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Utilization of surveillance after polypectomy in the medicare population--a cohort study.

Lansdorp-Vogelaar I, Fedewa S, Lin CC, Virgo KS, Jemal A - PLoS ONE (2014)

Bottom Line: Surveillance in patients with previous polypectomy was underused in the Medicare population in 1994.At the same time, 58%, 52% and 45% (p<0.001) of beneficiaries received a surveillance event within 5 years.Older age (≥ 70 years), female gender, later cohort (2000-2001 & 2002-2003), and severe comorbidity were the most important risk factors for failure to undergo a surveillance event.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.

ABSTRACT

Background: Surveillance in patients with previous polypectomy was underused in the Medicare population in 1994. This study investigates whether expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has reduced the inappropriate use of surveillance.

Methods: We used Kaplan-Meier analysis to estimate time to surveillance and polyp recurrence rates for Medicare beneficiaries with a colonoscopy with polypectomy between 1998 and 2003 who were followed through 2008 for receipt of surveillance colonoscopy. Generalized Estimating Equations were used to estimate risk factors for: 1) failing to undergo surveillance and 2) polyp recurrence among these individuals. Analyses were stratified into three 2-year cohorts based on baseline colonoscopy date.

Results: Medicare beneficiaries undergoing a colonoscopy with polypectomy in the 1998-1999 (n = 4,136), 2000-2001 (n = 3,538) and 2002-2003 (n = 4,655) cohorts had respective probabilities of 30%, 26% and 20% (p<0.001) of subsequent surveillance events within 3 years. At the same time, 58%, 52% and 45% (p<0.001) of beneficiaries received a surveillance event within 5 years. Polyp recurrence rates after 5 years were 36%, 30% and 26% (p<0.001) respectively. Older age (≥ 70 years), female gender, later cohort (2000-2001 & 2002-2003), and severe comorbidity were the most important risk factors for failure to undergo a surveillance event. Male gender and early cohort (1998-1999) were the most important risk factors for polyp recurrence.

Conclusions: Expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has not reduced underutilization of surveillance in the Medicare population. It is important to take action now to improve this situation, because polyp recurrence is substantial in this population.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier estimates of probability of first surveillance event, stratified by cohort based on date of baseline colonoscopy with polypectomy.
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pone-0110937-g001: Kaplan-Meier estimates of probability of first surveillance event, stratified by cohort based on date of baseline colonoscopy with polypectomy.

Mentions: Patients without a surveillance event were followed for a mean period of 5.1–6.4 years, depending on cohort. Among the 6,985 patients with surveillance, 47% of surveillance events occurred within 3 years, and 83% within 5 years. Mean follow-up until surveillance was 3.2–3.4 years. A Kaplan-Meier probability curve of surveillance utilization is presented in Figure 1. The cumulative probability of a surveillance event within three years decreased from 31.5% in the 1998–1999 cohort to 20.0% in the 2002–2003 cohort (p<0.001). At the same time, however, the cumulative probability of a subsequent surveillance event within 5 years also significantly decreased from 58% to 45% respectively (p<0.001). Consequently, the probability of failure to undergo a surveillance event within 5 years increased from 42% to 55% in this period.


Utilization of surveillance after polypectomy in the medicare population--a cohort study.

Lansdorp-Vogelaar I, Fedewa S, Lin CC, Virgo KS, Jemal A - PLoS ONE (2014)

Kaplan-Meier estimates of probability of first surveillance event, stratified by cohort based on date of baseline colonoscopy with polypectomy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230916&req=5

pone-0110937-g001: Kaplan-Meier estimates of probability of first surveillance event, stratified by cohort based on date of baseline colonoscopy with polypectomy.
Mentions: Patients without a surveillance event were followed for a mean period of 5.1–6.4 years, depending on cohort. Among the 6,985 patients with surveillance, 47% of surveillance events occurred within 3 years, and 83% within 5 years. Mean follow-up until surveillance was 3.2–3.4 years. A Kaplan-Meier probability curve of surveillance utilization is presented in Figure 1. The cumulative probability of a surveillance event within three years decreased from 31.5% in the 1998–1999 cohort to 20.0% in the 2002–2003 cohort (p<0.001). At the same time, however, the cumulative probability of a subsequent surveillance event within 5 years also significantly decreased from 58% to 45% respectively (p<0.001). Consequently, the probability of failure to undergo a surveillance event within 5 years increased from 42% to 55% in this period.

Bottom Line: Surveillance in patients with previous polypectomy was underused in the Medicare population in 1994.At the same time, 58%, 52% and 45% (p<0.001) of beneficiaries received a surveillance event within 5 years.Older age (≥ 70 years), female gender, later cohort (2000-2001 & 2002-2003), and severe comorbidity were the most important risk factors for failure to undergo a surveillance event.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Erasmus MC, Rotterdam, the Netherlands.

ABSTRACT

Background: Surveillance in patients with previous polypectomy was underused in the Medicare population in 1994. This study investigates whether expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has reduced the inappropriate use of surveillance.

Methods: We used Kaplan-Meier analysis to estimate time to surveillance and polyp recurrence rates for Medicare beneficiaries with a colonoscopy with polypectomy between 1998 and 2003 who were followed through 2008 for receipt of surveillance colonoscopy. Generalized Estimating Equations were used to estimate risk factors for: 1) failing to undergo surveillance and 2) polyp recurrence among these individuals. Analyses were stratified into three 2-year cohorts based on baseline colonoscopy date.

Results: Medicare beneficiaries undergoing a colonoscopy with polypectomy in the 1998-1999 (n = 4,136), 2000-2001 (n = 3,538) and 2002-2003 (n = 4,655) cohorts had respective probabilities of 30%, 26% and 20% (p<0.001) of subsequent surveillance events within 3 years. At the same time, 58%, 52% and 45% (p<0.001) of beneficiaries received a surveillance event within 5 years. Polyp recurrence rates after 5 years were 36%, 30% and 26% (p<0.001) respectively. Older age (≥ 70 years), female gender, later cohort (2000-2001 & 2002-2003), and severe comorbidity were the most important risk factors for failure to undergo a surveillance event. Male gender and early cohort (1998-1999) were the most important risk factors for polyp recurrence.

Conclusions: Expansion of Medicare reimbursement for colonoscopy screening in high-risk individuals has not reduced underutilization of surveillance in the Medicare population. It is important to take action now to improve this situation, because polyp recurrence is substantial in this population.

No MeSH data available.


Related in: MedlinePlus