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Outcome of effective intervention to improve screening colonoscopy in a downtown Brooklyn community hospital.

1540 Background: The Cancer Prevention and Control Program at New York City Department of Health and Mental Hygiene Launched the Colonoscopy Patient Navigator Program in 2003 to address the low rates of colorectal cancer screening in New York City. Brooklyn Hospital became part of this program in 2009. We wanted to evaluate the effectiveness of this intervention in our colonoscopy no show rates.


METHODS
Retrospective analysis of two groups of patients scheduled for colonoscopies in the year 2009- 2010 which bracketed the implementation of navigator in Downtown Brooklyn hospital was done to evaluate the efficacy of an intervention. We compared the no show rates for patients scheduled for colonoscopies pre and post navigator implementation. A generalized linear model was fitted, with fixed factors pre-post navigator, race, gender and their respective interactions. Asians were excluded since their small numbers introduced sampling zeroes. SAS (SAS Institute, Cary NC) Release 9.2 software was used.


RESULTS
Of the 1263 patients', 625 patients' were evaluated by the navigator. The no show rate decreased from 17.7% to 8.5% after the implementation of the navigator (p<0.001). The adjusted odds ratio of no-show for the post- vs. pre-navigator period is 0.43 (95% confidence interval [0.34, 0.54]). This improvement in no show rate was seen in both genders (17.6% to 9.5% in males and 17.6% to 8.2% in females). Our data also showed that the improvement in no show rate was seen across all races. Of interest, was significant decrease seen in no show rates among the Hispanic population which improved from 19.2% to 4.9%.


CONCLUSIONS
There was an association between screening colonoscopy compliance and patient navigator-based intervention in our community hospital consistent with findings in other institutions. The significant increase in utilization among Hispanic population can be attributed to the navigator's language proficiency. We postulate that patient's belief in navigator significantly increased along with better understanding of the procedure when communicated in their language. Our data supports patient navigation to be an effective tool in overcoming the health care system barriers.