Abstract
BACKGROUND: Timely colonoscopy completion in primary care can prevent diagnostic delays in colorectal cancer. Factors that influence why patients experience timely or delayed colonoscopy completion are unclear. We sought to identify potentially intervenable factors associated with earlier (or later) colonoscopy test completion in primary care.
METHODS: All colonoscopy orders placed by primary care clinicians in two clinics within a single hospital system between January 1 2018 and December 31 2021 were examined for time to completion using the Cox Proportional Hazards Model, where the hazards of completion were adjusted for variables potentially associated with the outcome, including sociodemographic, individual health-related, and care delivery factors.
RESULTS: Among 10,576 colonoscopy tests ordered, 56% were completed within one year and the median time to colonoscopy completion was 230 days, 95% CI [217, 242]. After multivariable adjustment, earlier colonoscopy completion was associated with receiving care at a community health center (HR 1.13, 95% CI [1.03, 1.24]), preferred spoken language other than English (HR 1.23, 95% CI [1.12, 1.34]), male sex (HR 1.09, 95% CI [1.03, 1.14]), Black race (HR 1.08, 95% CI [1.02, 1.16]), any college education (HR 1.07, 95% CI [1.01, 1.14]), a diagnosis of rectal bleeding (HR 1.88, 95% CI [1.69, 2.08]), and documented use of an electronic patient portal (HR 1.19, 95% CI [1.13, 1.26]). Completion occurred later among patients with Medicaid insurance (HR 0.82, 95% CI [0.75, 0.89]), subsidized commercial insurance (HR 0.80, 95% CI [0.69, 0.91]), depression (HR 0.95, 95% CI [0.89, 1.01]), and when ordered by a nurse practitioner (HR 0.77, 95% CI [0.68, 0.88]), resident (HR 0.92, 95% CI [0.85, 0.99]) or during a telehealth appointment (via telephone HR 0.56, 95% CI [0.49, 0.64] and via video HR 0.76, 95% CI [0.63, 0.90]). Results were similar for a sensitivity analysis restricted to patients within a Medicaid Accountable Care Organization (ACO) network.
CONCLUSIONS: Several sociodemographic, clinical, and telehealth factors were associated with time to colonoscopy completion, identifying potential opportunities for targeted care and future research.