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The Division of Gastroenterology, Hepatology and Endoscopy at Brigham and Women’s Hospital in Boston send out automated reminders to their patients through text and email. Read on to learn the results of their program.

Automated Reminders Boost Colonoscopy Prep Quality, Reduce No-Shows

Texting and emailing patients scheduled for colonoscopy to remind them about proper bowel preparation significantly improves the quality of their prep and avoids cancellations, new research shows.

“When patients miss their colonoscopy appointments or arrive with inadequate bowel preparation, care can be delayed and revenue lost. We evaluated the effect of an automated time-released colonoscopy reminder program on preparation quality and the rates of canceled procedures,” said Jennifer Nayor, MD, of the Division of Gastroenterology, Hepatology and Endoscopy at Brigham and Women’s Hospital in Boston, who led the effort.

Preparation instructions and appointment reminders were delivered to patients using an automated time-released HIPAA-compliant software platform (Medumo Inc.) to provide patients with a digital guide to bowel prep in advance of their procedure. The reminders included 20 messages—by text, email or both formats—that were specific to the patient’s preparation type, method of sedation and the location of the facility for the procedure.

The first reminder was sent the day after the colonoscopy was booked, and the final message was sent the day after the colonoscopy was completed. Patients completed a survey about their experience with the automated reminder system.

Included in the reminder program were 1,497 patients (59% women; mean age, 56 years) scheduled for colonoscopy at Brigham and Women’s over a three-month period in 2017. The primary outcome metrics were rate of inadequate bowel preparation, rate of canceled procedures and patient satisfaction with care.

Outcomes of the intervention were compared with colonoscopies performed during the same three months of the previous year; these patients served as the baseline cohort. The intervention group also was compared with patients who were excluded from the reminder program; they served as the nonintervention cohort.

At predetermined intervals, patients receive automated instructions and reminders explaining what steps they should complete at that time. Among these are notifications about when to stop eating solid food and when to consume the prep solution. On the day of their procedure, patients also received a text with directions to the center.

Staff originally had to manually input data from the electronic health record to Medumo for each patient, but that process is now automated from the time of scheduling.

Big Gains in Prep Quality

Before the intervention, 11.5% of the baseline cohort had inadequate prep quality within a three-month period. With the three-month reminder program in place, the rate of inadequate prep fell to 3.8% (P<0.001), according to the researchers.

In a sensitivity analysis, use of the automated reminder program increased the odds of adequate prep quality almost 3.5-fold (P<0.0001), Dr. Nayor reported.

In addition, the no-show rate dropped from 6.1% to 4.3% (P=0.01); the percentage of cancellations after arrival dropped from 1.8% to 1.1%. The impact on cancellations was only seen among women, however (P=0.0007). These changes resulted in a 1.9% increase in overall volume of completed colonoscopies, she said.

In the nonintervention group, the rates of inadequate preparation quality (11.8% vs. 11.5%; P=0.89) and procedure cancellation (6.6% vs. 6.1%; P=0.71) were similar to the baseline cohort.

“I anticipated that we’d see an improvement, but the preliminary results were beyond what I expected, and it continues to be successful,” Dr. Nayor said. “The feedback has also been really positive from patients. They like the idea that we’re helping them through this.”

Patients participating in the digital reminder program rated their satisfaction at a mean of 9.07 on a 10-point scale. Many made comments such as, “I felt like someone cared,” and “I don’t think I could go through the process without the instructions program,” she added.

Ma Somsouk, MD, MAS, the Dean M. Craig Endowed Chair in Gastrointestinal Medicine at the University of California, San Francisco, who has a research interest in vulnerable populations, said, “Colonoscopy can be complicated because it is a multistep procedure. First, it is arranged by another specialist and not the primary care provider. Scheduling the procedure can also be problematic since patients are not always aware of the need or indication for the colonoscopy. Therefore, any solution that enhances patient education, prep quality and physician-patient coordination for the procedure is an important service.”

Article by: Caroline Helwick, Gastroenterology and Endoscopy News

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