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BACKGROUND/RATIONALE:
Low endoscopy completion rates are a major problem in the VA, causing delay or failure to receive essential care, increased clinic wait times, lost capacity, increased costs, thus limiting endoscopic screening for colorectal cancer. This study tests whether an Interactive Voice Response (IVR) messaging system is equally effective in promoting the completion of flexible sigmoidoscopy and colonoscopy as usual clinical care practices that include phone calls from nurses to patients prior to preparation and procedures. This is the first study to evaluate the use of IVR for appointment reminders and to inform patients of steps to adequately prepare for flexible sigmoidoscopy and colonoscopy. It is also the first to compare the effectiveness of IVR and phone calls from nurses prior to an endoscopy appointment.
OBJECTIVE(S):
1) To test the equivalence of IVR messaging and usual clinical care in promoting completion rates of flexible sigmoidoscopy and colonoscopy. 2) To test the timing of the IVR messages to see if messages are more salient immediately before preparation for the appointment or one week before. 3) To test for differences in patient satisfaction with both systems.
METHODS:
We will use a three-arm randomized trial: 1) Usual care. Usual care (UC) at the Minneapolis VAMC consists of a mailed appointment notification letter after an appointment has been made and a personal reminder call from a clinic nurse 7 days prior to the veteran's appointment. Nurses use a computerized template to guide them through the call. They remind patients of their appointment date and time, thoroughly review preparation instructions, provide basic information about the procedure, and answer any questions patients may have. One day prior to the scheduled appointment, veterans receive a generic automated reminder call that informs them that they have an appointment scheduled at the Minneapolis VAMC. 2) Intervention 1 (IVR-7). The IVR system calls patients 7 days prior to their appointment. Information available in the IVR system is based on the same template nurses use in usual care and includes an appointment reminder, preparation instructions, basic information about the procedure, and answers to commonly asked questions. One day prior to the scheduled appointment, veterans receive a generic automated reminder call that informs them that they have an appointment scheduled at the Minneapolis VAMC. 3) Intervention 2 (IVR-3). Identical to Intervention 1, but IVR system calls patients 3 days prior to their appointment, instead of 7 days.
For 15 months all patients scheduled for colonoscopy or flexible sigmoidoscopy in the GI clinic will be randomized into one of the three groups.
The principal outcome measures will be (1) percent of colonoscopies completed; (2) percent of flexible sigmoidoscopies completed; (3) percent of no shows and patient cancellations for colonoscopy; (4) percent of no shows or patient cancellations for flexible sigmoidoscopy. Surveys will be sent to all individuals who made an appointment in the GI clinic to assess satisfaction within each arm. In addition, survey information will be collected to assess possible reasons why some patients do not show for their appointment or do not adequately prepare for the procedure.
FINDINGS/RESULTS:
No findings to date.
IMPACT:
The intervention may affect colorectal cancer screening rates (CRC-QUERI Goal II) and the complete diagnostic evaluation of positive colorectal cancer screening results (CRC-QUERI Goal I) The study extends the use of an established technology (IVR) to test its effectiveness in relation to a gold standard (nurse telephone calls). The focus on a single development site speeds the IVR development process, while inclusion of consulting experts from diverse partner sites facilitates the dissemination of results across clinics.
We are currently in the process of collecting data. The project impact remains the same.
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases, Health Services and Systems
DRE:
none
Keywords:
Cancer, Screening
MeSH Terms:
none
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