Article Figures & Data
Tables
- Table 1.
Three Iterations of FIT Daily Report Criteria—Definitions (D), Parameters (P), and Rationales (R)
Criteria First Iteration Second Iteration Third Iteration* Definitions, Parameters, and Rationales Age Age Age D: Age at the time of making the appointment. P: Range for patients ‘greater than or equal to 50 years and less than or equal to 85 years.’ Appointment Procedure D: Procedure code designating the specific procedure to be included. P: Set to equal the scheduling code for the general global colonoscopy procedure ENDO COLONOSCOPY [1685], i.e., ‘equal to 1685.’ R: Used the one procedure code IT provided. Appointment Procedure (revised) Appointment Procedure P: Added more colonoscopy procedure codes to include 11 discrete codes for the study. R: Initially unaware there were 21 procedure codes, used additional appropriate codes to capture all eligible patients. Appointment Status D: The patient’s appointment status, e.g., scheduled, cancelled, arrived, was bumped. P: Set as ‘equal to Scheduled.’ R: Initially unaware could capture appointment changes, such as cancelled. Appointment Status (deleted) n/a R: FIT Daily Report would output duplicates of the same appointments every time the report was run if the ‘Scheduled’ appointment fell within the specified Date Range. Replaced with Appointment Made on Date and Contact Type (below). Date Range D: Range of days from which the algorithm searches for colonoscopy appointments. P: Set as ‘from W + 3 to W + 12’ (21 to 84 or 85 days out from when the FIT Daily Report was run). R: This date range was set to send an invitation to eligible patients so stool specimen could be obtained before colonoscopy prep and within 4 months of scheduled colonoscopy. Date Range (revised) P: Set as ‘from W + 4 to W + 8’ (29 to 56 days out from when the FIT Daily Report was run). R: The recruitment start timeframe was extended to allow for subject and study mailings. Date Range (revised) D: Range of days from which the algorithm searches for colonoscopy appointment. Set as ‘from T-1 to Y + 4’ (from the day before the FIT Daily Report was run to 4 years out, the maximum allowed upper bound in Epic Reporting Workbench). P: The second iteration of the criterion missed appointments that were rescheduled beyond 56 days. Expanding the interval to encompass all reasonable dates on which the colonoscopies could be scheduled ensured that all scheduling changes could be tracked by researchers. R: Enforcing the recruitment timeframe (where colonoscopy appointment is between W + 4 and W + 8) was relegated to the Tracking Database. Encounter Department D: Code identifying the department and location of the room where the patient would encounter the colonoscopy. P: Set as ‘equal to Med GI/Hepatology Procedure Unit [10401129].’ R: IT provided one procedure unit code. Encounter Department (revised) Encounter Department P: Expanded to include a total of 3 locations where colonoscopies were performed. R: To increase number of eligible patients. Appointment Made on Date (added) Appointment Made on Date D: Constrains the algorithm to search for appointments made within a specified date range. P: Set to ‘equal to T-1’ (or T-3 on Monday), so that only appointments made on the previous business day are captured. R: Eliminated multiple outputs of the same appointment. Ensured all newly made appointments would be captured. Appointment Cancel Date (added) D: Constrains the algorithm to search for appointments cancelled within a specified date range. P: Set to ‘equal to T-1’ (or T-3 on Monday), so that only appointments cancelled on the previous business day are captured. R: Appointment Cancel Date restricted the FIT Daily Report to only capture cancellations that were made for appointments made and cancelled on T-1 (or T-3 on Monday), missing cancellations for appointments not made on that day. To capture all cancelled appointments a new report “FIT Daily Cancellations Report” was created to be run alongside the FIT Daily Report, where Appointment Cancel Date replaced Appointment Made on Date. Contact Type (added) D: Type of contact patient had with hospital (115 types, such as ‘Admission,’ ‘Documentation,’ and ‘Nursing Home Visit’). P: Set to include only ‘Appointment’ to imitate the function of Appointment Status. Epic IT staff recommended this criterion be added to make the algorithm run faster. R: The FIT Daily Report would have run correctly without this criterion but adding an additional restriction greatly reduced the population of patients to be filtered through the algorithm. Contact Type (revised) P: Expanded to also include ‘Hospital Encounter.’ R: Some colonoscopy reschedules were not being tracked after cancellation. Scheduling staff at the gastroenterology clinic explained that Contact Type ‘Appointment’ captured only outpatient scheduling of the procedures. Expanding to include ‘Hospital Encounter’ captured the missing colonoscopies that were being scheduled as inpatient procedures. ICD-10 Codes (added) ICD-10 Codes D: Classification of medical diagnoses. P: Set to ‘does not contain’. R: 175 values to exclude patients with specific conditions from study, such as colitis. Patient Type (added) Patient Type D: Special populations, e.g., prisoners, group home residents, student athletes, etc. P: Set to ‘does not exist’. R: Excludes all patients with a Patient Type designation. Nursing home residents were removed after manual review as they did not have a Patient Type code. ↵* All Appointments Report did not include the Appointment Made on/Cancel Date criteria, and the Date Range was set as ‘from T to M + 6.’.
T, Today; W, Week; M, Month; Y, Year; n/a, not available; IT, information technology; FIT, fecal immunochemical testing; GI, gastroenterology.
