The role of health, sociodemographic, and care delivery factors in timely completion of colonoscopy in a US-based primary care population: a retrospective analysis

Background Timely colonoscopy completion in primary care can prevent diagnostic delays in colorectal cancer. Factors that influence why patients experience timely or delayed colonoscopy completion are unclear. We sought to identify potentially intervenable factors associated with earlier (or later) colonoscopy test completion in primary care. Methods All colonoscopy orders placed by primary care clinicians in two clinics within a single hospital system between January 1 2018 and December 31 2021 were examined for time to completion using Cox Proportional Hazards Model, where the hazards of completion were adjusted for variables potentially associated with the outcome, including sociodemographic, individual health-related, and care delivery factors. Results Among 10,576 colonoscopy tests ordered, 56% were completed within one year. After multivariable adjustment, earlier colonoscopy completion was associated with receiving care at a community health center, preferred spoken language other than English, male sex, Black race, any college education, a diagnosis of rectal bleeding, and documented use of an electronic patient portal. Completion occurred later among patients with Medicaid insurance, subsidized commercial insurance, or depression, and among patients whose tests were ordered by a nurse practitioner or a resident, or during a telehealth appointment. Results were similar for a sensitivity analysis restricted to those patients within a Medicaid ACO, except for the finding that Black race was no longer associated with test completion. Conclusions Based on our findings, certain factors associated with –early or delayed- colonoscopy test completion lend themselves to possible interventions. Targeted care navigation (e.g. reminder calls, assisted scheduling, transportation assistance) may be needed for patients whose colonoscopy tests are ordered at telehealth appointments or by NPs or residents, or who have certain insurance types (e.g. Medicaid and high-deductible insurance). Harnessing strategies used at community health centers to improve culturally competent test scheduling may also be a promising area of future work to help patients book and attend colon cancer test appointments. More study is needed to understand the observed relationship between electronic portal use and test completion and why some patient characteristics such as non-English preference are associated with earlier completion of ordered tests in our study.