P4069 - A Quality Improvement Analysis of Patient Non-Compliance With Post-ERCP Follow-Up Recommendations in a Predominantly Hispanic Population

Bhavi Trivedi, MD¹, Jeff Angelo Taclob, MD¹, Brian Lee, DO², Sukhila Reddy, MD², Jared Bies, DO², Melina Ortiz, MD², Ammar Kalas, MD², Andrew Ortega, MD², Marc Zuckerman, MD¹, Ricardo Badillo, MD^1
1Texas Tech University Health Sciences Center, El Paso, TX; ²Texas Tech, El Paso, TX

Introduction: A timely repeat endoscopic retrograde cholangiopancreatography (ERCP) is necessary for various indications, such as stent removal, to prevent complications. Poor compliance with follow-up can drastically impact outcomes. This quality improvement project aimed to identify underlying reasons for non-compliance by performing a retrospective analysis of patient follow-up after ERCP at our academic tertiary referral center located on the United States/Mexico border among a predominantly Hispanic population.

Methods: A retrospective chart review of adult patients undergoing an index ERCP between 2017-2021 for any indication was done. Patients with prior ERCP, age < 18, and no indication for repeat ERCP were excluded. Data were retrospectively evaluated and grouped into appropriate and non-appropriate follow-ups based on post-ERCP recommendations. It was further analyzed by demographic factors: age, race, gender, primary language, insurance status, procedure outcomes, and physician team characteristics. Unadjusted logistic regression analysis was performed.

Results: 560 patients underwent index ERCP during our study. Overall, patients were predominantly Female(58.6%) and Hispanic(47.8%). A small majority spoke English as a primary language(50.5%), compared to Spanish primary(49.5%). Most patients(52.7%) were uninsured(Table 1). Of 560 ERCPs, a majority(62.9%) of patients in whom a follow-up ERCP was recommended either did not follow up or follow-up was inappropriately delayed(Table 2). Regression analysis revealed a higher likelihood of appropriate follow-up in patients undergoing ERCP with a stent for pancreaticobiliary strictures/leak (p< 0.001); while those with cholangitis or choledocholithiasis were less likely to follow up. Patients with subsequent GI clinic appointments were also most likely to have a timely repeat ERCP performed (OR 3.15). Unexpectedly, a Spanish-speaking physician tended to have a negative impact on follow-up rates with Spanish-speaking patients (OR 0.66). Gender, race, language, insurance status, and admitting team type did not influence follow-up rates.

Discussion: A large number of patients did not have appropriate follow-up after ERCP. Though language was not a barrier as expected given our center’s location along the U.S. border; follow-up in GI clinic and communication with patients about timely follow-up is crucial.


Disclosures:


Bhavi Trivedi, MD¹, Jeff Angelo Taclob, MD¹, Brian Lee, DO², Sukhila Reddy, MD², Jared Bies, DO², Melina Ortiz, MD², Ammar Kalas, MD², Andrew Ortega, MD², Marc Zuckerman, MD¹, Ricardo Badillo, MD¹. P4069 - A Quality Improvement Analysis of Patient Non-Compliance With Post-ERCP Follow-Up Recommendations in a Predominantly Hispanic Population, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.