VANCOUVER, B.C.—Hiring a full-time patient navigator may significantly improve outcomes in underinsured patients undergoing colonoscopy, according to data presented at the 2023 annual meeting of the American College of Gastroenterology.
Findings from the single-institution study showed that implementation of a full-time patient navigator resulted in an 85% rate of adequate bowel preparations and a greater than 90% rate of procedure completions among underinsured patients, which is in line with nationally established quality metrics. The intervention also led to a reduction in the disparity between insured and underinsured patients in colonoscopy metrics.
“Underinsured patients historically have a higher colorectal cancer mortality rate, partially due to inadequate screening procedures,” said lead study author Anuj Gupta, BA, an MD candidate at the Renaissance School of Medicine at Stony Brook University, in New York. “We have shown with this study that implementation of a patient navigator can help in closing the gap between underinsured and insured populations with regards to bowel prep quality.”
The two-year study conducted by Mr. Gupta and his co-investigators included 2,250 screening and diagnostic colonoscopies performed in 2021 and 2022 (abstract P1193). The cases in 2021 were conducted without a patient navigator, whereas those in 2022 included one to assist the underinsured individuals.
The patient navigator made reminder calls to underinsured patients and reviewed their bowel preparation instructions with them. Bowel preparation quality was assessed using the Boston Bowel Preparation Scale or, if that was missing, subjective reporting by the colonoscopist.
Overcoming Disparities
Before the intervention, the researchers measured significant disparities between the insured and underinsured groups in terms of bowel preparation and procedure completion. Compared with insured patients, underinsured patients had significantly lower rates of adequate bowel preparation (79.4% vs. 93.5%; P<0.0001) and significantly lower rates of procedure completion (92.8% vs. 97.2%; P<0.05).
After the introduction of the patient navigator, however, underinsured patients’ bowel preparation adequacy rates rose to 84.5% compared with 90.3% for insured patients. The rates of procedure completion also increased, with no significant difference seen between the underinsured and insured groups, at 95.2% and 98%, respectively.
“Following the intervention of a full-time navigator, the disparity in procedure completion rates between the insured and underinsured groups became statistically insignificant,” Mr. Gupta said. “This work could serve as a call for others to help reduce healthcare disparities faced by the underinsured.”
According to Mr. Gupta, one of the most interesting observations from the study was that language does not need to be a barrier to quality preparation. Spanish-speaking patients in the underinsured group who required an interpreter had even better preparation quality rates than English-speaking patients.
The investigators plan to conduct additional training for medical professionals to improve the explanation of bowel preparation to patients, and they are looking to hire more translators and navigators. Although they are considering automating some elements of patient outreach, Mr. Gupta underscored the importance of maintaining the personal, one-on-one interaction between navigators and patients.
“The role of patient navigators is not limited to guiding individuals through healthcare processes,” Mr. Gupta concluded. “They provide valuable support by building community connections and facilitating communication between patients and providers.”
Neil Stollman, MD, the chief of the Division of Gastroenterology at Alta Bates Summit Medical Center, in Oakland, Calif., told Gastroenterology & Endoscopy News that there have been many efforts to improve prep and completion rates with the use of patient navigators. “This study adds to the literature nicely, [showing] that such interventions can improve exam outcomes,” Dr. Stollman said. “The novel and exciting feature of this report specifically is that they also demonstrated that navigator use diminished disparities between well-insured and underinsured patients, and this is very encouraging, too.”
According to Dr. Stollman, this research is also consistent with data published last year showing that a programmatic stool testing (fecal immunochemical test) intervention also can reduce disparities between racial and ethnic groups (N Engl J Med 2022;386[8]:796-798).
“I think there are consistent data now to this point,” he concluded, “although there remains a question of support and resources for these additional personnel, especially in a time of diminishing reimbursement from payors.”
—Chase Doyle
Mr. Gupta and Dr. Stollman reported no relevant financial disclosures.
This article is from the January 2024 print issue.