Reducing VA No-Shows: Evaluation of Predictive Overbooking Applied to Colonoscopy (No-show)

In this research study, investigators use colonoscopy as a case example to evaluate a predictive overbooking model derived using patient-level predictors of absenteeism. The no-show overbooking intervention employs a logistic regression model that uses patient data to predict the odds of no-showing with 80% accuracy. These projected no-show appointments will be overbooked by clerks for patients who agree to join a "fast track" short-call line. By rapidly processing endoscopy patients and moving them out of traditional slots, investigators predict more scheduling slots would become available for patients awaiting colonoscopy.

Study Overview

• Status: Completed
• Conditions: Colon Cancer
• Intervention / Treatment: Other: Predictive no-show overbooking

Detailed Description

Patient "no-shows" are especially common in VA gastrointestinal (GI) endoscopy units, where both open-access endoscopy scheduling and patient dislike of procedures contribute to high absenteeism. In this proposal, investigators use endoscopy as a case example to evaluate a predictive overbooking model derived using patient-level predictors of absenteeism. The no-show overbooking intervention employs a logistic regression model that uses patient data to predict the odds of no-showing with 80% accuracy. These projected no-show appointments will be overbooked by clerks for patients who agree to join a "fast track" short-call line. However, patients scheduled for upper endoscopies in the "fast track" assume a small risk of service denial on the day of their overbooking in case of inaccurate predictions. If this occurs, the patient is guaranteed service in the next available position and is assured of having a shorter wait time. Patients scheduled for colonoscopies will never be turned down but may experience delays in the waiting room the day of their "fast track" appointment. By rapidly processing endoscopy patients and moving them out of traditional slots, investigators predict more scheduling slots would become available for patients awaiting colonoscopy. Investigators propose to conduct a prospective, 24-month, interrupted time series (ITS) trial in the WLAVA (West Los Angeles Veterans Administration) GI clinic endoscopy unit. During intervention periods, investigators will activate the no-show predictive overbooking strategy described above. Investigators will compare outcomes between scheduling strategies, including differences in percent utilization of capacity (primary outcome), number of Veterans served, mean patient lag time between scheduling and procedure, number of unexpected service denials ("bumps") from no-show predictive overbooking, and direct costs of care. Investigators will analyze differences using both traditional univariate and multivariate approaches, and using autoregressive integrated moving average (ARIMA) analyses to adjust for auto-correlations in ITS data.

• Study Type: Interventional
• Enrollment (Actual): 180
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • West Los Angeles, California, United States, 90073
      • VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients who are scheduled for upper endoscopy and agree to the terms of "fast track" offer.

Exclusion Criteria:

• If a patient expresses concern about service denial, confusion about the bargain, or refuses to participate, the investigators will schedule these patients routinely.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Fast-tracked; 'Predictive no-show overbooking' intervention. Patients who volunteer to enroll in "fast-track" line, which gives them an opportunity to overbook their appointment for endoscopy earlier in a predictive no-show slots.	Other: Predictive no-show overbooking; During intervention period, every Veteran scheduled for an endoscopy will be offered "fast-track" offer, which gives them a chance to get their endoscopy procedure done earlier than usual scheduling by overbooking their appointment in a predictive no-show slot.
No Intervention: Control; Patients who are scheduled routinely

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percentage of GI Clinic Capacity Filled	Investigators' primary objective will be to evaluate the impact of no-show predictive overbooking on percentage of the GI endoscopy clinic that are filled on a given day. Days where at least one Fast-tracked patient attended an appointment were compared to days where only Control patients attended appointments. Percentage of GI Clinic Capacity is calculated as the number of appointments completed divided by number of appointment spots available on a given day. This percentage was compared between Fast-tracked days and Control days, using data from 1672 patients.	After 12 months of running study in clinic

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Scheduling-to-procedure Lag Time	The investigators will calculate the mean daily lag time for all colonoscopy and upper endoscopies performed per day	After 12 months of running study in clinic
Daily Service Denials ("Bumps")	The investigators will compare the number of patients bumped per day between scheduling approaches	After 12 months of running study in clinic
Advanced Adenoma Detection/Cecal Intubation Rates	The investigators will compare daily advanced adenomatous polyp detection and daily cecal intubation rates between groups.	After 20 months of running study in clinic
Length of Workday	Length of Workday in hours (comparing days with Fast-Tracked Appointments to Control days without)	After 12 months of running study in clinic
Cost Comparisons	For cost comparisons, the investigators will aggregate total provider overtime costs for colonoscopies performed. Cost is reported per day.	After 12 months of running study in clinic

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Paul G. Shekelle, MD PhD MPH, VA Greater Los Angeles Healthcare System, West Los Angeles, CA

Publications and helpful links

General Publications

• Reid MW, Cohen S, Wang H, Kaung A, Patel A, Tashjian V, Williams DL Jr, Martinez B, Spiegel BM. Preventing patient absenteeism: validation of a predictive overbooking model. Am J Manag Care. 2015 Dec;21(12):902-10.
• Reid MW, May FP, Martinez B, Cohen S, Wang H, Williams DL Jr, Spiegel BM. Preventing Endoscopy Clinic No-Shows: Prospective Validation of a Predictive Overbooking Model. Am J Gastroenterol. 2016 Sep;111(9):1267-73. doi: 10.1038/ajg.2016.269. Epub 2016 Jul 5.
• May FP, Reid MW, Cohen S, Dailey F, Spiegel BM. Predictive overbooking and active recruitment increases uptake of endoscopy appointments among African American patients. Gastrointest Endosc. 2017 Apr;85(4):700-705. doi: 10.1016/j.gie.2016.09.001. Epub 2016 Sep 10.

Study record dates

Study Major Dates

• Study Start (Actual): July 8, 2013
• Primary Completion (Actual): July 6, 2015
• Study Completion (Actual): June 30, 2016

Study Registration Dates

• First Submitted: July 9, 2012
• First Submitted That Met QC Criteria: July 9, 2012
• First Posted (Estimate): July 12, 2012

Study Record Updates

• Last Update Posted (Actual): April 12, 2018
• Last Update Submitted That Met QC Criteria: March 13, 2018
• Last Verified: March 1, 2018

More Information

Terms related to this study

• Keywords: Patient satisfaction; quality improvement; Health plan implementation; Costs and cost analysis; Organization and Administration
• Additional Relevant MeSH Terms: Digestive System Diseases; Neoplasms; Neoplasms by Site; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Colorectal Neoplasms; Colonic Neoplasms
• Other Study ID Numbers: IIR 12-055; 1I01HX000878-01 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No