Colonoscopy: Practice Patterns and Limitations

结肠镜检查：实践模式和局限性

• 批准号: 7745498
• 负责人: GREGORY S. COOPER
• 金额: $ 26.06万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-01 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7745498
• 关键词: Age; Age-Years; Area; Benign; Caucasoid Race; Characteristics; Colonic Adenoma; Colonic Polyps; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Polyp; Data; Databases; Detection; Development; Diagnosis; Diagnostic Neoplasm Staging; Early treatment; Effectiveness; Excision; Frequencies; Future; General Population; Goals; Guidelines; Health Planning; Incidence; Knowledge; Lesion; Link; Malignant - descriptor; Malignant Neoplasms; Measures; Medicare; Medicare claim; Operative Surgical Procedures; Outcome; Patients; Pattern; Phase; Physicians; Policies; Polypectomy; Polyps; Population; Premalignant; Procedures; Randomized Controlled Trials; Recording of previous events; Rectum; Registries; Relative (related person); Risk; Risk Factors; Sampling; Screening procedure; Specialist; Specific qualifier value; Staging; Testing; Time; Treatment outcome; Use Effectiveness; base; beneficiary; cancer recurrence; clinical practice; cohort; colorectal cancer screening; design; follow-up; indexing; medical specialties; population based; prospective; public health relevance; routine practice

DESCRIPTION (provided by applicant): Colonoscopy is considered by many professional and lay groups to be the preferred option for colorectal cancer screening and by virtue of polypectomy, it allows removal of premalignant lesions and possibly curative treatment of early stage cancers. Despite the positive attributes of screening colonoscopy, because of development of interval cancers following colonoscopy, concerns about the accuracy of colonoscopy as currently practiced have been raised. It also appears that there is relative overuse of the procedure for follow up after polyp removal. There is a relative paucity of population-based data regarding colonoscopy utilization and outcomes. The proposed study will include two components, one using a cancer-free population and one using patients with incident colorectal cancer. In the first phase, a cohort of patients undergoing colonoscopy with polypectomy will be identified through a 5% random sample of Medicare claims data. Previous claims will be searched to stratify according to a prior history of colon polyps or other risk factors, or colonic surgery. Following the index polypectomy, claims will be examined to determine the timing and outcome of repeat colonoscopy and other colonic procedures, with a particular focus on colonoscopies performed before the 3-year minimum interval. Practice patterns will be compared between patient, physician and facility characteristics. In the second phase, patients with a first diagnosis of colorectal cancer will be identified through SEER registry files. Among patients with a polyp containing early stage cancer, the outcome of treatment with endoscopic resection will be compared to surgical resection, and delayed outcomes, including the need for subsequent surgery will be measured. Factors that predict the use of endoscopic resection will be identified and propensity scores for treatment will be developed and used to compare outcomes. Among all patients with incident cancer, prior claims data will be searched to determine the use of colonoscopy. A cohort of patients with potentially missed or interval cancer will be identified and compared to other patients according to patient, physician, facility, and small area characteristics. The studies proposed in this application will provide important data about the use and potential effectiveness of colonoscopy in routine practice. Given the increased emphasis on colonoscopy as a preferred screening test in the general population, these data will help inform future policy decisions. PUBLIC HEALTH RELEVANCE: Colorectal cancer, the second most fatal cancer in the U.S., is largely preventable through the removal of polyps. However, there is only limited knowledge about the treatment and outcome of colorectal polyps in routine clinical practice. Using data from a large number of Medicare patients, we will study practice patterns for polyp removal via colonoscopy, evaluate its effectiveness in the treatment of early stage colorectal cancer, and estimate the potential failed detection rate at colonoscopy.

描述（由申请人提供）：结肠镜检查被许多专业和非专业团体认为是结直肠癌筛查的首选，由于息肉切除术，它可以切除癌前病变，并可能治愈早期癌症。尽管筛查结肠镜检查具有积极的属性，但由于结肠镜检查后间歇性癌症的发展，目前实施的结肠镜检查的准确性已引起关注。此外，息肉切除后的随访程序似乎相对过度使用。关于结肠镜检查的使用和结果，基于人群的数据相对较少。拟议的研究将包括两个组成部分，一个使用无癌症人群，另一个使用结肠直肠癌患者。在第一阶段，将通过医疗保险索赔数据的5%随机样本确定接受结肠镜检查和息肉切除术的患者队列。以前的索赔将根据结肠息肉或其他风险因素或结肠手术的既往史进行分层。在索引息肉切除术后，将检查索赔以确定重复结肠镜检查和其他结肠手术的时间和结果，特别关注在3年最小间隔之前进行的结肠镜检查。将在患者、医生和机构特征之间比较实践模式。在第二阶段，首次诊断为结直肠癌的患者将通过SEER注册文件进行识别。在患有包含早期癌症的息肉的患者中，将内镜切除术的治疗结果与手术切除术进行比较，并测量延迟结果，包括后续手术的需要。将确定预测使用内镜切除术的因素，并制定治疗倾向评分，用于比较结局。在所有发生癌症的患者中，将检索先前的索赔数据，以确定结肠镜检查的使用。将根据患者、医生、机构和小区域特征，确定一组可能漏诊或间隔癌症的患者，并与其他患者进行比较。本申请中提出的研究将提供有关结肠镜检查在常规实践中的使用和潜在有效性的重要数据。鉴于越来越重视结肠镜检查作为一般人群的首选筛查测试，这些数据将有助于为未来的政策决策提供信息。 公共卫生相关性：结直肠癌是美国第二大致命癌症，在很大程度上可以通过切除息肉来预防。然而，在常规临床实践中，对结肠直肠息肉的治疗和结局的了解有限。使用大量医疗保险患者的数据，我们将研究通过结肠镜切除息肉的实践模式，评估其在早期结直肠癌治疗中的有效性，并估计结肠镜检查的潜在失败率。