Diagnostic testing following fecal occult blood screening in the elderly.
Diagnostic testing following fecal occult blood screening in the elderly.
复制标题
老年人粪便潜血筛查后的诊断测试。
DOI：
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复制
发表时间：
1999
期刊：
影响因子：
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通讯作者：
H. Welch
中科院分区：
文献类型：
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作者：
Jon D. Lurie;H. Welch
背景
在对照试验中，粪便潜血试验（FOBT）筛查已被证明可降低结直肠癌死亡率。最近，医疗保险批准支付FOBT筛查。我们评估了老年医疗保险受益人最初FOBT后的诊断测试模式。从长远来看，这种后续测试将影响广泛使用FOBT的成本和效益。
方法
使用医疗保险的国家索赔历史系统，我们确定了24246名65岁或以上的美国人，他们在1995年1月1日至4月30日期间接受了FOBT。在FOBT之前，这些人没有任何证据表明FOBT可以用于诊断的任何条件。我们在随后的8个月内检查了该队列的相关诊断测试，并确定了接受美国医师学会推荐的评估的比例。
结果
每1000名接受FOBT的Medicare受益人中，有93名（95%置信区间= 89-96/1000）在随后的8个月内有阳性结果和相关测试。其中，34%的患者接受了结肠镜检查或乙状结肠镜检查和气钡灌肠检查。另外34%的患者接受了乙状结肠镜检查或钡灌肠检查。其余32%的患者接受了其他胃肠道（GI）检查，但未对结肠腔进行评价：腹部计算机断层扫描或磁共振成像（15%）、上消化道造影（10%）、癌胚抗原（7%）和上消化道内镜检查（2%）。将分析限制在初始FOBT后2个月内进行的试验，得到了类似的结果。
结论
在FOBT之后，许多医疗保险受益人得到进一步的诊断测试，但只有一小部分人得到了推荐的评估。在这种实践模式下，人群筛查可能比对照试验估计的成本更高，效果更差。
BACKGROUND
Screening with a fecal occult blood test (FOBT) has been shown to reduce colorectal cancer mortality in controlled trials. Recently, Medicare approved payment for FOBT screening. We evaluated the pattern of diagnostic testing following the initial FOBT in elderly Medicare beneficiaries. Such follow-up testing would in the long run influence both the cost and the benefit of widespread use of FOBT.
METHODS
Using Medicare's National Claims History System, we identified 24 246 Americans 65 years old or older who received FOBT at physician visits between January 1 and April 30, 1995. Prior to FOBT, these people had no evidence of any conditions for which FOBT might be used diagnostically. We examined relevant diagnostic testing in this cohort during the subsequent 8 months and determined what proportion of those received an evaluation recommended by the American College of Physicians.
RESULTS
For every 1000 Medicare beneficiaries who received FOBT, 93 (95% confidence interval = 89-96 per 1000) had positive findings and relevant testing in the subsequent 8 months. Of these, 34% had the recommended evaluation of either colonoscopy or flexible sigmoidoscopy with an air-contrast barium enema. Another 34% received a partial colonic evaluation with either flexible sigmoidoscopy or a barium enema. The remaining 32% received other gastrointestinal (GI) testing without evaluation of the colonic lumen: computed tomography or magnetic resonance imaging of the abdomen (15%), upper GI series (10%), carcinoembryonic antigen (7%), and upper endoscopy (2%). Restricting the analysis to testing performed within 2 months of the initial FOBT yielded similar results.
CONCLUSION
Following FOBT, many Medicare beneficiaries get further diagnostic testing, but only a small proportion receives the recommended evaluation. With this pattern of practice, population screening is likely to be more costly and less effective than estimated from controlled trials.
影响因子：
158.5
作者：
MANDEL, JS;BOND, JH;EDERER, F
通讯作者：
EDERER, F
结直肠肿瘤筛查：医生坚持完整的诊断评估。
影响因子：
12.7
作者：
Myers,RE;Balshem,AM;Wolf,TA;Ross,EA;Millner,L
通讯作者：
Millner,L