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Colon CancerNo-showNCT01639443

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

A study testing Predictive no-show overbooking in people with Colon Cancer, run by VA Office of Research and Development at 1 site in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

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. Read more about this study

Who is it for?
Ages 18 years and olderHealthy volunteers can take part
Conditions the study is for
Colon Cancer
What is being tested?
Predictive no-show overbooking
Could I receive a placebo?
No, everyone receives an active treatment
How many people
180 participants
Where
1 siteUnited States
Study dates
8 Jul 2013to 30 Jun 2016
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Who may be able to join

  • Patients who are scheduled for upper endoscopy and agree to the terms of "fast track" offer.

Who cannot join

  • If a patient expresses concern about service denial, confusion about the bargain, or refuses to participate, the investigators will schedule these patients routinely.

Trial locations and contacts

1 site in 1 country.

United States1 site

  • VA Greater Los Angeles Healthcare System, West Los Angeles, CA

    West Los Angeles, California, 90073

Other trials in United States

About this study

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.

Read the 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 (West Los Angeles Veterans Administration) 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.

Conditions
Colon Cancer
Being tested
Predictive no-show overbooking
Keywords
quality improvement, Organization and Administration, Costs and cost analysis, Patient satisfaction, Health plan implementation
Medical subject headings
Colonic Neoplasms, Patient Satisfaction

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Predictive no-show overbookingOther

    During intervention period, every Veteran scheduled for an 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.

Study groups in NCT01639443
Study groupRoleWhat they receive
Fast-trackedExperimental'Predictive no-show overbooking' intervention. 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.
Receives: Other: Predictive no-show overbooking
ControlNo interventionPatients who are scheduled routinely

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of GI Clinic Capacity Filled

    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.

    Measured: After 12 months of running study in clinic

Secondary outcomes (5)

  1. Scheduling-to-procedure Lag Time

    The investigators will calculate the mean daily lag time for all colonoscopy and upper endoscopies performed per day

    Measured: After 12 months of running study in clinic

  2. Daily Service Denials ("Bumps")

    The investigators will compare the number of patients bumped per day between scheduling approaches

    Measured: After 12 months of running study in clinic

  3. Advanced Adenoma Detection/Cecal Intubation Rates

    The investigators will compare daily advanced adenomatous polyp detection and daily cecal intubation rates between groups.

    Measured: After 20 months of running study in clinic

  4. Length of Workday

    Length of Workday in hours (comparing days with Fast-Tracked Appointments to Control days without)

    Measured: After 12 months of running study in clinic

  5. Cost Comparisons

    For cost comparisons, the investigators will aggregate total provider overtime costs for colonoscopies performed. Cost is reported per day.

    Measured: After 12 months of running study in clinic

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted12 Jul 2012 (estimated)
  2. Study start8 Jul 2013
  3. Primary completion6 Jul 2015
  4. Study completion30 Jun 2016

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
180 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01639443
Sponsor's protocol ID
IIR 12-055
Other IDs
1I01HX000878-01
Acronym
No-show
Status last verified
Mar 2018
First submitted
9 Jul 2012
Last updated
12 Apr 2018
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Reid MW, Cohen S, Wang H, Kaung A, Patel A, Tashjian V, Williams DL Jr, Martinez B, Spiegel BM. Preventing patient absenteeism: validation of a predictive overbooking model. Am J Manag Care. 2015 Dec;21(12):902-10.

    PubMed 26671702

  • Reid MW, May FP, Martinez B, Cohen S, Wang H, Williams DL Jr, Spiegel BM. Preventing Endoscopy Clinic No-Shows: Prospective Validation of a Predictive Overbooking Model. Am J Gastroenterol. 2016 Sep;111(9):1267-73. doi: 10.1038/ajg.2016.269. Epub 2016 Jul 5.

    PubMed 27377518

  • May FP, Reid MW, Cohen S, Dailey F, Spiegel BM. Predictive overbooking and active recruitment increases uptake of endoscopy appointments among African American patients. Gastrointest Endosc. 2017 Apr;85(4):700-705. doi: 10.1016/j.gie.2016.09.001. Epub 2016 Sep 10.

    PubMed 27623103

Questions about this trial

What is this clinical trial studying?

A study testing Predictive no-show overbooking in people with Colon Cancer, run by VA Office of Research and Development at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Apr 2018. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 31 Oct 2016). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of GI Clinic Capacity Filled (time frame: After 12 months of running study in clinic). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01639443, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Apr 2018.

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