{
  "abstract": "Background Targeting 20% most deprived communities with clinical early-stage cancer diagnosis focus can reduce patient harm (Core20PLUS5 Framework). DNA (Did Not Attend) appointments impact patient health outcomes in cancer diagnostic tests; treatment delays, additional re-arranging resources and potentially more severe diagnosis/prognosis. A multi-disciplinary team developed a predictive risk model, identifying DNA high-risk patients due to health inequalities and piloted patient healthcare navigation.Methods Machine learning model trained on 2-years of 39,447 endoscopy appointments data identified endoscopy high-risk DNA patients based on risk factors including health inequalities. Probability factors contributing, positively or negatively, include; attendance behaviours, demographic factors; deprivation, age, gender, and procedure type. Variables such as prior DNAs, rurality, and socio-economic deprivation were among the most predictive. Over 12-weeks patients with 10% or greater probability of DNA received pre-appointment healthcare navigation calls; understanding and helping mitigate attendance barriers.Results Pre-appointment calls were made between 7 October 2024 and 17 January 2025. 540 predicted high-risk DNA patients were contacted (78% engagement rate). Themes identified: forgetting, anxiety and feeling un-informed. Baseline DNA rate, (same time period, previous year) estimated 17% for ‘high-risk’ patients. Pilot results: ‘high-risk’ patient DNA rate fell to 5% for patients contacted (11% including patients unable to contact). Endoscopy patient text reminders paused March 2024 resuming November 2024, 3.5 weeks into pilot. Pilot observed 52 DNAs from 650 appointments. Scaling data up over a year, assuming 10.8% DNA rate consistent, estimated preventing 150 DNAs; calls alone generate 10% DNA reduction for ‘high-risk’ patients and 20% reduction with reminder text.Conclusion Targeted pre-appointment patient calls for those predicted DNA high-risk are associated with statistically significant reduction in the proportion of DNAs. The work has scaled up; further 5 service areas developing predictor models. This small-scale study’s findings are limited to NHS trust endoscopy service in the Northeast of England; further formalised research is necessary.",
  "authors": [
    {
      "affiliations": [
        "Public Health, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK"
      ],
      "name": "Lisa Nevens"
    },
    {
      "affiliations": [
        "Public Health, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK"
      ],
      "name": "Christopher Wilcockson"
    },
    {
      "affiliations": [
        "Information Services, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK"
      ],
      "name": "Fabian Beigang"
    },
    {
      "affiliations": [
        "Information Services, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK"
      ],
      "name": "Richard Bilsborogh"
    },
    {
      "affiliations": [
        "Public Health, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK"
      ],
      "name": "Clare Stebbings"
    },
    {
      "affiliations": [
        "Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK"
      ],
      "name": "Tom Lee"
    }
  ],
  "title": "P16-7 Reducing health inequalities in endoscopy attendance rates through non-attendance prediction and healthcare navigation: a mixed methods study",
  "uid": "24cdd20d-15a4-562e-98e7-66eb293ea131"
}