Abstract
Background The frequency of early repeat and follow-up tests (RAFTs) occurring after colonoscopy has not been previously examined in the literature. RAFTs incur cost, discomfort, and inconvenience to patients who have undergone colonoscopic examination; therefore, it is important to identify factors associated with their use. Methods We identified elderly Medicare recipients who had colonoscopy performed in 1999 from the 5% Medicare administrative files (N = 69,282). We determined the number of early RAFTs (repeat colonoscopy, barium enema, flexible sigmoidoscopy) occurring within the year of initial colonoscopy. Results Of the study sample, 8.3% required at least one RAFT during the year. Using multivariable analysis, we found that RAFTs varied significantly with age, race, sex, income, comorbidity, provider type, and place of service. RAFTs were 22% higher in African Americans compared to whites. Gastroenterologists used 20–35% fewer RAFTs than the other provider types performing colonoscopy. Conclusions The frequency of early RAFTs after colonoscopy occurs in 8.3% of the Medicare population. Important differences exist in the frequency of RAFTs by race and provider type.
Similar content being viewed by others
References
The Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.
Quality and outcomes assessment in gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. 2000;52:827–830.
ASGE (American Society for Gastrointestinal Endoscopy). Principles of training in gastrointestinal endoscopy. Gastrointest Endosc. 1999;49:845–853. doi:10.1016/S0016-5107(99)70316-0.
Freeman ML. Training and competence in gastrointestinal endoscopy. Rev Gastroenterol Disord. 2001;1:73–86.
Medicare Utilization for Part B (Supplemental Insurance SMI). Physician/Supplier Data. Available at: http://cms.hhs.gov/statistics/feeforservice/default.asp: Centers for Medicare and Medicaid Services, 2000.
Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–1751. doi:10.1001/jama.280.20.1747.
US Public Health Services. International Classification of Diseases, 9th revision: Clinical modification. Los Angeles: PMIC; 1996.
Nattinger AB, McAuliffe TL, Schapira MM. Generalizability of the Surveillance, Epidemiology, and End Results registry population: factors relevant to epidemiologic and health care research. J Clin Epidemiol. 1997;50:939–945. doi:10.1016/S0895-4356(97)00099-1.
Blustein J, Hanson K, Shea S. Preventable hospitalizations and socioeconomic status. Health Affairs. 1998;17:177–189. doi:10.1377/hlthaff.17.2.177.
Current Procedure Terminology. Chicago: American Medical Association; 1999.
Meyer GS, Cheng EY, Elting J. Differences between generalists and specialists in characteristics of patients receiving gastrointestinal procedures. J Gen Intern Med. 2000;15:188–194. doi:10.1046/j.1525-1497.2000.06039.x.
Gornick ME, Eggers PW, Reilly TW, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–799. doi:10.1056/NEJM199609123351106.
Burns RB, McCarthy EP, Freund KM, et al. Black women receive less mammography even with similar use of primary care. Ann Intern Med. 1996;125:173–182.
Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med. 1999;341:1359–1367. doi:10.1056/NEJM199910283411806.
Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;341:1198–1205. doi:10.1056/NEJM199910143411606.
McMahon LF, Wolfe RA, Huang S, Tedeschi P, Manning W, Edlund MJ. Racial and gender variation in use of diagnostic colonic procedures in the Michigan Medicare population. Med Care. 1999;37:712–717. doi:10.1097/00005650-199907000-00011.
Mayberry R, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57(Supplement 1):108–145.
Charlson ME. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: a response. J Clin Epidemiol. 1993;46:1083–1084. doi:10.1016/0895-4356(93)90105-A.
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619. doi:10.1016/0895-4356(92)90133-8.
Cox DR. Regression models and life-tables. J R Stat Soc [Ser A]. 1972;34:187–220.
American Medical Association. Physicians’ current procedure terminology: CPT 94. Chicago, IL: American Medical Association; 1993.
