News from AGA

In last month’s Gastroenterology,  Vijay H. Shah, MD, and colleagues share a commentary on the esteemed career of this year’s Julius Friedenwald Medal recipient, Michael Camilleri, MD, of the Mayo Clinic in Rochester, Minnesota. Here are some fun facts about this year’s honoree:

• While growing up in Malta, he was influenced by a combination of his uncle, a kindly family physician, and by watching the shows Dr. Kildare and Marcus Welby, M.D., on a black-and-white television set during his childhood, which led Dr. Camilleri to commit to a career in medicine by the age of 8.
• Dr. Camilleri started his journey at the Mayo Clinic as a research fellow in 1983 conducting fundamental clinical research in GI motility.
• With 660 peer-reviewed original articles and 290 published invited reviews and editorial publications, Dr. Camilleri has redefined the understanding and treatment of disorders covering the entire GI tract from rumination syndrome to pelvic dyssynergia.
• Dr. Camilleri has mentored 79 postdoctoral fellows since he joined the faculty at Mayo Clinic 35 years ago.

Read more about Dr. Camilleri’s life and contribution to the GI community in this Gastroenterology commentary, written by his colleagues and friends, including Dr. Shah and Adil E. Bharucha, MBBS, MD; David A. Katzka, MD; and Gregory J. Gores, MD.

In last month’s Gastroenterology,  Vijay H. Shah, MD, and colleagues share a commentary on the esteemed career of this year’s Julius Friedenwald Medal recipient, Michael Camilleri, MD, of the Mayo Clinic in Rochester, Minnesota. Here are some fun facts about this year’s honoree:

• While growing up in Malta, he was influenced by a combination of his uncle, a kindly family physician, and by watching the shows Dr. Kildare and Marcus Welby, M.D., on a black-and-white television set during his childhood, which led Dr. Camilleri to commit to a career in medicine by the age of 8.
• Dr. Camilleri started his journey at the Mayo Clinic as a research fellow in 1983 conducting fundamental clinical research in GI motility.
• With 660 peer-reviewed original articles and 290 published invited reviews and editorial publications, Dr. Camilleri has redefined the understanding and treatment of disorders covering the entire GI tract from rumination syndrome to pelvic dyssynergia.
• Dr. Camilleri has mentored 79 postdoctoral fellows since he joined the faculty at Mayo Clinic 35 years ago.

Read more about Dr. Camilleri’s life and contribution to the GI community in this Gastroenterology commentary, written by his colleagues and friends, including Dr. Shah and Adil E. Bharucha, MBBS, MD; David A. Katzka, MD; and Gregory J. Gores, MD.

In last month’s Gastroenterology,  Vijay H. Shah, MD, and colleagues share a commentary on the esteemed career of this year’s Julius Friedenwald Medal recipient, Michael Camilleri, MD, of the Mayo Clinic in Rochester, Minnesota. Here are some fun facts about this year’s honoree:

• While growing up in Malta, he was influenced by a combination of his uncle, a kindly family physician, and by watching the shows Dr. Kildare and Marcus Welby, M.D., on a black-and-white television set during his childhood, which led Dr. Camilleri to commit to a career in medicine by the age of 8.
• Dr. Camilleri started his journey at the Mayo Clinic as a research fellow in 1983 conducting fundamental clinical research in GI motility.
• With 660 peer-reviewed original articles and 290 published invited reviews and editorial publications, Dr. Camilleri has redefined the understanding and treatment of disorders covering the entire GI tract from rumination syndrome to pelvic dyssynergia.
• Dr. Camilleri has mentored 79 postdoctoral fellows since he joined the faculty at Mayo Clinic 35 years ago.

Read more about Dr. Camilleri’s life and contribution to the GI community in this Gastroenterology commentary, written by his colleagues and friends, including Dr. Shah and Adil E. Bharucha, MBBS, MD; David A. Katzka, MD; and Gregory J. Gores, MD.

American Gastroenterological Association, American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy issued a statement of support that also notes our Multi-Society Task Force on Colorectal Cancer is finalizing our own recommendation to start screening at 45 years of age as well. 

Incoming AGA President John M. Inadomi, MD, AGAF, notes that, “We expect this important change to save lives and improve the health of the U.S. population.” 

AGA fully supports the decision of the U.S. Preventive Services Task Force to reduce the age at which to initiate screening among individuals at average risk for development of colorectal cancer to 45 years. This decision harmonizes the recommendations between the major U.S. screening guidelines including the American Cancer Society and American College of Physicians.  

“The analysis by the USPSTF is timely and incredibly helpful to population health and to gastroenterologists and other providers,” says Bishr Omary, MD, PhD, AGAF, president of AGA. “We now have clear guidance to start colorectal cancer screening at age 45 for those with average risk and discontinue screening after age 85.”

