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

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ClinicalTrials.gov Identifier: NCT01639443
Recruitment Status : Completed
First Posted : July 12, 2012
Results First Posted : October 31, 2016
Last Update Posted : April 12, 2018
Sponsor:
Information provided by (Responsible Party):
VA Office of Research and Development

Study Type Interventional
Study Design Allocation: Randomized;   Intervention Model: Parallel Assignment;   Masking: None (Open Label);   Primary Purpose: Health Services Research
Condition Colon Cancer
Intervention Other: Predictive no-show overbooking
Enrollment 180
Recruitment Details  
Pre-assignment Details  
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description

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.

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.

Patients who are scheduled routinely
Period Title: Overall Study
Started 180 [1] 4855 [2]
Completed 180 [3] 4855 [4]
Not Completed 0 0
[1]
These individuals opted into Fast-tracked group and were consented.
[2]
These individuals opted to not participate in Fast-tracked group, and were not consented.
[3]
Intervention is limited to appointment booking, and all completed.
[4]
These individuals all booked appointments using typical booking.
Arm/Group Title Fast-tracked Control Total
Hide Arm/Group Description

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.

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.

Patients who are scheduled routinely Total of all reporting groups
Overall Number of Baseline Participants 180 4855 5035
Hide Baseline Analysis Population Description
All Participants in all study phases.
Age, Categorical  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 180 participants 4855 participants 5035 participants
<=18 years
0
   0.0%
0
   0.0%
0
   0.0%
Between 18 and 65 years
112
  62.2%
2812
  57.9%
2924
  58.1%
>=65 years
68
  37.8%
2043
  42.1%
2111
  41.9%
Age, Continuous  
Mean (Standard Deviation)
Unit of measure:  Years
Number Analyzed 180 participants 4855 participants 5035 participants
59.3  (13.6) 62.2  (10.0) 62.1  (10.1)
Sex: Female, Male  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 180 participants 4855 participants 5035 participants
Female
12
   6.7%
206
   4.2%
218
   4.3%
Male
168
  93.3%
4649
  95.8%
4817
  95.7%
Ethnicity (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 180 participants 4855 participants 5035 participants
Hispanic or Latino
17
   9.4%
565
  11.6%
582
  11.6%
Not Hispanic or Latino
163
  90.6%
4290
  88.4%
4453
  88.4%
Unknown or Not Reported
0
   0.0%
0
   0.0%
0
   0.0%
Race (NIH/OMB)  
Measure Type: Count of Participants
Unit of measure:  Participants
Number Analyzed 180 participants 4855 participants 5035 participants
American Indian or Alaska Native
2
   1.1%
35
   0.7%
37
   0.7%
Asian
5
   2.8%
109
   2.2%
114
   2.3%
Native Hawaiian or Other Pacific Islander
2
   1.1%
28
   0.6%
30
   0.6%
Black or African American
70
  38.9%
1584
  32.6%
1654
  32.9%
White
83
  46.1%
2414
  49.7%
2497
  49.6%
More than one race
2
   1.1%
41
   0.8%
43
   0.9%
Unknown or Not Reported
16
   8.9%
644
  13.3%
660
  13.1%
Region of Enrollment  
Measure Type: Number
Unit of measure:  Participants
United States Number Analyzed 180 participants 4855 participants 5035 participants
180 4855 5035
1.Primary Outcome
Title Percentage of GI Clinic Capacity Filled
Hide Description 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.
Time Frame After 12 months of running study in clinic
Hide Outcome Measure Data
Hide Analysis Population Description
These 1672 patients are a subset of all patients who were enrolled in this study. We dropped data on a first wave of participants (69 Fast-tracked and 3294 Controls) because of problems incorporating recruitment strategy into clinic. However, data from these individuals was used to build predictive model.
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description:

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.

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.

