P3652 - Improving Post-Acute Diverticulitis Colonoscopy Adherence in an Urban Safety Net Hospital Using Computed Tomography Reports

Luke Chmielecki, MD¹, Marisa Wu, MD², Nathan H. Pham, MD³, Avneesh Gupta, MD¹, Laura Chiu, MD, MPH¹, Paul C. Schroy, MD, MPH^1
1Boston Medical Center, Boston University School of Medicine, Boston, MA; ²Boston Medical Center, Boston, MA; ³University of Washington, San Jose, CA

Introduction: Despite the recommendation for timely colonoscopy following an episode of acute diverticulitis to rule out missed colorectal cancer, a significant gap exists between recommended practice and real-world application. We aimed to determine if including the AGA’s current best practice guideline in the abdominal computed tomography (CT) scan report would increase post-diverticulitis colonoscopy completion rates.

Methods: Patients with either complicated or uncomplicated acute diverticulitis diagnosed by CT between 12/1/2018 and 12/20/2019 prior to the Covid pandemic (“preCovid”) and between 7/1/2021 and 6/30/2022 during the post-emergency pandemic phase (“postCovid”) were evaluated. During the postCovid phase, a “Dot Phrase” was added to the radiology reports of eligible patients, recommending a follow-up colonoscopy within 6-8 weeks after an episode of complicated diverticulitis or after the first episode of uncomplicated diverticulitis if no colonoscopy had been performed within the prior year. A protocol was developed whereby providers could page an endoscopy scheduler to expedite timely colonoscopy follow-up. The primary outcome was the completion of a colonoscopy within 6 months from diagnosis to account for possible scheduling delays.

Results: In the preCovid group there were 106 cases of acute diverticulitis, including 27 (25%) complicated cases and 79 (75%) uncomplicated. In contrast, the intervention postCovid group included 177 cases of acute diverticulitis, of which 38 (21%) were complicated and 139 (79%) uncomplicated. Overall, the 6-month colonoscopy completion rates were higher in the post-Covid group compared to the preCovid group (26% vs 12%; p< 0.01). This increase was seen in both uncomplicated cases (24% vs. 8%; p< 0.01), and complicated cases (32% vs. 22%; p=0.41), although the latter did not reach statistical significance. Completion rates were also higher among the 23% of patients in the postCovid group whose reports included the dot phrase compared to those whose reports did not (50% vs. 19%; p< 0.001). Among the 58 patients who underwent colonoscopy overall, 4 (6.89%) were found to have advanced polyps and none had colorectal cancer.

Discussion: This study demonstrates that inclusion of a guideline-based recommendation in the CT report increases post-diverticulitis colonoscopy adherence rates. The intervention is cheap, easy to implement and amenable to widespread dissemination. Adoption by radiologists is a major challenge to overall effectiveness.



Disclosures:


Luke Chmielecki, MD¹, Marisa Wu, MD², Nathan H. Pham, MD³, Avneesh Gupta, MD¹, Laura Chiu, MD, MPH¹, Paul C. Schroy, MD, MPH¹. P3652 - Improving Post-Acute Diverticulitis Colonoscopy Adherence in an Urban Safety Net Hospital Using Computed Tomography Reports, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.