Rolling out a rideshare-based pilot program for colonoscopy screening patients

From the Dr. Rachel Issaka and Dr. Scott D. Ramsey Labs, Cancer Epidemiology, Prevention & Control Program, Cancer Consortium.

Your phone rings. You pick it up. It’s your doctor, telling you that a routine health check-up came back abnormal, and she recommends you schedule a colonoscopy. Unless you want to stay awake for the procedure, you can’t drive yourself home due to the procedural anesthesia. But you recently moved to a new city, and you don’t know anyone or have family in the area that can drive you. What do you do? Do you cancel the colonoscopy, potentially risking your health? Do you keep the appointment but pay out-of-pocket for an expensive taxi? This is a real scenario that many patients face, and Dr. Rachel B. Issaka, a gastroenterologist and Assistant Professor at Fred Hutch, is leading the charge to fix it, as explained in a recent study published in Frontiers of Health Services.

“Dr. Issaka’s research is motivated by the goal to reduce racial and socioeconomic disparities and improve outcomes in Colorectal Cancer (CRC) by increasing access to screening,” explains Ari Bell-Brown, a Project Manager and first-author on the study. “CRC [mortality] is preventable but remains one of the top causes of cancer-related death due to inadequate levels of screening…One area that has been identified as a barrier to completing colonoscopy is access to transportation and to having an escort available to get you home from your colonoscopy. As a colonoscopy requires procedural sedation, many healthcare organizations require patients have an escort to take them home at the end of the procedure. From our research, we knew that lack of transportation and/or patient escort was a priority area to address to improve access to CRC screening”.

A patient talks with his doctor about his options to get home following routine sedation for a colonoscopy.
Implementing Non-Emergency Medical Transportation (NEMT) services could improve colorectal cancer screening follow-through by expanding patient access to healthcare and subverting the transportation barriers faced by many patients from lower socioeconomic or disadvantaged backgrounds (figure from Creative Commons). Figure provided by Dr. Rachel Issaka, Artist: Alan Boswell.

Non-emergency medical transportation (NEMT) services do exist with major rideshare companies, such as Uber and Lyft, and they can be scheduled by the healthcare team in a HIPAA-compliant manner. This allows the medical team to arrange for a rideshare pickup, track the patient’s ride home, and bill the patient’s insurance. However, there are still significant barriers to it being used widely for colorectal cancer screening patients. “NEMT is an offered benefit to Medicaid patients via local transportation companies but can be unreliable for patients,” explains Bell-Brown. “[However,] to offer rideshare to that population, we need a separate contract executed with the Washington State Healthcare Authority. We hope to overcome this barrier through ongoing conversations with the Healthcare Authority as rideshare NEMT could be a valuable resource, especially for Medicaid patients.” Another, perhaps unexpected barrier? “Rideshare companies do not offer “door to door” services but rather “curb to curb.” If a patient has significant mobility, cognitive conditions or even post-sedation effects that would make it hard for them to navigate from their curbside to their door without assistance, rideshare NEMT may not be the best solution,” said Bell-Brown.

This study focused on implementing NEMT at Harborview Medical Center – a safety-net healthcare system that provides care to residents of King County and beyond. Dr. Issaka and members of her team met with stakeholders at all levels of hospital administration, from health system medical directors to primary care and gastroenterology doctors, nursing leaders and rideshare industry representatives. The research team explained their ideas using storyboards, to make sure everyone was on the same page, and through a series of interviews identified the concerns of each stakeholder. The findings from these meetings informed “a cross-sector partnership between a healthcare system and industry” to pilot an improved rideshare program for CRC patients, according to the authors. The pilot study they designed based on these interviews mobilizes the healthcare team to use the rideshare platform on behalf of the patient, and to act as a “staff escort” to ensure patients get into the car safely and are dropped off at the right location. “The most exciting moment [of our research] was actually executing the contract to enable us to pilot a rideshare program for patient’s receiving colonoscopy at Harborview Medical Center,” explained Bell-Brown. “Since launching this pilot study, we have enrolled patients that had no other transportation options to get home after their colonoscopy. This project is an exciting step in examining rideshare NEMT as a solution to transportation barriers for patient’s receiving procedural sedation and, if successful, offers a practical and scalable solution to one of the major barriers in colonoscopy completion”.

Harborview Medical Center is administrated by University of Washington Medicine, and Dr. Rachel Issaka is both a Fred Hutch investigator and a practicing UW gastroenterologist. The Cancer Consortium fosters close collaboration between participating institutions.

A Bell-Brown, L Chew, BJ Weiner, L Strate, B Balmadrid, CC Lewis, P Hannon, JM Inadomi, SC Ramsey, and RB Issaka. 2022. Operationalizing a rideshare intervention for colonoscopy completion: Barriers, facilitators, and process recommendations. Frontiers in Health Services. 1: 799816. DOI: 10.3389/frhs.2021.799816.

This work was funded by the National Institutes of Health National Cancer Institute.

Cancer Consortium members Dr. Rachel Issaka and Dr. Scott Ramsey contributed to this work.