Patients who are scheduled routinely
Overall Number of Participants Analyzed 111 1561
Mean (Standard Deviation)
Unit of Measure: percentage of clinic capacity filled
99.6  (19.4) 86.4  (21.6)
Show Statistical Analysis 1 Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Fast-tracked, Control
Comments We counted days containing at least one Fast-tracked participant as a "Fast-tracked" day for the sake of analysis at the clinic level. Our null hypothesis is that these days will not differ in terms of percentage of clinic capacity filled. We are powered to detect a 0.5 Standard Deviation (SD) difference in clinic capacity (Type I error rate = 5%; Power = 81%), with a equal ratio of Experimental and Control days.
Type of Statistical Test Superiority or Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value <0.0001
Comments [Not Specified]
Method t-test, 2 sided
Comments [Not Specified]
2.Secondary Outcome
Title Scheduling-to-procedure Lag Time
Hide Description The investigators will calculate the mean daily lag time for all colonoscopy and upper endoscopies performed per day
Time Frame After 12 months of running study in clinic
Hide Outcome Measure Data
Hide Analysis Population Description
These 1672 patients are a subset of all patients who were enrolled in this study. We dropped data on a first wave of participants (69 Fast-tracked and 3294 Controls) because of problems incorporating recruitment strategy into clinic. However, data from these individuals was used to build predictive model.
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description:

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.

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.

Patients who are scheduled routinely
Overall Number of Participants Analyzed 111 1561
Mean (Standard Deviation)
Unit of Measure: days
8.3  (24.3) 10.8  (24.0)
Show Statistical Analysis 1 Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Fast-tracked, Control
Comments We calculated this measure on the patient level. Our null hypothesis is that the lag time between scheduling and appointment, measured in days, will not differ between groups. We are powered to detect a 0.3 SD difference in lag time (Type I error rate = 5%; Power = 84%), accounting for the large sampling ratio (approximately 14:1).
Type of Statistical Test Superiority or Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.29
Comments [Not Specified]
Method t-test, 2 sided
Comments [Not Specified]
3.Secondary Outcome
Title Daily Service Denials ("Bumps")
Hide Description The investigators will compare the number of patients bumped per day between scheduling approaches
Time Frame After 12 months of running study in clinic
Hide Outcome Measure Data
Hide Analysis Population Description
These 1672 patients are a subset of all patients who were enrolled in this study. We dropped data on a first wave of participants (69 Fast-tracked and 3294 Controls) because of problems incorporating recruitment strategy into clinic. However, data from these individuals was used to build predictive model.
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description:

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.

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.

Patients who are scheduled routinely
Overall Number of Participants Analyzed 111 1561
Measure Type: Number
Unit of Measure: participants
0 29
Show Statistical Analysis 1 Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Fast-tracked, Control
Comments We did not explicitly power this study to detect differences in the number of service bumps, but we can compare them using Fisher's Exact Test
Type of Statistical Test Superiority or Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.49
Comments We would have only expected 2 patients to be bumped in the Experimental Group, and observed 0.
Method Fisher Exact
Comments [Not Specified]
4.Secondary Outcome
Title Advanced Adenoma Detection/Cecal Intubation Rates
Hide Description The investigators will compare daily advanced adenomatous polyp detection and daily cecal intubation rates between groups.
Time Frame After 20 months of running study in clinic
Hide Outcome Measure Data
Hide Analysis Population Description
We only collected data on polyp detection for the first half of our Fast-tracked participants and all Controls seen over the same time period (4897 in total).
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description:

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.

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.

Patients who are scheduled routinely
Overall Number of Participants Analyzed 90 4807
Mean (Standard Deviation)
Unit of Measure: Number of Polyps Detected per patient
2.35  (1.58) 2.88  (2.56)
Show Statistical Analysis 1 Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Fast-tracked, Control
Comments We calculated this measure on the patient level, but were hampered by a large sampling ratio (more than 50:1). Our null hypothesis is that the number of polyps detected will not differ between groups. We are powered to detect a 0.25 SD difference in polyp count per patient (Type I error rate = 5%; Power = 80%).
Type of Statistical Test Superiority or Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.05
Comments [Not Specified]
Method t-test, 2 sided
Comments [Not Specified]
5.Secondary Outcome
Title Length of Workday
Hide Description Length of Workday in hours (comparing days with Fast-Tracked Appointments to Control days without)
Time Frame After 12 months of running study in clinic
Hide Outcome Measure Data
Hide Analysis Population Description
These 1672 patients are a subset of all patients who were enrolled in this study. We dropped data on a first wave of participants (69 Fast-tracked and 3294 Controls) because of problems incorporating recruitment strategy into clinic. However, data from these individuals was used to build predictive model.
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description:

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.