American Gastroenterological Association, American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy issued a statement of support that also notes our Multi-Society Task Force on Colorectal Cancer is finalizing our own recommendation to start screening at 45 years of age as well. 

Incoming AGA President John M. Inadomi, MD, AGAF, notes that, “We expect this important change to save lives and improve the health of the U.S. population.” 

AGA fully supports the decision of the U.S. Preventive Services Task Force to reduce the age at which to initiate screening among individuals at average risk for development of colorectal cancer to 45 years. This decision harmonizes the recommendations between the major U.S. screening guidelines including the American Cancer Society and American College of Physicians.  

“The analysis by the USPSTF is timely and incredibly helpful to population health and to gastroenterologists and other providers,” says Bishr Omary, MD, PhD, AGAF, president of AGA. “We now have clear guidance to start colorectal cancer screening at age 45 for those with average risk and discontinue screening after age 85.”

American Gastroenterological Association, American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy issued a statement of support that also notes our Multi-Society Task Force on Colorectal Cancer is finalizing our own recommendation to start screening at 45 years of age as well. 

Incoming AGA President John M. Inadomi, MD, AGAF, notes that, “We expect this important change to save lives and improve the health of the U.S. population.” 

AGA fully supports the decision of the U.S. Preventive Services Task Force to reduce the age at which to initiate screening among individuals at average risk for development of colorectal cancer to 45 years. This decision harmonizes the recommendations between the major U.S. screening guidelines including the American Cancer Society and American College of Physicians.  

“The analysis by the USPSTF is timely and incredibly helpful to population health and to gastroenterologists and other providers,” says Bishr Omary, MD, PhD, AGAF, president of AGA. “We now have clear guidance to start colorectal cancer screening at age 45 for those with average risk and discontinue screening after age 85.”

We are pleased to announce that the AGA Research Foundation’s research awards cycle is now open.

The cycle begins with our two specialty awards focused on digestive and gastric cancers – applications are due on July 21. 

AGA–Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer: One $40,000 award supports an early career investigator who holds a career development award devoted to digestive cancer research.

AGA–R. Robert & Sally Funderburg Research Award in Gastric Cancer One $100,000 award supports an established investigator working on novel approaches in gastric cancer research.

In addition to our usual awards portfolio focused on a broad range of digestive diseases, we have established several new awards that will fund research focused on health and health care disparities. Click on the links below to learn more about each award and application requirements. 

• Pilot Research Awards: Currently accepting applications
• Research Scholar Awards: Open Aug. 12 

We are pleased to announce that the AGA Research Foundation’s research awards cycle is now open.

The cycle begins with our two specialty awards focused on digestive and gastric cancers – applications are due on July 21. 

AGA–Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer: One $40,000 award supports an early career investigator who holds a career development award devoted to digestive cancer research.

AGA–R. Robert & Sally Funderburg Research Award in Gastric Cancer One $100,000 award supports an established investigator working on novel approaches in gastric cancer research.

In addition to our usual awards portfolio focused on a broad range of digestive diseases, we have established several new awards that will fund research focused on health and health care disparities. Click on the links below to learn more about each award and application requirements. 

• Pilot Research Awards: Currently accepting applications
• Research Scholar Awards: Open Aug. 12 

We are pleased to announce that the AGA Research Foundation’s research awards cycle is now open.

The cycle begins with our two specialty awards focused on digestive and gastric cancers – applications are due on July 21. 

AGA–Caroline Craig Augustyn & Damian Augustyn Award in Digestive Cancer: One $40,000 award supports an early career investigator who holds a career development award devoted to digestive cancer research.

AGA–R. Robert & Sally Funderburg Research Award in Gastric Cancer One $100,000 award supports an established investigator working on novel approaches in gastric cancer research.

In addition to our usual awards portfolio focused on a broad range of digestive diseases, we have established several new awards that will fund research focused on health and health care disparities. Click on the links below to learn more about each award and application requirements. 

• Pilot Research Awards: Currently accepting applications
• Research Scholar Awards: Open Aug. 12 

If you want to make a lasting impact at the AGA Research Foundation, one of the easiest ways is to name us as a beneficiary of one of your assets, such as your retirement plan, life insurance policy, bank account, or donor-advised fund.

When you do, don’t forget to notify us of your decisions. Many charities and individuals aren’t aware that they have been named to receive a gift. Informing them helps preserve your intentions and ensures that your beneficiaries are able to follow your wishes.
 

Steps to protect the people and charities you love

• Review your beneficiary designations periodically because circumstances change throughout your lifetime.
• Alert your beneficiaries that you have a life insurance policy or have named them as beneficiaries of a retirement plan.
• Share the location and details of the policy or plan with your beneficiaries.

