Clinical Scorecard: Overcoming Transportation Challenges to Improve Access to Timely Diagnostic Colonoscopies and Reduce Disparities

At a Glance

Key Highlights

• Moderate-certainty evidence links patient navigation to increased diagnostic colonoscopy completion.

• Uniform policies requiring personal escorts hinder access for vulnerable populations.

• Individualized assessment and care plans are essential for patients undergoing endoscopy.

• Transportation arrangements should be routinely addressed during pre-colonoscopy contacts.

• Standardized tools can help evaluate patient readiness for discharge.

Guideline-Based Recommendations

Diagnosis

• Ensure timely diagnostic colonoscopy after positive stool-based tests.

Management

• Utilize patient navigators to facilitate scheduling and education.

Monitoring & Follow-up

• Assess cognitive and balance restoration before discharge.

Risks

• Avoid blanket restrictions that prevent patients from undergoing endoscopy.

Patient & Prescribing Data

Patients undergoing diagnostic colonoscopy with moderate sedation

Address transportation needs and discharge planning to improve access.

Clinical Best Practices

• Involve patient navigators in the care process.

• Start discharge planning well before the procedure.

• Empower gastroenterologists to engage in shared decision-making.

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