Improving attendance to outpatient endoscopy appointments among blacks

描述（由申请人提供）：在美国，大约每十例死亡中就有一例可归因于胃肠道系统的基础疾病。门诊内窥镜检查构成了诊断和治疗这些疾病的护理计划的一个组成部分。在过去的十年中，内镜筛查癌前病变的检测一直在增加。由于幽门螺杆菌感染和结直肠癌的患病率较高，服务不足的人群通常通过内窥镜检查预防、诊断或治疗胃肠道疾病，如消化性溃疡疾病，从而造成更高的负担。不幸的是，据报道，在服务不足的人群中，特别是在安全网医院，门诊内窥镜检查的不依从率很高。患者导航服务已被证明可以提高依从性，但增加的人力成本阻止了这种策略在大多数少数民族服务机构中成为常规。因此，需要一种容易获得且低成本的替代方案来改善服务不足人群中的内窥镜检查递送。我们观察到，已婚患者更符合癌症筛查是否需要护送（结肠镜检查）或不（乳房X光检查）。因此，我们假设，直接涉及患者的社会联系人将提高门诊内镜检查的依从性，在出现他们的程序和以下准备说明。没有以前的研究已经评估了直接参与患者的社会接触，以改善内窥镜检查服务提供。我们计划招募400例已安排进行门诊筛查结肠镜检查的患者，并将其随机分为两组，按婚姻状况分层（已婚与未婚）：在常规护理中（第1组），仅患者在计划程序前3天接受电话提醒。在干预组（第2组）中，将像常规护理一样提醒患者，但也将联系社会联系人并要求其承担患者导航员的角色，以鼓励患者并促进其完成计划的结肠镜检查。我们将比较结肠镜检查患者的百分比，并通过肠道准备的充分性来比较手术的质量。

DESCRIPTION (provided by applicant): Approximately one out of every ten deaths in the United States is attributable to an underlying disease of the gastrointestinal system. Outpatient endoscopy constitutes an integral part of the care plan to diagnose and treat these disorders. In the last decade, endoscopic screening for detection of premalignant lesions has been increasing. Underserved populations have a disproportionally higher burden from gastrointestinal diseases that are commonly prevented, diagnosed or treated with endoscopy such as peptic ulcer disease due to higher prevalence of Helicobacter Pylori infection and colorectal cancer. Unfortunately, a high rate of non- compliance to outpatient endoscopy has been reported among underserved populations particularly in safety net hospitals. Patient navigation services have been shown to improve adherence, but the added manpower cost has prevented this strategy from being routine in most minority serving institutions. Therefore, there is a need for a readily available and low cost alternative to improve endoscopy delivery among the underserved. We observed that married patients were more compliant with cancer screening whether there is a need for escort (colonoscopy) or not (mammography). Therefore, we hypothesize that directly involving the patient's social contact person will improve compliance to out-patient endoscopy in terms of showing up for their procedures and following preparation instructions. No previous study has evaluated the direct involvement of a patient's social contact to improve endoscopy services delivery. We plan to recruit 400 patients who have been scheduled for out-patient screening colonoscopy and randomly assign them into two groups stratified by marital status (married versus unmarried): In usual care (group 1), only the patient will be given a telephone reminder 3 days before their scheduled procedures. In the intervention arm (group 2), the patient will be reminded as in usual care, but the social contact will also be contacted and asked to assume the role of a patient navigator to encourage the patient and facilitate his/her completion of the scheduled colonoscopy. We will compare the percentage of patients who show up for their colonoscopy and also compare the quality of the procedure performed as measured by the adequacy of bowel preparation.