As you update your beneficiary designations, consider making a gift of a life insurance policy or retirement plan to the AGA Research Foundation so that we can continue to progress with our mission. Then let us know about your decision so that we can carry out your wishes as intended and thank you for your gift.
 

We want to hear from you

If you have already named the AGA Research Foundation as a beneficiary of a life insurance policy or retirement plan assets, please contact us at [email protected] today. If you are still creating your estate plan, we would be happy to answer any questions you may have about making this type of gift.

If you want to make a lasting impact at the AGA Research Foundation, one of the easiest ways is to name us as a beneficiary of one of your assets, such as your retirement plan, life insurance policy, bank account, or donor-advised fund.

When you do, don’t forget to notify us of your decisions. Many charities and individuals aren’t aware that they have been named to receive a gift. Informing them helps preserve your intentions and ensures that your beneficiaries are able to follow your wishes.
 

Steps to protect the people and charities you love

• Review your beneficiary designations periodically because circumstances change throughout your lifetime.
• Alert your beneficiaries that you have a life insurance policy or have named them as beneficiaries of a retirement plan.
• Share the location and details of the policy or plan with your beneficiaries.

As you update your beneficiary designations, consider making a gift of a life insurance policy or retirement plan to the AGA Research Foundation so that we can continue to progress with our mission. Then let us know about your decision so that we can carry out your wishes as intended and thank you for your gift.
 

We want to hear from you

If you have already named the AGA Research Foundation as a beneficiary of a life insurance policy or retirement plan assets, please contact us at [email protected] today. If you are still creating your estate plan, we would be happy to answer any questions you may have about making this type of gift.

If you want to make a lasting impact at the AGA Research Foundation, one of the easiest ways is to name us as a beneficiary of one of your assets, such as your retirement plan, life insurance policy, bank account, or donor-advised fund.

When you do, don’t forget to notify us of your decisions. Many charities and individuals aren’t aware that they have been named to receive a gift. Informing them helps preserve your intentions and ensures that your beneficiaries are able to follow your wishes.
 

Steps to protect the people and charities you love

• Review your beneficiary designations periodically because circumstances change throughout your lifetime.
• Alert your beneficiaries that you have a life insurance policy or have named them as beneficiaries of a retirement plan.
• Share the location and details of the policy or plan with your beneficiaries.

As you update your beneficiary designations, consider making a gift of a life insurance policy or retirement plan to the AGA Research Foundation so that we can continue to progress with our mission. Then let us know about your decision so that we can carry out your wishes as intended and thank you for your gift.
 

We want to hear from you

If you have already named the AGA Research Foundation as a beneficiary of a life insurance policy or retirement plan assets, please contact us at [email protected] today. If you are still creating your estate plan, we would be happy to answer any questions you may have about making this type of gift.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

From Rafael Ching Companioni, MD: Malnutrition, elevated liver enzymes, anemia, and malabsorption

“Early 30 year-old female who was initially referred to GI in December 2020 for abnormal liver enzymes ALT 263, AST 114, alk phosp 212, albumin 3.2, bili [within normal limits]. At that time, she reports some diarrhea, few episodes of diarrhea per day, diffuse abdominal pain, ~20 LBs weight loss. She denied herbal medications, OTC medications or other medications. Last travel was 2 years ago to England. No history of anorexia nervosa or bulimia. On examination, cachexia and extremity edema. She has iron deficiency anemia and reactive thrombocytosis. Her initial lipid panel in November 2020, the lipid panel shows total cholesterol 208, LDL 113, triglycerides 227.

“She is still losing weight: 20 lbs from Feb 2021. The liver enzymes elevation resolved. She has anemia, malnutrition and malabsorption. I recommended gluten free diet, MVI, iron pills, protein bars. I had ordered scleroderma workup and SIBO tests today. I am planning to do MRE.”

See how AGA members responded and join the discussion: https://community.gastro.org/posts/24416.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

From Rafael Ching Companioni, MD: Malnutrition, elevated liver enzymes, anemia, and malabsorption

“Early 30 year-old female who was initially referred to GI in December 2020 for abnormal liver enzymes ALT 263, AST 114, alk phosp 212, albumin 3.2, bili [within normal limits]. At that time, she reports some diarrhea, few episodes of diarrhea per day, diffuse abdominal pain, ~20 LBs weight loss. She denied herbal medications, OTC medications or other medications. Last travel was 2 years ago to England. No history of anorexia nervosa or bulimia. On examination, cachexia and extremity edema. She has iron deficiency anemia and reactive thrombocytosis. Her initial lipid panel in November 2020, the lipid panel shows total cholesterol 208, LDL 113, triglycerides 227.

“She is still losing weight: 20 lbs from Feb 2021. The liver enzymes elevation resolved. She has anemia, malnutrition and malabsorption. I recommended gluten free diet, MVI, iron pills, protein bars. I had ordered scleroderma workup and SIBO tests today. I am planning to do MRE.”

