Overcoming Transportation Challenges to Improve Access to Timely Diagnostic Colonoscopies

Background

Colorectal cancer screening programs have been implemented to reduce morbidity and mortality, yet timely follow-up with diagnostic colonoscopy remains a challenge, especially for underserved populations. Disparities in access to care can lead to increased incidence and mortality rates among these groups. Understanding and addressing the barriers to completing diagnostic colonoscopies is essential for improving health outcomes.

Data Highlights

The source material reports moderate-certainty evidence that patient navigation increases completion of diagnostic colonoscopy after a positive stool-based test. It also identifies personal-escort requirements after procedures as a potential access barrier, particularly for patients with limited social support, and describes individualized discharge assessments and transportation support as approaches to improve access.

Key Findings

• Moderate-certainty evidence links patient navigation to increased completion rates of diagnostic colonoscopy after positive stool tests.

• Policies requiring personal escorts for patients post-procedure create barriers, particularly for those with limited social support.

• Individualized assessments and care plans for patients undergoing endoscopy can enhance access and safety.

• Standardized tools can help clinical teams evaluate patient readiness for discharge without an escort.

• Addressing transportation needs during pre-colonoscopy communications can improve access to procedures.

Clinical Implications

Healthcare systems should consider removing blanket policies that require personal escorts for patients undergoing diagnostic colonoscopy.

Conclusion

Improving access to timely diagnostic colonoscopies requires a multifaceted approach that includes patient navigation and addressing transportation barriers.

Related Resources & Content

1. Gonzalez Mosquera et al., Journal of General Internal Medicine, 2023 -- Overcoming Transportation Challenges to Improve Access to Timely Diagnostic Colonoscopies and Reduce Disparities

2. ASCO Publications, 2020 -- Resolving transportation disparity in cancer care

3. NCQA, 2023 -- NCQA Advances Development of a New HEDIS® Measure for Colorectal Cancer Screening Follow-Up

4. ASCO Publications — Road to post-pandemic recovery: Regional equity in colorectal cancer screening in the U.S.

5. ASCO Publications — Road to post-pandemic recovery: Regional equity in colorectal cancer screening in the U.S.

6. ASCO Publications — Racial comparisons in receipt of timely guideline-based colon cancer treatment in an equal-access health system.

7. Colorectal Cancer: Screening | United States Preventive Services Taskforce

8. Clinician's Reference: Stool-Based Tests for Colorectal Cancer Screening

9. NCQA Advances Development of a New HEDIS® Measure for Colorectal Cancer Screening Follow-Up - NCQA

10. Rates and Timing of Follow-up Colonoscopy After a Positive Stool-Based Test in an Integrated Health System | Journal of General Internal Medicine | Springer Nature Link

11. PowerPoint Presentation

12. Association Between Time to Colonoscopy After a Positive Fecal Test Result and Risk of Colorectal Cancer and Cancer Stage at Diagnosis | Colorectal Cancer | JAMA | JAMA Network

13. Improving Diagnostic Colonoscopy Completion After Positive Stool-Based Screening in Health-Disparity Populations: A Systematic Review and Meta-analysis - Geisinger

14. Evaluation of Intervention Strategies to Improve Follow-Up Colonoscopy After Abnormal FIT/FOBT Result: A Systematic Review and Meta-Analysis | Colorectal Cancer | JAMA Internal Medicine | JAMA Network

15. Time to Follow-Up Colonoscopy After Positive Fecal Immunochemical Test with Centralized Patient Navigation: A Randomized Clinical Trial - PMC

16. Health System-Provided Rideshare is Safe and Addresses Barriers to Colonoscopy Completion - PMC

17. Assurance of Transportation | Medicaid