Reducing VA No-Shows: Evaluation of Predictive Overbooking Applied to Colonoscopy (No-show)
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Purpose
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 upper endoscopy patients and moving them out of traditional slots, investigators predict more scheduling slots would become available for patients awaiting colonoscopy.
| Condition | Intervention |
|---|---|
|
Colon Cancer |
Other: Predictive no-show overbooking |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Health Services Research |
| Official Title: | Reducing VA No-Shows: Evaluation of Predictive Overbooking Applied to Colonoscopy |
- Percent capacity [ Time Frame: After 8 months ] [ Designated as safety issue: No ]Investigators' primary objective will be to evaluate the impact of no-show predictive overbooking on percent capacity of the GI endoscopy unit.
- Scheduling-to-procedure lag time [ Time Frame: After 8 months ] [ Designated as safety issue: No ]We will calculate the mean and median daily lag time for all colonoscopy and upper endoscopies performed per day
- Daily service denials ("bumps") [ Time Frame: After 8 months ] [ Designated as safety issue: No ]We will compare the number of patients bumped per day between scheduling approaches
- Advanced adenoma detection/Cecal intubation rates [ Time Frame: After 8 months ] [ Designated as safety issue: No ]We will compare daily advanced adenomatous polyp detection and daily cecal intubation rates between groups.
- Daily withdrawal time [ Time Frame: After 8 months ] [ Designated as safety issue: No ]
- Cost comparisons [ Time Frame: After 8 months ] [ Designated as safety issue: No ]For cost comparisons, we will aggregate total accumulated cost per arm accounting for provider overtime and fee-for-service colonoscopies performed.
- patient satisfaction [ Time Frame: After 8 months ] [ Designated as safety issue: No ]To compare patient satisfaction with the endoscopic experience, we will use a validated 7-item questionnaire modified by the American Society for Gastrointestinal Endoscopy.
| Estimated Enrollment: | 500 |
| Study Start Date: | May 2013 |
| Estimated Study Completion Date: | October 2015 |
| Estimated Primary Completion Date: | October 2014 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Fast-tracked
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 upper 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
|
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 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. By rapidly processing upper 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 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.
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | Yes |
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, we will schedule these patients routinely.
Contacts and Locations| Contact: Brennan Spiegel, MD MSHS | (310) 478-3711 ext 43360 | Brennan.spiegel@va.gov |
| Contact: Jennifer Talley | (310) 478-3711 ext 44516 | jennifer.talley2@va.gov |
| United States, California | |
| VA Greater Los Angeles Healthcare System, West Los Angeles, CA | Not yet recruiting |
| West Los Angeles, California, United States, 90073 | |
| Contact: Brennan Spiegel, MD MSHS 310-478-3711 ext 43360 Brennan.spiegel@va.gov | |
| Contact: Jennifer Talley (310) 478-3711 ext 44516 jennifer.talley2@va.gov | |
| Principal Investigator: Brennan Spiegel, MD MSHS | |
| Principal Investigator: | Brennan Spiegel, MD MSHS | VA Greater Los Angeles Healthcare System, West Los Angeles, CA |
More Information
No publications provided
| Responsible Party: | Department of Veterans Affairs |
| ClinicalTrials.gov Identifier: | NCT01639443 History of Changes |
| Other Study ID Numbers: | IIR 12-055, 1 I01 HX000878-01 |
| Study First Received: | July 9, 2012 |
| Last Updated: | December 28, 2012 |
| Health Authority: | United States: Federal Government |
Keywords provided by Department of Veterans Affairs:
|
quality improvement Organization and Administration Costs and cost analysis Patient satisfaction Health plan implementation |
Additional relevant MeSH terms:
|
Colonic Neoplasms Colorectal Neoplasms Intestinal Neoplasms Gastrointestinal Neoplasms Digestive System Neoplasms Neoplasms by Site |
Neoplasms Digestive System Diseases Gastrointestinal Diseases Colonic Diseases Intestinal Diseases |
ClinicalTrials.gov processed this record on May 23, 2013