See how AGA members responded and join the discussion: https://community.gastro.org/posts/24416.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. Here’s a preview of a recent popular clinical discussion:  

From Rafael Ching Companioni, MD: Malnutrition, elevated liver enzymes, anemia, and malabsorption

“Early 30 year-old female who was initially referred to GI in December 2020 for abnormal liver enzymes ALT 263, AST 114, alk phosp 212, albumin 3.2, bili [within normal limits]. At that time, she reports some diarrhea, few episodes of diarrhea per day, diffuse abdominal pain, ~20 LBs weight loss. She denied herbal medications, OTC medications or other medications. Last travel was 2 years ago to England. No history of anorexia nervosa or bulimia. On examination, cachexia and extremity edema. She has iron deficiency anemia and reactive thrombocytosis. Her initial lipid panel in November 2020, the lipid panel shows total cholesterol 208, LDL 113, triglycerides 227.

“She is still losing weight: 20 lbs from Feb 2021. The liver enzymes elevation resolved. She has anemia, malnutrition and malabsorption. I recommended gluten free diet, MVI, iron pills, protein bars. I had ordered scleroderma workup and SIBO tests today. I am planning to do MRE.”

See how AGA members responded and join the discussion: https://community.gastro.org/posts/24416.

The Foundation introduced new awards in the 2021 awards cycle addressing diversity of GI investigators and the need for GI-specific COVID-19 research.

The American Gastroenterological Association is excited to announce the 45 researchers inducted into the 2021 class of AGA Research Foundation Awards Program recipients.

In the 2021 awards cycle, the AGA Research Foundation will provide more than $2.5 million in research funding to investigators working on projects that will further enhance our understanding of gastrointestinal and liver conditions and ultimately lead to the development of better treatment options for digestive diseases patients.

“This year, we made several enhancements to our awards portfolio to address current priorities for AGA and the field – we launched a new COVID-19 research award and established a summer undergraduate research fellowship to introduce talented underrepresented minority students into GI research,” said Robert S. Sandler, MD, MPH, AGAF, chair of the AGA Research Foundation. “We continue to change our funding program to meet the needs of GI research. What does not change is our long-standing commitment to support the research careers of talented early career investigators.”

The AGA Research Foundation Awards Program recruits, retains, and supports the most promising researchers in gastroenterology and hepatology. With funding from the foundation, recipients have protected time to take their research to the next level.

View the full list of recipients online.

The AGA Research Awards Program is made possible thanks to generous donors and funders. Learn more about the AGA Research Foundation at http://foundation.gastro.org.  

The Foundation introduced new awards in the 2021 awards cycle addressing diversity of GI investigators and the need for GI-specific COVID-19 research.

The American Gastroenterological Association is excited to announce the 45 researchers inducted into the 2021 class of AGA Research Foundation Awards Program recipients.

In the 2021 awards cycle, the AGA Research Foundation will provide more than $2.5 million in research funding to investigators working on projects that will further enhance our understanding of gastrointestinal and liver conditions and ultimately lead to the development of better treatment options for digestive diseases patients.

“This year, we made several enhancements to our awards portfolio to address current priorities for AGA and the field – we launched a new COVID-19 research award and established a summer undergraduate research fellowship to introduce talented underrepresented minority students into GI research,” said Robert S. Sandler, MD, MPH, AGAF, chair of the AGA Research Foundation. “We continue to change our funding program to meet the needs of GI research. What does not change is our long-standing commitment to support the research careers of talented early career investigators.”

The AGA Research Foundation Awards Program recruits, retains, and supports the most promising researchers in gastroenterology and hepatology. With funding from the foundation, recipients have protected time to take their research to the next level.

View the full list of recipients online.

The AGA Research Awards Program is made possible thanks to generous donors and funders. Learn more about the AGA Research Foundation at http://foundation.gastro.org.  

The Foundation introduced new awards in the 2021 awards cycle addressing diversity of GI investigators and the need for GI-specific COVID-19 research.

The American Gastroenterological Association is excited to announce the 45 researchers inducted into the 2021 class of AGA Research Foundation Awards Program recipients.

In the 2021 awards cycle, the AGA Research Foundation will provide more than $2.5 million in research funding to investigators working on projects that will further enhance our understanding of gastrointestinal and liver conditions and ultimately lead to the development of better treatment options for digestive diseases patients.

“This year, we made several enhancements to our awards portfolio to address current priorities for AGA and the field – we launched a new COVID-19 research award and established a summer undergraduate research fellowship to introduce talented underrepresented minority students into GI research,” said Robert S. Sandler, MD, MPH, AGAF, chair of the AGA Research Foundation. “We continue to change our funding program to meet the needs of GI research. What does not change is our long-standing commitment to support the research careers of talented early career investigators.”

