Use of colonoscopy for polyp surveillance in Medicare beneficiaries.
Use of colonoscopy for polyp surveillance in Medicare beneficiaries.
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DOI：
10.1002/cncr.27990
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发表时间：
2013-05-15
期刊：
影响因子：
6.2
通讯作者：
Schluchter, Mark D.
中科院分区：
文献类型：
--
作者：
Cooper, Gregory S.;Kou, Tzuyung D.;Sloan, Jill S. Barnholtz;Koroukian, Siran M.;Schluchter, Mark D.
专业协会指南建议对切除的结肠腺瘤患者进行后续结肠镜检查。然而，在常规临床实践中对指南建议的坚持并没有得到很好的表征。使用基于人群的医疗保险受益人样本，我们确定了2001-2004年间所有70岁及以上的患者要求结肠镜下息肉切除术或热活检。截至2009年的医疗保险索赔确定在接下来的五年内进行结肠镜检查，以及FOBT、乙状结肠镜和钡灌肠检查。研究对象为12,771名患者。在五年内，45.7%的人再次接受结肠镜检查，其中32.3%的手术包括息肉切除术。术后5年FOBT、乙状结肠镜和钡灌肠率分别为54.0%、3.8%和2.9%。随着最近几年的指标性检查，在1、3和5年重复结肠镜检查的次数明显减少。其他预测再次接受结肠镜检查的因素包括较年轻的年龄、非裔美国人种族以及指数检查前的结肠镜检查。这与医生的专业无关。在多变量分析中，结肠镜检查的使用率随着时间的延长而减少。在这个老年医疗保险受益者的样本中，息肉切除后5年的随访结肠镜检查使用不足，不到一半的人接受了重复检查。特别是，在四年的研究期间，这一程序的使用有所减少。再加上其他数据显示，在没有息肉的患者中过度使用后续结肠镜检查，指南和实际操作之间似乎存在显著的不一致。
Professional society guidelines recommend follow up colonoscopy in patients with resected colonic adenomas. However, adherence to guideline recommendations in routine clinical practice has not been well characterized. Using a population-based sample of Medicare beneficiaries, we identified all patients aged 70 and older with a claim for colonoscopy with polypectomy or hot biopsy in 2001–2004. Medicare claims through 2009 identified colonoscopy within the following five years, as well as FOBT, sigmoidoscopy and barium enema. 12,771 patients were included. At five years, 45.7% received another colonoscopy, with 32.3% of procedures including polypectomy. Rates of FOBT, flexible sigmoidoscopy and barium enema at five years were 54.0%, 3.8% and 2.9%, respectively. There was a marked decrease in repeat colonoscopy at 1, 3, and 5 years with more recent years of index procedures. Other predictors of undergoing repeat colonoscopy were younger age, African American race, and a colonoscopy prior to the index examination. There was no association with physician specialty. The decreasing use of colonoscopy with time was maintained in a multivariable analysis. In this sample of elderly Medicare beneficiaries, there was underuse of follow up colonoscopy at 5 years after polypectomy, with fewer than half receiving a repeat examination. In particular, the use of this procedure has decreased over the four-year study period. Coupled with other data showing overuse of follow up colonoscopy in patients without polyps, there appears to be significant discordance between guidelines and actual practice.
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DOI：
10.1016/j.cgh.2008.12.009
发表时间：
2009-05
期刊：
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association
影响因子：
--
作者：
Laiyemo AO;Pinsky PF;Marcus PM;Lanza E;Cross AJ;Schatzkin A;Schoen RE
通讯作者：
Schoen RE
影响因子：
6.2
作者：
Cooper, Gregory S.;Kou, Tzuyung Doug;Reynolds, Harry L., Jr.
通讯作者：
Reynolds, Harry L., Jr.
影响因子：
39.2
作者：
Boolchand, Vikram;Olds, Gregory;Cooper, Gregory S.
通讯作者：
Cooper, Gregory S.
影响因子：
158.5
作者：
WINAWER, SJ;ZAUBER, AG;SHIKE, M
通讯作者：
SHIKE, M
影响因子：
7.7
作者：
Singh, N;Harrison, M;Rex, DK
通讯作者：
Rex, DK