patient population. J Clin Gastroenterol 2009, 43(7):652-660.
- [6]DuMontier C, Rindfleisch K, Pruszynski J, Frey JJ: A Multi-Method Intervention to Reduce No-Show in an Urban Residency Clinic. Fam Med 2013, 45(9):634-641.
- [7]Nguyen DL, Dejesus RS, Wieland ML: Missed appointments in resident continuity clinic: patient characteristics and health care outcomes. J Grad Med Educ 2011, 3(3):350-355.
- [8]Lasser KE, Mintzer IL, Lambert A, Cabral H, Bor DH: Missed appointment rates in primary care: the importance of site of care. J Health Care Poor Underserved 2005, 16(3):475-486.
- [9]Majeroni BA, Cowan T, Osborne J, Braham RP: Missed Appointments and Medicaid Managed Care. Arch Fam Med 1996, 5(9):507-511.
- [10]The Kaiser Commission on Medicaid and the Uninsured. Expanding Medicaid to Low-Income Childless Adults under Health Reform: Key Lessons from State Experiences. Washington, DC: The Kaiser Family Foundation; 2010. [Accessed 9/29/2015]. http://kaiserfamilyfoundation.files.wordpress.com/2013/01/8087.pdf webcite
- [11]Crowley R, Golden W: Health Policy Basics: Medicaid Expansion. Ann Intern Med 2014, 160(6):423-425.
- [12]Berg BP, Murr M, Chermak D, Woodall J, Pignone M, Sandler RS, et al.: Estimating the Cost of No-Shows and Evaluating the Effects of Mitigation Strategies. Med Decis Making 2013, 33(8):976-985.
- [13]Regenstein M, Huang JH. Stresses to the safety net: the public hospital perspective. Report of the Kaiser Commission on Medicaid and the Uninsured. 2005 Sep [Accessed 9/29/2015]. Available online at. https://kaiserfamilyfoundation.files.wordpress.com/2005/05/stresses-to-the-safety-net-the-public-hospital-perspective-report.pdf webcite
- [14]California HealthCare Foundation. Examining Access to Specialty Care for California’s Uninsured: Full Report. 2004. [Accessed 9/29/2015]. http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/PDF%20A/PDF%20AccessToSpecialtyCareForCalifUninsuredReport.pdf webcite
- [15]Gold R, Bailey S, O’Malley J, Hoopes MJ, Cowburn S, Marino M, et al. Estimating Demand for Care After a Medicaid Expansion: Lessons From Oregon. J Ambul Care Manage. 2014; 37(4): 282–292.
- [16]Everhart JE, Ruhl CE: Burden of digestive disease in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology 2009, 136(2):376-386.
- [17]Brown ML, Klabunde CN, Mysliwiec P: Current capacity for endoscopic colorectal cancer screening in the United States: data from the National Cancer Institute survey of colorectal cancer screening practices. Am J Med 2003, 115:129-133.
- [18]Vijan S, Inadomi J, Hayward RA, Hofer TP, Fendrick AM: Projections of demand and capacity for colonoscopy related to increasing rates of colorectal cancer screening in the United States. Ailment Pharmacol Ther 2004, 20(5):507-515.
- [19]Adams LA, Pawlik J, Forbes GM: Nonattendance at outpatient endoscopy. Endoscopy 2004, 36:402-404.
- [20]Gurudu SR, Fry LC, Fleischer DE, Jones BH, Trunkenbolz MR, Leighton JA: Factors contributing to patient nonattendance at open-access endoscopy. Dig Dis Sci 2006, 51(11):1942-1945.
- [21]Sola-Vera J, Saez J, Laveda R, Girona E, Garcia-Sepulcre MF, Cuesta A, et al.: Factors associated with non-attendance at outpatient endoscopy. Scand J Gastroenterol 2008, 43(2):202-206.
- [22]Turner BJ, Weiner M, Yang C, TenHave T: Predicting adherence to colonoscopy or flexible sigmoidoscopy on the basis of physician appointment-keeping behavior. Ann Intern Med 2004, 140(7):528-532.
- [23]Kazarian E, Carreira F, Toribara N, Denberg TD: Colonoscopy completion in a large safety net health care system. Clin Gastrol and Hepatol 2008, 6(4):438-442.
- [24]Liu H, Waxman DA, Main R, Mattke S: Utilization of Anesthesia Services During Outpatient Endoscopies and Colonoscopies and Associated Spending in 2003–2009. JAMA 2012, 307(11):1178-1184.
- [25]San Francisco General Hospital Annual Report, 2011–2012. [Accessed 9/29/2015]. http://www.sfdph.org/dph/files/SFGHdocs/AnnualRpt_20112012.pdf webcite
- [26]Fisher DA, Jeffreys A, Coffman CJ, Fasanella K: Barriers to full colon evaluation for a positive fecal occult blood test. Cancer Epidemiol Biomarkers Prev 2006, 15:1232-1235.
- [27]Ananthakrishnan AN, Schellhase KG, Sparapani RA, Laud PW, Neuner JM: Disparities in colon cancer screening in the Medicare population. Arch Int Med 2007, 167:258-264.
- [28]Ponce NA, Hays RD, Cunningham WE: Linguistic disparities in health care access and health status among older adults. J Gen Int Med 2006, 21:786-791.
- [29]Fiscella K, Franks P, Doescher MP, Saver BG: Disparities in health care by race, ethnicity, and language among the insured: findings from a national sample. Med Care 2002, 40:52-59.