The AGA Research Foundation Awards Program recruits, retains, and supports the most promising researchers in gastroenterology and hepatology. With funding from the foundation, recipients have protected time to take their research to the next level.

View the full list of recipients online.

The AGA Research Awards Program is made possible thanks to generous donors and funders. Learn more about the AGA Research Foundation at http://foundation.gastro.org.  

Patient navigation as a best practice for GI procedures

Colonoscopy is the preferred method for colorectal cancer (CRC) screening. Among scheduled outpatient colonoscopies, key metrics like no-show rates and poor bowel preparation can be as high as 25% in some facilities. These missed appointments and repeated calls with patients have been an important source of wasted resources, poor patient outcomes, and revenue loss for endoscopy facilities (estimated to be up to $1 million dollars for 10-member GI practice).

Studies have shown that patient navigation (PN), a patient-centered approach, overcomes barriers in health care delivery, thus improving adherence to CRC screening. Typically, navigators are specialized health practitioners who fill a variety of functions, including providing updates and instructions to patients, as well as assisting with test-related fears. Despite the overall cost-effectiveness, PN programs require significant resources from hospitals or medical groups. The continued focus in the United States on value-based medicine has provided an urgent need for cost-effective treatments that are also readily available to most physicians.
 

Digital navigation to automate navigation for colonoscopy and other GI procedures

Digital navigation (DN) is a new navigation technique that enables patients to receive appointment updates, resources related to a treatment or condition, stepwise bowel prep directions, and other periprocedural guidance in an automated and convenient manner (see Figure below). Given the widespread use of mobile phones, DN has the ability to change the way doctors and health care providers work. This led to Mount Sinai Health System, New York, conducting a quality improvement program to automate and evaluate the effectiveness of an automated text messaging and web-based “digital navigation” platform for decreasing colonoscopy appointment no-show rates.

Dr. Ashish Atreja/Icahn School of Medicine

If a valid phone number was available in the patient’s electronic medical record chart and they did not opt out of receiving text message communications from the Mount Sinai Health System, patients over the age of 18 years who were scheduled for a colonoscopy at either of Mount Sinai Hospital, Mount Sinai Morningside, or Mount Sinai West were automatically sent DN SMS messages. The RxUniverse software platform (Rx.Health, New York) was used to send DN content through SMS to all eligible patients. The software platform interfaces with the EMR and endoscopy system (Provation) to automatically extract patient phone number and appointment details.
 

Impact of digital navigation and patient engagement

This study at Mount Sinai Health System demonstrated that patient engagement with SMS-based navigation is strongly predictive of colonoscopy completion. Patients with high engagement with digital navigation are about four times more likely to complete colonoscopy. Of all covariates included in the model, high DN engagement level had the largest effect size (odds ratio, 3.97), compared with no engagement. For health systems with patient navigators, targeting patients who are unlikely to engage DN or are low-engagers may be a more efficient use of person-to-person navigation.

Value-based reimbursement and cost-effectiveness have emerged as core principles in American health care reform, possibly requiring the creation of affordable, cost-effective approaches. Our research at Mount Sinai Health System suggested that SMS-based navigation can be a potential cost-effective strategy for reducing no-show rates. Beyond appointment no-shows, adequate bowel preparation is another important component of the preprocedure navigation process. Insufficient bowel preparation requires a repeat procedure, as poor visualization of the colon results in reduced therapeutic benefit from screening colonoscopy. We’ve shown in previous studies that our DN platform can increase bowel preparation efficiency, which results in lower rates of aborted procedures.

Missed colonoscopies not only cause longer wait times for patients, but they also cost the average facility $725 a day in lost revenue. It has been found through studies that traditional PN is cost-effective, with additional revenue generated from increased colonoscopy completion rates exceeding the costs of program implementation. While formal cost analyses have not been conducted on DN, estimates have shown around $1 million in annual savings for an average ambulatory surgery center or 10-member GI practice.
 

Looking ahead: AGA digital transformation network

After positive results for the Rx.Health’s platform were seen at Mount Sinai Health System, the American Gastroenterological Association partnered with Rx.Health to provide the GI community with a GI endoscopy transformation network. The core purpose of this endoscopy transformation network is to take an evidence-based approach and use digital medicine to positively affect key metrics and safety around periprocedural care and support “procedure bundles.” To illustrate the specific case of colonoscopy, these included the following: enhancing colorectal cancer surveillance rates though a comprehensive screening test strategy, decreasing no-show rates through shared decision-making and better preprocedure engagement, improving rates of adequate bowel preparation, benchmarking safety of procedures nationwide, and ensuring patient satisfaction and adequate recall for repeat procedures. These metrics represent key sources of revenue loss for provider organizations and, more importantly, have negative implications on patient care.

