Specialty Differences in Polyp Detection, Removal, and Biopsy during Colonoscopy
Specialty Differences in Polyp Detection, Removal, and Biopsy during Colonoscopy
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DOI：
10.1016/j.amjmed.2010.01.016
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发表时间：
2010-06-01
影响因子：
5.9
通讯作者：
Baldwin, Laura-Mae
中科院分区：
文献类型：
--
作者：
Ko, Cynthia W.;Dominitz, Jason A.;Baldwin, Laura-Mae
背景：结肠镜检查是一项技术复杂的程序，通常用于检测和清除结直肠病变。本研究探讨了供应商的特点对息肉检测，息肉切除和诊断活检rate.METHODS的影响：我们进行了一项回顾性横断面研究，使用2003年医疗保险索赔的20%的样本。主要结果指标是诊断性活检、息肉检测和息肉切除的使用。我们使用广义估计方程来确定结果的独立预测因子，并根据患者和提供者的特征进行调整。在328，167例门诊结肠镜检查中，非胃肠病学家的息肉检出率和切除率明显低于胃肠病学家，息肉检出的校正相对危险度为0.80（95%置信区间[CI]，0.77-0.83），普通外科医生和0.93（95% CI，0.89-0.98），内科医生。与胃肠病学家相比，普通外科医生（相对危险度[RR] 0.69; 95%CI，0.65-0.74）或结直肠外科医生（RR 0.58; 95%CI，0.52-0.65）进行诊断性活检的可能性明显较低。在每年结肠镜检查量的中间2个四分位数的医生中，息肉检测和切除的可能性较高，但在最高和最低四分位数的医生中相似。息肉的检测和去除显着不太可能在门诊手术中心或办公室比医院门诊设置的检查，而诊断性活检是显着不太可能在办公室settings.CONCLUSIONS：医师专业，每年结肠镜检查量，和网站的服务是重要的预测息肉检测，息肉切除，诊断性活检。这些发现可能对结肠镜检查的有效性有重要意义。(C)2010年爱思唯尔公司All rights reserved. .美国医学杂志（2010）123，528-535
BACKGROUND: Colonoscopy is a technically complex procedure commonly performed to detect and remove colorectal pathology. This study examined the influence of provider characteristics on polyp detection, polyp removal, and diagnostic biopsy rates.METHODS: We conducted a retrospective cross-sectional study using a 20% sample of 2003 Medicare claims. Primary outcome measures were use of diagnostic biopsy, polyp detection, and polyp removal. We used generalized estimating equations to identify independent predictors of the outcomes, adjusting for patient and provider characteristics.RESULTS: Among 328,167 outpatient colonoscopies, polyp detection and removal rates were significantly lower for nongastroenterologists than gastroenterologists, with adjusted relative risk for polyp detection between 0.80 (95% confidence interval [CI], 0.77-0.83) for general surgeons and 0.93 (95% CI, 0.89-0.98) for internists. Compared with gastroenterologists, diagnostic biopsy was significantly less likely for general (relative risk [RR] 0.69; 95% CI, 0.65-0.74) or colorectal surgeons (RR 0.58; 95% CI, 0.52-0.65). The likelihood of polyp detection and removal was higher for physicians in the middle 2 quartiles of annual colonoscopy volume, but similar for physicians in the highest and lowest volume quartiles. Polyp detection and removal were significantly less likely for examinations in ambulatory surgery centers or offices than hospital outpatient settings, while diagnostic biopsy was significantly less likely in office settings.CONCLUSIONS: Physician specialty, annual colonoscopy volume, and site of service are significant predictors of polyp detection, polyp removal, and diagnostic biopsy. These findings may have important implications for the effectiveness of colonoscopy. (C) 2010 Elsevier Inc. All rights reserved. . The American Journal of Medicine (2010) 123, 528-535