S598 PrepCheck+: A Quality Improvement Protocol to Enhance Bowel Preparation in Underserved Patients Undergoing Colonoscopy

Introduction: Inadequate bowel preparation is a leading cause of missed lesions, repeated procedures, and diagnostic delays in colorectal cancer (CRC) screening. These consequences are more prevalent among underserved populations, who often encounter language barriers, limited health literacy, and socioeconomic challenges. At community-based hospitals, this can lead to increased healthcare utilization and disparities in cancer outcomes. PrepCheck+ is a prospective quality improvement (QI) project aimed at improving bowel preparation quality by incorporating a bilingual visual self-assessment tool and structured navigator support to empower patients and streamline care. The objective of this initiative is to implement and evaluate a standardized, patient-centered intervention aimed at improving bowel preparation adequacy among underserved patients undergoing outpatient colonoscopy. Methods: This prospective QI project will be conducted at a large, urban, community-based teaching hospital. Sixty patients aged 45–75 who meet underserved criteria, defined as Medicaid-insured/uninsured, having a non-English language preference, or residing in a disadvantaged ZIP code, will be enrolled using a pre-post design. The pre-intervention group (n = 30) will receive standard care, while the post-intervention group (n = 30) will receive the PrepCheck+ intervention. This includes 2 components: a bilingual, color-coded PrepCheck Card featuring a visual stool guide (green = adequate, yellow = borderline, red = inadequate), distributed at scheduling or by mail, and a navigator phone call 24 hours before the procedure to review the patient’s self-assessment and provide tailored support or rescheduling guidance. Data will be collected from de-identified EHR. Results: The primary outcome is bowel preparation adequacy, defined as a Boston Bowel Preparation Scale (BBPS) score ≥6 with no segment <2. Secondary outcomes include same-day cancellations, repeat procedures, and patient-reported understanding of instructions. We anticipate at least a 20% absolute improvement in bowel preparation adequacy in the intervention group compared to baseline. We expect improvements in patient comprehension and a reduction in procedural inefficiencies. Conclusion: PrepCheck+ is a scalable, patient-centered intervention addressing bowel prep disparities in underserved populations. By combining visual self-assessment with navigator support, it aims to improve preparation quality, reduce inefficiencies, and support equitable, cost-effective CRC screening.