Background: Health disparities in colorectal cancer screening, diagnosis, and treatment related to socioeconomic status and insurance are well documented. These disparities often intersect with self-identified race, ethnicity, and language. We sought to identify equity-relevant associations with completion of a colonoscopy order within a Medicaid population.
Methods: We identified all colonoscopy orders for patients with Medicaid insurance seen at a hospital-based practice and an affiliated community health center during a three-year period (2018-2021.) Time between ordering and completion of colonoscopy was the outcome of interest in a Cox proportional hazards model. The model was adjusted by equity-specific variables and other potential confounders.
Results: In this Medicaid population, 48.8% (972/1997) colonoscopy orders were not completed within 365 days. Patients seen at a community health center and those using a patient portal had a higher hazard ratio of colonoscopy completion, when controlling for other potential confounders and equity-specific variables (p =.002, p =.005.) Patients with depression and those whose colonoscopy was ordered after a telehealth visit had lower HR of completing colonoscopy (p=.002 and p<.0001, respectively.) Self-reported race, Hispanic ethnicity, and language were not independently associated with the outcome.
Conclusions: Successful completion within 365 days of a colonoscopy order was very low overall (48.8%). Care at a community health center and documented use of the patient portal increased the hazards of a colonoscopy order, whereas a preceding telehealth appointment and a diagnosis of depression lowered the hazards of success. Common practices at the CHC, such as additional scheduling support, might explain its protective effect, suggesting important resiliency factors that warrant further exploration.