Display Field Name Description First Iteration Second Iteration Third Iteration MRN Patient medical record number ✓ ✓ ✓ Status Scheduling status: scheduled, cancelled, no show, arrived, completed, etc. ✓ ✓ ✓ Date Date of colonoscopy ✓ ✓ ✓ First Name Patient’s first name ✓ ✓ ✓ Preferred Name Patient's preferred name Last Name Patient’s last name ✓ ✓ ✓ DOB Date of birth ✓ ✓ ✓ Age Age ✓ ✓ ✓ Sex Sex ✓ ✓ ✓ Race Race ✓ ✓ ✓ Hispanic Ethnicity Yes/No answers ✓ ✓ ✓ Preferred Language Preferred language ✓ Phone Primary phone number ✓ ✓ ✓ Home Home phone number ✓ ✓ Cell Cell phone number ✓ Patient Email Address Email address ✓ Patient Address (Line 1) Patient address (line 1) ✓* ✓ ✓ Patient Address (Line 2) Patient address (line 2) ✓* ✓ ✓ City City ✓* ✓ ✓ State State ✓* ✓ ✓ ZIP Code ZIP code ✓* ✓ Department Department at which the procedure will be performed ✓ ✓ Type Type of colonoscopy procedure ✓ ✓ ✓ Ordering Provider Ordering provider ✓ ✓ ✓ Attending Provider Attending provider ✓ ✓ ✓ Associated Diagnosis Associated Dx in the order for colonoscopy ✓ ✓ Indication Physician’s indication for the Dx in the order ✓ ✓ Rectal Bleeding† Patient had rectal bleeding in the past 60 days ✓ ASN† Appointment serial number—A unique identifier for all appointments associated with a physician order. Used in combination with CSN to track appointment changes. ✓ CSN‡ Contact serial number—A unique identifier for a new appointment. Used in combination with ASN to track appointment changes. ✓ ↵* Address was a single field in the first iteration. Subsequent iterations imported discrete fields.
↵† The ICD-10 codes associated with rectal bleeding (K62.5, K92.1, and R19.5) were found in the encounter diagnoses from encounters that occurred in the past 60 days and grouped together to create a single variable, Rectal Bleeding. These were distinct from the ICD-10 codes criterion, which was designed to search the problem list.
↵‡ In Epic, a unique Contact Serial Number (CSN) is generated for each new appointment that is made for an Order. The first CSN to be generated is designated as the Appointment Serial Number (ASN), which serves as the reference number connecting all subsequent appointment changes that occur for that Order.
Iteration Criteria n Day 1 Day 2 Day 3 First Iteration* Age, Appointment Procedures, Appointment Status, and Encounter Department 219 225 174 All Criteria minus Age 267 276 215 All Criteria minus Appointment Procedures 771 807 782 All Criteria minus Appointment Status‡ 270 276 228 All Criteria minus Encounter Department§ § § § All Criteria witd substitute Encounter Department 0 0 0 Second Iteration† Patient Type 261 266 218 Appointment Procedures‖ 415 420 431 ICD-10 Codes (Using Boolean Operator OR)¶ 415 420 431 ICD-10 Codes (Using Boolean Operator AND) 336 331 348 Encounter Department‖ 657 647 703 Contact Type 530 544 531 Appointment Made on Date 15 14 32 Third Iteration† Contact Type‖ 21 14 39 Date Range 38 30 61 ↵* Compare against n in top row.
↵† Each criterion is added sequentially. Compare against n of the immediately preceding criterion.
‡The second iteration began with the removal of Appointment Procedures. Therefore, values in this row serve as the baseline for the second iteration.
§The FIT Daily Report timed out due to restrictions in place from Epic Reporting Workbench and did not yield results. In this institution’s Epic system, reports must include at least the Providers or Encounter Department field or have a patient base selected to prevent timing out.
‖These criteria are revised from the previous iteration.
¶See Appendix B for further details.
Procedure Name [Code Number] Appropriate for Use IRL COLONOSCOPY PROCEDURE [325] ENDO COLON COMPLEX- RN SED [1687] ENDO COLONOSCOPY [1685] ENDO COLONOSCOPY COMPLEX [1191] ENDO COLONOSCOPY COMPLEX- ANES [1373] ENDO COLONOSCOPY- ANES [1686] ENDO COLONOSCOPY-RN SED [1190] ENDO/COLON COMBO [1775] ENDO/COLON COMBO - ANES [1777] ENDO/COLON COMBO - RN SED [1776] ENDO COLON [328] Inappropriate for Use ENDO CLN W STENT PLCMNT-RN SED [1689] ENDO COLON STENT PLCMNT FLUORO [1194] ENDO COLON STENT PLCMNT- ANES [1375] ENDO COLON STENT PLT- ANES ONLY [1481] ENDO COLON W STENT PLACEMENT [1193] ENDO COLON W STL TRANS- ANES [1376] ENDO COLON W STOOL TRANSPLANT [1196] ENDO COLON/ILEO STOMA- ANES [1374] ENDO COLON/ILEO STOMA- RN SED [1688] ENDO COLON/ILEO THROUGH STOMA [1192]
