Disparities in Utilization of Medical Specialists for Colonoscopy
Disparities in Utilization of Medical Specialists for Colonoscopy
复制标题
DOI：
10.1089/heq.2019.0052
复制
发表时间：
2019-01-01
期刊：
影响因子：
2.7
通讯作者：
Eberth, Jan M.
中科院分区：
文献类型：
--
作者：
Josey, Michele J.;Odahowski, Cassie L.;Eberth, Jan M.
目的：结肠镜检查是预防结直肠癌（CRC）的首选筛查方式。手术的质量各不相同，尽管胃肠病学家和结直肠外科医生等医学专家往往有更好的结果。我们的目的是确定是否有人口统计学和临床差异，接受结肠镜检查的专家与那些接受结肠镜检查的非专家。研究方法：使用基于人群的南卡罗来纳州门诊手术数据库，我们回顾性地获得了2010年至2014年的患者级内窥镜检查记录。我们使用多水平逻辑回归模型来模拟患者是否去看专家进行结肠镜检查。主要变量是病人的种族和保险类型，和农村的相互作用进行了测试。结果：在纳入分析的392，285例患者中，81%的患者接受了结肠镜检查。居住县解释了30%的结果变异性。非西班牙裔黑人（OR=0.65;置信区间[95% CI]：0.64-0.67）和西班牙裔患者（OR=0.75; 95% CI：0.67-0.84）看专科医生的可能性显著低于非西班牙裔白色患者。与商业/HMO保险相比，所有其他类型的保险都不太可能去看专家，农村患者更是如此。种族与农村的交互作用不显著。结论：专家在CRC筛查中发挥关键作用，并可能影响后期下游结果。这项研究表明，少数民族和有公共或其他保险的成年人，特别是在农村地区，最有可能不去看专科医生。这些结果与CRC发病率、死亡率和生存率的差异一致。
Purpose: Colonoscopy is the preferred screening modality for colorectal cancer (CRC) prevention. The quality of the procedure varies although medical specialists such as gastroenterologists and colorectal surgeons tend to have better outcomes. We aimed to determine whether there are demographic and clinical differences between those who received a colonoscopy from a specialist versus those who received a colonoscopy from a nonspecialist. Methods: Using the population-based South Carolina Outpatient Ambulatory Surgery Database, we looked retrospectively to obtain patient-level endoscopy records from 2010 to 2014. We used multilevel logistic regression to model whether patients saw a specialist for their colonoscopy. The primary variables were patient race and insurance type, and an interaction by rurality was tested. Results: Of the 392,285 patients included in the analysis, 81% saw a specialist for their colonoscopy. County of residence explained 30% of the variability in the outcome. Non-Hispanic black (OR=0.65; confidence interval [95% CI]: 0.64-0.67) and Hispanic patients (OR=0.75; 95% CI: 0.67-0.84) were significantly less likely than non-Hispanic white patients to see a specialist. Compared with commercial/HMO insurance, all other types were less likely to see a specialist, and even more so for rural patients. The interaction of race by rurality was not significant. Conclusions: Specialists play a key role in CRC screening and can affect later downstream outcomes. This study has shown that ethnic minorities and adults with public or other insurance, particularly in rural areas, are most likely not to see a specialist. These results are consistent with disparities in CRC incidence, mortality, and survival.