This collaboration is now supporting the implementation and expansion of the digital navigation program to all GI procedures at more than 15 different sites across the country.

Dr. Atreja is an adjunct associate professor at the Icahn School of Medicine at Mount Sinai, New York, and chief information officer and chief digital health officer at UC Davis Medical Center, Sacramento. The Icahn School of Medicine has licensed technology to Rx.Health. Dr. Atreja has no other conflicts to disclose

Patient navigation as a best practice for GI procedures

Colonoscopy is the preferred method for colorectal cancer (CRC) screening. Among scheduled outpatient colonoscopies, key metrics like no-show rates and poor bowel preparation can be as high as 25% in some facilities. These missed appointments and repeated calls with patients have been an important source of wasted resources, poor patient outcomes, and revenue loss for endoscopy facilities (estimated to be up to $1 million dollars for 10-member GI practice).

Studies have shown that patient navigation (PN), a patient-centered approach, overcomes barriers in health care delivery, thus improving adherence to CRC screening. Typically, navigators are specialized health practitioners who fill a variety of functions, including providing updates and instructions to patients, as well as assisting with test-related fears. Despite the overall cost-effectiveness, PN programs require significant resources from hospitals or medical groups. The continued focus in the United States on value-based medicine has provided an urgent need for cost-effective treatments that are also readily available to most physicians.
 

Digital navigation to automate navigation for colonoscopy and other GI procedures

Digital navigation (DN) is a new navigation technique that enables patients to receive appointment updates, resources related to a treatment or condition, stepwise bowel prep directions, and other periprocedural guidance in an automated and convenient manner (see Figure below). Given the widespread use of mobile phones, DN has the ability to change the way doctors and health care providers work. This led to Mount Sinai Health System, New York, conducting a quality improvement program to automate and evaluate the effectiveness of an automated text messaging and web-based “digital navigation” platform for decreasing colonoscopy appointment no-show rates.

Dr. Ashish Atreja/Icahn School of Medicine

If a valid phone number was available in the patient’s electronic medical record chart and they did not opt out of receiving text message communications from the Mount Sinai Health System, patients over the age of 18 years who were scheduled for a colonoscopy at either of Mount Sinai Hospital, Mount Sinai Morningside, or Mount Sinai West were automatically sent DN SMS messages. The RxUniverse software platform (Rx.Health, New York) was used to send DN content through SMS to all eligible patients. The software platform interfaces with the EMR and endoscopy system (Provation) to automatically extract patient phone number and appointment details.
 

Impact of digital navigation and patient engagement

This study at Mount Sinai Health System demonstrated that patient engagement with SMS-based navigation is strongly predictive of colonoscopy completion. Patients with high engagement with digital navigation are about four times more likely to complete colonoscopy. Of all covariates included in the model, high DN engagement level had the largest effect size (odds ratio, 3.97), compared with no engagement. For health systems with patient navigators, targeting patients who are unlikely to engage DN or are low-engagers may be a more efficient use of person-to-person navigation.

Value-based reimbursement and cost-effectiveness have emerged as core principles in American health care reform, possibly requiring the creation of affordable, cost-effective approaches. Our research at Mount Sinai Health System suggested that SMS-based navigation can be a potential cost-effective strategy for reducing no-show rates. Beyond appointment no-shows, adequate bowel preparation is another important component of the preprocedure navigation process. Insufficient bowel preparation requires a repeat procedure, as poor visualization of the colon results in reduced therapeutic benefit from screening colonoscopy. We’ve shown in previous studies that our DN platform can increase bowel preparation efficiency, which results in lower rates of aborted procedures.

Missed colonoscopies not only cause longer wait times for patients, but they also cost the average facility $725 a day in lost revenue. It has been found through studies that traditional PN is cost-effective, with additional revenue generated from increased colonoscopy completion rates exceeding the costs of program implementation. While formal cost analyses have not been conducted on DN, estimates have shown around $1 million in annual savings for an average ambulatory surgery center or 10-member GI practice.
 

Looking ahead: AGA digital transformation network

After positive results for the Rx.Health’s platform were seen at Mount Sinai Health System, the American Gastroenterological Association partnered with Rx.Health to provide the GI community with a GI endoscopy transformation network. The core purpose of this endoscopy transformation network is to take an evidence-based approach and use digital medicine to positively affect key metrics and safety around periprocedural care and support “procedure bundles.” To illustrate the specific case of colonoscopy, these included the following: enhancing colorectal cancer surveillance rates though a comprehensive screening test strategy, decreasing no-show rates through shared decision-making and better preprocedure engagement, improving rates of adequate bowel preparation, benchmarking safety of procedures nationwide, and ensuring patient satisfaction and adequate recall for repeat procedures. These metrics represent key sources of revenue loss for provider organizations and, more importantly, have negative implications on patient care.

