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Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study

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...

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Autores principales: Lansdorp-Vogelaar, Iris, Fedewa, Stacey, Lin, Chun Chieh, Virgo, Katherine S., Jemal, Ahmedin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230916/
https://www.ncbi.nlm.nih.gov/pubmed/25393312
http://dx.doi.org/10.1371/journal.pone.0110937
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author Lansdorp-Vogelaar, Iris
Fedewa, Stacey
Lin, Chun Chieh
Virgo, Katherine S.
Jemal, Ahmedin
author_facet Lansdorp-Vogelaar, Iris
Fedewa, Stacey
Lin, Chun Chieh
Virgo, Katherine S.
Jemal, Ahmedin
author_sort Lansdorp-Vogelaar, Iris
collection PubMed
description 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.
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spelling pubmed-42309162014-11-18 Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study Lansdorp-Vogelaar, Iris Fedewa, Stacey Lin, Chun Chieh Virgo, Katherine S. Jemal, Ahmedin PLoS One Research Article 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. Public Library of Science 2014-11-13 /pmc/articles/PMC4230916/ /pubmed/25393312 http://dx.doi.org/10.1371/journal.pone.0110937 Text en © 2014 Lansdorp-Vogelaar et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Lansdorp-Vogelaar, Iris
Fedewa, Stacey
Lin, Chun Chieh
Virgo, Katherine S.
Jemal, Ahmedin
Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study
title Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study
title_full Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study
title_fullStr Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study
title_full_unstemmed Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study
title_short Utilization of Surveillance after Polypectomy in the Medicare Population – A Cohort Study
title_sort utilization of surveillance after polypectomy in the medicare population – a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230916/
https://www.ncbi.nlm.nih.gov/pubmed/25393312
http://dx.doi.org/10.1371/journal.pone.0110937
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