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.

Patients who are scheduled routinely
Overall Number of Participants Analyzed 111 1561
Mean (Standard Deviation)
Unit of Measure: hours
8.31  (1.32) 7.84  (1.32)
Show Statistical Analysis 1 Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Fast-tracked, Control
Comments We counted days containing at least one Fast-tracked participant as a "Fast-tracked" day for the sake of analysis at the clinic level. Our null hypothesis is that these days will not differ in terms of length of workday. We are powered to detect approximately 0.5 SD difference in workday length in hours (Type I error rate = 5%; Power = 81%), with a equal ratio of Experimental and Control days.
Type of Statistical Test Superiority or Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.024
Comments [Not Specified]
Method t-test, 2 sided
Comments [Not Specified]
6.Secondary Outcome
Title Cost Comparisons
Hide Description For cost comparisons, the investigators will aggregate total provider overtime costs for colonoscopies performed. Cost is reported per day.
Time Frame After 12 months of running study in clinic
Hide Outcome Measure Data
Hide Analysis Population Description
These 1672 patients are a subset of all patients who were enrolled in this study. We dropped data on a first wave of participants (69 Fast-tracked and 3294 Controls) because of problems incorporating recruitment strategy into clinic. However, data from these individuals was used to build predictive model.
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description:

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.

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.

Patients who are scheduled routinely
Overall Number of Participants Analyzed 111 1561
Mean (Standard Deviation)
Unit of Measure: dollars
63.01  (107.01) 36.88  (101.73)
Show Statistical Analysis 1 Hide Statistical Analysis 1
Statistical Analysis Overview Comparison Group Selection Fast-tracked, Control
Comments We counted days containing at least one Fast-tracked participant as a "Fast-tracked" day for the sake of analysis at the clinic level. Our null hypothesis is that these days will not differ in terms of cost per day. We are powered to detect a 0.5 SD difference in clinic capacity (Type I error rate = 5%; Power = 81%), with a equal ratio of Experimental and Control days.
Type of Statistical Test Superiority or Other
Comments [Not Specified]
Statistical Test of Hypothesis P-Value 0.11
Comments [Not Specified]
Method t-test, 2 sided
Comments [Not Specified]
Time Frame After 24 months of running study in clinic
Adverse Event Reporting Description This study involved scheduling patients for appointments, so the odds of an adverse event are extremely low.
 
Arm/Group Title Fast-tracked Control
Hide Arm/Group Description

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.

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.

Patients who are scheduled routinely
All-Cause Mortality
Fast-tracked Control
Affected / at Risk (%) Affected / at Risk (%)
Total   --/--   --/-- 
Show Serious Adverse Events Hide Serious Adverse Events
Fast-tracked Control
Affected / at Risk (%) Affected / at Risk (%)
Total   0/180 (0.00%)   0/4855 (0.00%) 
Show Other (Not Including Serious) Adverse Events Hide Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events 0%
Fast-tracked Control
Affected / at Risk (%) Affected / at Risk (%)
Total   0/180 (0.00%)   0/4855 (0.00%) 
This study was impeded by our ability to schedule Veterans into Fast-Tracked appointments. Although the method is very promising, integration of predictive scheduling is vital for this program to benefit Veterans on a large scale.
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
Results Point of Contact
Name/Title: Jennifer Talley Soares
Organization: West Los Angeles VA / Cedars-Sinai Medical Center
Phone: (310) 478-3711 ext 83240
Responsible Party: VA Office of Research and Development
ClinicalTrials.gov Identifier: NCT01639443     History of Changes
Other Study ID Numbers: IIR 12-055
1I01HX000878-01 ( U.S. NIH Grant/Contract )
First Submitted: July 9, 2012
First Posted: July 12, 2012
Results First Submitted: June 30, 2016
Results First Posted: October 31, 2016
Last Update Posted: April 12, 2018