Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer
Relation between Medicare screening reimbursement and stage at diagnosis for older patients with colon cancer
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DOI：
10.1001/jama.296.23.2815
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发表时间：
2006-12-20
影响因子：
120.7
通讯作者：
Tinetti, Mary E.
中科院分区：
文献类型：
--
作者：
Gross, Cary P.;Andersen, Martin S.;Tinetti, Mary E.
背景医疗保险的报销政策于1998年改变，为结肠癌风险增加的患者提供结肠镜检查筛查的覆盖范围，并于2001年进一步扩大，以覆盖所有individual.Objective确定医疗保险报销政策的变化是否与结肠镜检查使用或早期结肠癌诊断的增加相关。和参与者在监测、流行病学和最终结果医疗保险链接数据库中的患者，年龄在67岁及以上，在1992-2002年期间被初步诊断为结肠癌，以及一组居住在监测、流行病学、主要结果测量无癌症的医疗保险受益人中结肠镜检查和乙状结肠镜检查的使用趋势采用多变量泊松回归进行评估。在患有癌症的患者中，阶段被分类为早期（阶段I）与所有其他（阶段II-IV）。时间分为第1阶段（无筛查覆盖率，1992 - 1997年）、第2阶段（有限覆盖率，1998年1月-2001年6月）和第3阶段（普遍覆盖率，2001年7月-2002年12月）。采用多因素logistic回归分析（结果=早期）评估诊断时分期的时间趋势;包括肿瘤部位和时间之间的相互作用项。结果结肠镜检查的使用率从第1期的285/10万/季度增加到第2期的889/10万和1919/10万/季度（P
Context Medicare's reimbursement policy was changed in 1998 to provide coverage for screening colonoscopies for patients with increased colon cancer risk, and expanded further in 2001 to cover screening colonoscopies for all individuals.Objective To determine whether the Medicare reimbursement policy changes were associated with an increase in either colonoscopy use or early stage colon cancer diagnosis.Design, Setting, and Participants Patients in the Surveillance, Epidemiology, and End Results Medicare linked database who were 67 years of age and older and had a primary diagnosis of colon cancer during 1992-2002, as well as a group of Medicare beneficiaries who resided in Surveillance, Epidemiology, and End Results areas but who were not diagnosed with cancer.Main Outcome Measures Trends in colonoscopy and sigmoidoscopy use among Medicare beneficiaries without cancer were assessed using multivariate Poisson regression. Among the patients with cancer, stage was classified as early ( stage I) vs all other ( stages II-IV). Time was categorized as period 1 ( no screening coverage, 19921997), period 2 ( limited coverage, January 1998-June 2001), and period 3 ( universal coverage, July 2001-December 2002). A multivariate logistic regression (outcome = early stage) was used to assess temporal trends in stage at diagnosis; an interaction term between tumor site and time was included.Results Colonoscopy use increased from an average rate of 285/ 100 000 per quarter in period 1 to 889 and 1919/100 000 per quarter in periods 2 ( P