S660 Identifying Delays in Endoscopic Care: The Role of Income, Insurance, and Patient-Reported Barriers

Introduction: Timely access to colonoscopy and esophagogastroduodenoscopy (EGD) is critical for gastrointestinal disease management and colorectal cancer prevention. Despite scheduling interventions, procedure completion disparities persist, particularly in underserved populations. While demographic predictors of access are well studied, patient-reported barriers remain underexplored. This study examines the relationships between sociodemographic characteristics, perceived barriers, and the timeliness of procedures. Methods: We conducted a cohort study of 658 patients scheduled for colonoscopy or EGD at a tertiary care center. Patients were grouped based on (1) time from procedure scheduling to completion and (2) time from procedure ordering to completion. Structured telephone surveys were administered to assess patient-reported barriers. This data was integrated with sociodemographic and procedural characteristics to identify factors associated with timeliness and completion. Results: Older age was moderately associated with longer time from both scheduling (P < 0.001) and ordering (P < 0.001) to completion. Median household income was inversely correlated with time to procedure completion (P = 0.015), with higher-income patients experiencing shorter delays. Patients with Horizon insurance had significantly shorter procedure completion times (65.9 days) compared to those with charity care (76.2 days) and Medicare (80.9 days) (P = 0.026). Hispanic patients experienced significantly longer time from scheduling to completion (mean 64.7 days) compared to White (45.1 days) and Black (64.3 days) patients (P = 0.003). For time from ordering to completion, Hispanic patients had the longest delays (mean 71.7 days), while White and Black patients had shorter durations (P = 0.010). Spanish-speaking patients showed significantly longer times from procedure ordered to completion than English speakers (mean 73.8 vs 65.2 days, P = 0.013). Patients whose physicians did not emphasize the importance of completing the procedure had longer delays from order to completion (mean 124.2 vs 74.3 days, P = 0.035). Conclusion: Older age, lower income, public insurance, and Spanish language were associated with longer delays in procedure completion. Patients whose providers did not emphasize the need for the procedure had the greatest delays, underscoring the role of provider endorsement in promoting timely follow-through. Addressing social determinants and improving patient-provider interactions may help reduce disparities in timely endoscopic care.