This collaboration is now supporting the implementation and expansion of the digital navigation program to all GI procedures at more than 15 different sites across the country.

Dr. Atreja is an adjunct associate professor at the Icahn School of Medicine at Mount Sinai, New York, and chief information officer and chief digital health officer at UC Davis Medical Center, Sacramento. The Icahn School of Medicine has licensed technology to Rx.Health. Dr. Atreja has no other conflicts to disclose

Patient navigation as a best practice for GI procedures

Colonoscopy is the preferred method for colorectal cancer (CRC) screening. Among scheduled outpatient colonoscopies, key metrics like no-show rates and poor bowel preparation can be as high as 25% in some facilities. These missed appointments and repeated calls with patients have been an important source of wasted resources, poor patient outcomes, and revenue loss for endoscopy facilities (estimated to be up to $1 million dollars for 10-member GI practice).

Studies have shown that patient navigation (PN), a patient-centered approach, overcomes barriers in health care delivery, thus improving adherence to CRC screening. Typically, navigators are specialized health practitioners who fill a variety of functions, including providing updates and instructions to patients, as well as assisting with test-related fears. Despite the overall cost-effectiveness, PN programs require significant resources from hospitals or medical groups. The continued focus in the United States on value-based medicine has provided an urgent need for cost-effective treatments that are also readily available to most physicians.
 

Digital navigation to automate navigation for colonoscopy and other GI procedures

Digital navigation (DN) is a new navigation technique that enables patients to receive appointment updates, resources related to a treatment or condition, stepwise bowel prep directions, and other periprocedural guidance in an automated and convenient manner (see Figure below). Given the widespread use of mobile phones, DN has the ability to change the way doctors and health care providers work. This led to Mount Sinai Health System, New York, conducting a quality improvement program to automate and evaluate the effectiveness of an automated text messaging and web-based “digital navigation” platform for decreasing colonoscopy appointment no-show rates.

Dr. Ashish Atreja/Icahn School of Medicine

If a valid phone number was available in the patient’s electronic medical record chart and they did not opt out of receiving text message communications from the Mount Sinai Health System, patients over the age of 18 years who were scheduled for a colonoscopy at either of Mount Sinai Hospital, Mount Sinai Morningside, or Mount Sinai West were automatically sent DN SMS messages. The RxUniverse software platform (Rx.Health, New York) was used to send DN content through SMS to all eligible patients. The software platform interfaces with the EMR and endoscopy system (Provation) to automatically extract patient phone number and appointment details.
 

Impact of digital navigation and patient engagement

This study at Mount Sinai Health System demonstrated that patient engagement with SMS-based navigation is strongly predictive of colonoscopy completion. Patients with high engagement with digital navigation are about four times more likely to complete colonoscopy. Of all covariates included in the model, high DN engagement level had the largest effect size (odds ratio, 3.97), compared with no engagement. For health systems with patient navigators, targeting patients who are unlikely to engage DN or are low-engagers may be a more efficient use of person-to-person navigation.

Value-based reimbursement and cost-effectiveness have emerged as core principles in American health care reform, possibly requiring the creation of affordable, cost-effective approaches. Our research at Mount Sinai Health System suggested that SMS-based navigation can be a potential cost-effective strategy for reducing no-show rates. Beyond appointment no-shows, adequate bowel preparation is another important component of the preprocedure navigation process. Insufficient bowel preparation requires a repeat procedure, as poor visualization of the colon results in reduced therapeutic benefit from screening colonoscopy. We’ve shown in previous studies that our DN platform can increase bowel preparation efficiency, which results in lower rates of aborted procedures.

Missed colonoscopies not only cause longer wait times for patients, but they also cost the average facility $725 a day in lost revenue. It has been found through studies that traditional PN is cost-effective, with additional revenue generated from increased colonoscopy completion rates exceeding the costs of program implementation. While formal cost analyses have not been conducted on DN, estimates have shown around $1 million in annual savings for an average ambulatory surgery center or 10-member GI practice.
 

Looking ahead: AGA digital transformation network

After positive results for the Rx.Health’s platform were seen at Mount Sinai Health System, the American Gastroenterological Association partnered with Rx.Health to provide the GI community with a GI endoscopy transformation network. The core purpose of this endoscopy transformation network is to take an evidence-based approach and use digital medicine to positively affect key metrics and safety around periprocedural care and support “procedure bundles.” To illustrate the specific case of colonoscopy, these included the following: enhancing colorectal cancer surveillance rates though a comprehensive screening test strategy, decreasing no-show rates through shared decision-making and better preprocedure engagement, improving rates of adequate bowel preparation, benchmarking safety of procedures nationwide, and ensuring patient satisfaction and adequate recall for repeat procedures. These metrics represent key sources of revenue loss for provider organizations and, more importantly, have negative implications on patient care.

