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...
| Main Authors: | , , , , |
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| Format: | Journal Article |
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Public Library of Science
2014
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| Online Access: | http://hdl.handle.net/20.500.11937/49838 |
| _version_ | 1848758327633248256 |
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| author | Lansdorp_Vogelaar, Iris Fedewa, S. Lin, C. Virgo, K. Jemal, A. |
| author_facet | Lansdorp_Vogelaar, Iris Fedewa, S. Lin, C. Virgo, K. Jemal, A. |
| author_sort | Lansdorp_Vogelaar, Iris |
| building | Curtin Institutional Repository |
| collection | Online Access |
| 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. |
| first_indexed | 2025-11-14T09:42:14Z |
| format | Journal Article |
| id | curtin-20.500.11937-49838 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T09:42:14Z |
| publishDate | 2014 |
| publisher | Public Library of Science |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-498382017-09-13T15:37:23Z Utilization of surveillance after Polypectomy in the Medicare population - A cohort study Lansdorp_Vogelaar, Iris Fedewa, S. Lin, C. Virgo, K. Jemal, A. 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. 2014 Journal Article http://hdl.handle.net/20.500.11937/49838 10.1371/journal.pone.0110937 Public Library of Science unknown |
| spellingShingle | Lansdorp_Vogelaar, Iris Fedewa, S. Lin, C. Virgo, K. Jemal, A. 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 |
| url | http://hdl.handle.net/20.500.11937/49838 |