Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system
Predictors of guideline concordance for surveillance colonoscopy recommendations in patients at a safety-net health system
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DOI：
10.1007/s10552-015-0661-x
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发表时间：
2015-11-01
影响因子：
2.3
通讯作者：
Singal, Amit G.
中科院分区：
文献类型：
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作者：
Kahn, Ben;Freeland, Zachary;Singal, Amit G.
结直肠癌（CRC）筛查的适当监测间隔是医疗保险和医疗补助服务中心2014年医生质量报告系统措施之一。监测间隔的适当性将继续密切监测，特别是当补偿与质量措施挂钩时。量化并确定腺瘤息肉切除术后指南一致性监测建议的预测因素。我们对2011年6月至2013年12月期间在安全网卫生系统接受结肠镜检查和息肉切除术的患者进行了回顾性队列研究。比指南建议短和长的监督建议被定义为潜在的过度使用和使用不足。我们使用多变量逻辑回归来确定指南一致性监测建议、过度使用和使用不足的相关性。在1，822例息肉切除术患者中，1，329例腺瘤为千分之一。1，410名（77.4%）患者的监测间隔建议与指南一致，263名（14.4%）患者可能过度使用，85名（4.7%）患者可能未充分使用，64名（3.5%）患者缺失。多变量分析中指南一致性建议的预测因素包括年龄> 65岁（OR 1.36，95% CI 1.02-1.80）、不完全切除（OR 3.58，95% CI 1.41-9.09）和良好/极佳准备质量（OR 2.22，95% CI 1.72-2.86）。未充分使用的建议更有可能发生在腺瘤为千分之一的患者中;过度使用的建议更有可能发生在高度异型增生或准备质量一般的患者中，而在部分切除、腺瘤为千分之一的患者、年龄> 65岁或西班牙裔患者中的可能性较小。干预措施，以提高准备质量和指南一致性的监督建议，可以提高成本效益的CRC筛查。
Appropriate surveillance intervals for colorectal cancer (CRC) screening is one of the Centers for Medicare and Medicaid Services 2014 physician quality reporting system measures. Appropriateness of surveillance intervals will continue to be monitored closely, particularly as reimbursements become tied to quality measures.Quantify and identify predictors for guideline-concordant surveillance recommendations after adenoma polypectomy.We conducted a retrospective cohort study of patients who had colonoscopy with polypectomy at a safety-net health system between June 2011 and December 2013. Surveillance recommendations shorter and longer than guideline recommendations were defined as potential overuse and underuse. We used multivariate logistic regression to identify correlates of guideline-concordant surveillance recommendations, overuse, and underuse.Among 1,822 patients with polypectomy, 1,329 had a parts per thousand yen1 adenoma. Surveillance interval recommendations were guideline-concordant in 1,410 (77.4 %) patients, potential overuse in 263 (14.4 %), potential underuse in 85 (4.7 %), and missing in 64 (3.5 %) patients. Predictors of guideline-concordant recommendations in multivariate analyses included age > 65 years (OR 1.36, 95 % CI 1.02-1.80), incomplete resection (OR 3.58, 95 % CI 1.41-9.09), and good/excellent prep quality (OR 2.22, 95 % CI 1.72-2.86). Underuse recommendations were more likely in patients with a parts per thousand yen3 adenomas; overuse recommendations were more likely in patients with high-grade dysplasia or fair prep quality and less likely in those with piecemeal resection, a parts per thousand yen3 adenomas, age > 65, or Hispanic ethnicity.Surveillance recommendations are not concordant with guidelines in one of four cases. Interventions to improve prep quality and guideline concordance of surveillance recommendations can improve cost-effectiveness of CRC screening.