This collaboration is now supporting the implementation and expansion of the digital navigation program to all GI procedures at more than 15 different sites across the country.

Dr. Atreja is an adjunct associate professor at the Icahn School of Medicine at Mount Sinai, New York, and chief information officer and chief digital health officer at UC Davis Medical Center, Sacramento. The Icahn School of Medicine has licensed technology to Rx.Health. Dr. Atreja has no other conflicts to disclose

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The following is a preview of a recent popular clinical discussion.  

In the post “Cessation of surveillance colonoscopy,” Gyanprakash A. Ketwaroo, MD, asked the following:Wanted to get your thoughts on how you approach stopping surveillance colonoscopy for older adults. Do you use decision support tools, assessing life-expectancy, prior polyp history, etc? Or is it more practical to defer to PCP for goals of care discussion prior to surveillance colonoscopy at certain age (eg 75 or 80)?See how AGA members responded and join the discussion: https://community.gastro.org/posts/24089.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The following is a preview of a recent popular clinical discussion.  

In the post “Cessation of surveillance colonoscopy,” Gyanprakash A. Ketwaroo, MD, asked the following:Wanted to get your thoughts on how you approach stopping surveillance colonoscopy for older adults. Do you use decision support tools, assessing life-expectancy, prior polyp history, etc? Or is it more practical to defer to PCP for goals of care discussion prior to surveillance colonoscopy at certain age (eg 75 or 80)?See how AGA members responded and join the discussion: https://community.gastro.org/posts/24089.

Physicians with difficult patient scenarios regularly bring their questions to the AGA Community (https://community.gastro.org) to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses. The following is a preview of a recent popular clinical discussion.  

In the post “Cessation of surveillance colonoscopy,” Gyanprakash A. Ketwaroo, MD, asked the following:Wanted to get your thoughts on how you approach stopping surveillance colonoscopy for older adults. Do you use decision support tools, assessing life-expectancy, prior polyp history, etc? Or is it more practical to defer to PCP for goals of care discussion prior to surveillance colonoscopy at certain age (eg 75 or 80)?See how AGA members responded and join the discussion: https://community.gastro.org/posts/24089.

Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also help us fund research grants to talented investigators whose work will shape the future of clinical care.

• A gift in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
• A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.

Learn more about ways to recognize and acknowledge someone by visit our website at https://foundation.gastro.org/ways-to-contribute/.

Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also help us fund research grants to talented investigators whose work will shape the future of clinical care.

• A gift in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
• A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.

Learn more about ways to recognize and acknowledge someone by visit our website at https://foundation.gastro.org/ways-to-contribute/.

Make a tribute gift to honor someone whose life has been touched by GI research or celebrate a special occasion such as a birthday while supporting the AGA Research Awards Program through the AGA Research Foundation. A tribute gift will make your loved one feel special because it honors their passion, and also help us fund research grants to talented investigators whose work will shape the future of clinical care.

• A gift in memory of a loved one. A memorial gift is a meaningful way to celebrate the legacy of a family member, friend, or colleague.
• A gift today. An outright gift will help fund the AGA Research Awards Program. Your gift will assist in furthering basic digestive disease research which can ultimately advance research into all digestive diseases. The financial benefits include an income tax deduction and possible elimination of capital gains tax.

Learn more about ways to recognize and acknowledge someone by visit our website at https://foundation.gastro.org/ways-to-contribute/.

The world’s premier meeting for gastroenterology, hepatology, endoscopy, and gastrointestinal surgery professionals will be a fully virtual event, May 21-23, 2021. We invite you to take advantage of this unique opportunity to exchange knowledge with colleagues from all over the world and explore the latest advances in the field – all from the convenience of your home. Plus, your registration grants you access to everything offered at Digestive Disease Week® (DDW) this year (no additional ticketed sessions). Learn more and register at ddw.org.

The world’s premier meeting for gastroenterology, hepatology, endoscopy, and gastrointestinal surgery professionals will be a fully virtual event, May 21-23, 2021. We invite you to take advantage of this unique opportunity to exchange knowledge with colleagues from all over the world and explore the latest advances in the field – all from the convenience of your home. Plus, your registration grants you access to everything offered at Digestive Disease Week® (DDW) this year (no additional ticketed sessions). Learn more and register at ddw.org.

The world’s premier meeting for gastroenterology, hepatology, endoscopy, and gastrointestinal surgery professionals will be a fully virtual event, May 21-23, 2021. We invite you to take advantage of this unique opportunity to exchange knowledge with colleagues from all over the world and explore the latest advances in the field – all from the convenience of your home. Plus, your registration grants you access to everything offered at Digestive Disease Week® (DDW) this year (no additional ticketed sessions). Learn more and register at ddw.org.