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

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by (Responsible Party):
VA Office of Research and Development
ClinicalTrials.gov Identifier:
NCT01639443
First received: July 9, 2012
Last updated: January 6, 2016
Last verified: January 2016
  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 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

Resource links provided by NLM:


Further study details as provided by VA Office of Research and Development:

Primary Outcome Measures:
  • Percent capacity [ Time Frame: After 24 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.


Secondary Outcome Measures:
  • Scheduling-to-procedure lag time [ Time Frame: After 8 months ] [ Designated as safety issue: No ]
    The investigators 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 ]
    The investigators 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 ]
    The investigators 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 24 months ] [ Designated as safety issue: No ]
    For cost comparisons, the investigators will aggregate total accumulated cost per arm accounting for provider overtime and fee-for-service colonoscopies performed.


Enrollment: 180
Study Start Date: July 2013
Estimated Study Completion Date: July 2017
Primary Completion Date: July 2015 (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 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 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
Criteria

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.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01639443

Locations
United States, California
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, California, United States, 90073
Sponsors and Collaborators
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
  More Information

Publications:
Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT01639443     History of Changes
Other Study ID Numbers: IIR 12-055  1I01HX000878-01 
Study First Received: July 9, 2012
Last Updated: January 6, 2016
Health Authority: United States: Federal Government

Keywords provided by VA Office of Research and Development:
quality improvement
Organization and Administration
Costs and cost analysis
Patient satisfaction
Health plan implementation

ClinicalTrials.gov processed this record on February 11, 2016