S1515 Significantly Longer Delays to Colonoscopy in Underinsured Patients on Gastroenterology (GI) Fellows’ Panel Following the Novel Coronavirus Disease (COVID-19) Pandemic

Introduction: Underinsured patients have limited access to colonoscopy, which leads to delayed diagnosis and higher incidence of conditions such as colorectal cancer. Many academic centers in the U.S. schedule underinsured patients in GI fellows’ clinic under faculty supervision, with fewer available slots and longer wait times for procedures. At our institution, suspension of procedures and deployment of fellows during the COVID-19 pandemic resulted in cancellation of 40% of colonoscopies on the fellows’ panel. The aim of this study was to assess the impact of the pandemic on wait times for colonoscopy on GI fellows’ panel to develop strategies to improve delivery of colonoscopy. Methods: We conducted a retrospective chart review of 273 colonoscopies performed on our GI fellows’ panel from January 1, 2019 to December 31, 2021. We obtained data on patient demographics, indication for colonoscopy, and the time interval between the initial GI clinic visit and the day of the procedure. Each colonoscopy was classified as a screening, surveillance, or diagnostic procedure based on history of colonic adenoma or neoplasia and presence of any pertinent symptoms. Kruskal-Wallis one-way analyses of variance were conducted in GraphPad Prism to identify differences in wait times across the years. Results: A total of 102, 67, and 104 colonoscopies were performed on the GI fellows’ panel in years 2019, 2020, and 2021, respectively. 77% of the patients self-identified as non-White ethnicities and nearly half of the patients preferred languages other than English (Table 1). The overall median wait time between the initial clinic visit and the procedure increased significantly from 84 days in 2019 and 70 days in 2020 to 147 days in 2021 (P < 0.001; Figure 1). The median wait time for screening colonoscopy increased significantly from 73.5 days in 2019 to 161 days in 2021 (P < 0.001; Figure 1). The median wait time for diagnostic colonoscopy increased significantly from 63.5 days in 2020 to 126 days in 2021 (P < 0.01; Figure 1). Conclusion: Underinsured patients experienced significantly longer wait times for both screening and diagnostic colonoscopies following the COVID-19 pandemic. Excess mortality owing to delayed diagnoses is predicted to rise in the post-pandemic era and will disproportionately affect people from low socioeconomic status and ethnic minorities. We plan to hire a patient navigator and expand the fellows’ endoscopy slots to prevent widening of health disparities in this vulnerable population. Table 1. - Fellows' panel encounter demographics 2019-2021 2019N = 102 2020N = 67 2021N = 104 2019-2021N = 273 Median Age ± IQR (years) 54 ± 14 56 ± 19 51 ± 17 52 ±16 Sex (%)MaleFemale 43 (42%)59 (58%) 40 (60%)27 (40%) 40 (38%)64 (62%) 123 (45%)150 (55%) Race/Ethnicity (%)White/White (Not Hispanic or Latino)Hispanic or LatinoBlack/African AmericanAsian 30 (29%)55 (54%)12 (12%)5 (5%) 20 (30%)33 (49%)10 (15%)4 (6%) 14 (13%)70 (68%)14 (13%)6 (6%) 64 (23%)158 (58%)36 (13%)15 (6%) Language Preference (%)EnglishSpanishOther 66 (65%)33 (32%)3 (3%) 32 (48%)27 (40%)8 (12%) 47 (45%)49 (47%)8 (8%) 145 (53%)109 (40%)19 (7%) Colonoscopy Indication (%)ScreeningSurveillanceDiagnostic 24 (23%)8 (8%)70 (69%) 14 (21%)7 (10%)46 (69%) 39 (38%)5 (5%)60 (57%) 77 (28%)20 (7%)176 (65%) Figure 1.: Median wait time in days (± IQR) from the initial clinic visit to colonoscopy.