Du X, Freeman JL, Warren JL, Nattinger AB, Zhang D, Goodwin JS. Accuracy and completeness of Medicare claims data for surgical treatment of breast cancer. Med Care. 2000;38:719–727. doi:10.1097/00005650-200007000-00004.
Javitt JC, McBean M, DiPaolo F. Accuracy of coding in Medicare Part B claims. Arch Ophthal. 1993;111:605–607.
Richards RJ, Reker DM. Racial differences in the use of colonoscopy, sigmoidoscopy and barium enema in Medicare beneficiaries. Dig Dis Sci. 2002;47:2715–2719. doi:10.1023/A:1021001121026.
Ristikankare M, Hartikainen J, Heikkinen M, Janatuinen E, Julkunen R. The effects of gender and age on the colonoscopic examination. J Clin Gastroenterol. 2001;32:69–75. doi:10.1097/00004836-200101000-00016.
Walter LC, de Garmo P, Covinsky KE. Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy. Am J Med. 2004;116:174–178. doi:10.1016/j.amjmed.2003.09.030.
Anderson JC, Messina CR, Cohn W, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc. 2001;54:558–562. doi:10.1067/mge.2001.118950.
Anderson JC, Gonzalez JD, Messina CR, Pollack BJ. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol. 2000;95:2784–2787. doi:10.1111/j.1572-0241.2000.03186.x.
Mitchell RM, McCallion K, Gardiner KR, Watson RG, Collins JS. Successful colonoscopy; completion rates and reasons for incompletion. Ulster Med J. 2002;71:34–37.
Worthington DV. Colonoscopy: procedural skills. Am Fam Physician. 2000;62:1177–1182.
Wexner SD, Garbus JE, Singh JJ. A prospective analysis of 13, 580 colonoscopies. Reevaluation of credentialing guidelines. Surg Endosc. 2001;15:251–261. doi:10.1007/s004640080147.
Edwards JK, Norris TE. Colonoscopy in rural communities: can family physicians perform the procedure with safe and efficacious results? J Am Board of Fam Pract. 2004;17:353–358.
Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc. 2002;55:307–314. doi:10.1067/mge.2002.121883.
Rodney WM, Dabov G, Orientale E, Reeves WP. Sedation associated with a more complete colonoscopy. J Fam Pract. 1993;36:394–400.
Pierzchajlo RP, Ackermann RJ, Vogel RL. Colonoscopy performed by a family physician. A case series of 751 procedures. J Fam Pract. 1997;44:473–480.
Cancer facts and figures for African Americans 2000–2001. Atlanta: American Cancer Society; 2000.
Chen VW, Fenoglio-Preiser CM, Wickerham DL, et al. Aggressiveness of colon carcinoma in blacks and whites. Cancer Epidemiol Biomarkers Prev. 1997;6:1087–1093.
Dayal H, Polissar L, Yang CY, Dahlberg S. Race, socioeconomic status, and other prognostic factors for survival from colo-rectal cancer. J Chronic Dis. 1987;40:857–864. doi:10.1016/0021-9681(87)90185-8.
Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–584. doi:10.1056/NEJMsa040609.
Auerbach J, Krimgold B, eds. Income, Socioeconomic Status, and Health: Exploring the Relationships. Washington DC: National Policy Association; 2001. Report #299.
Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96:1797–1802. doi:10.1111/j.1572-0241.2001.03874.x.
Taylor C, Schubert ML. Decreased efficacy of polyethylene glycol lavage solution (golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol. 2001;96:710–714. doi:10.1111/j.1572-0241.2001.03610.x.
Robertson DJ, Lawrence LB, Shaheen N, et al. Quality of colonoscopy reporting: A process of care study. Am J Gastroenterol. 2002;97:2651–2656. doi:10.1111/j.1572-0241.2002.06044.x.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Richards, R.J., Crystal, S. The Frequency of Early Repeat Tests After Colonoscopy in Elderly Medicare Recipients. Dig Dis Sci 55, 421–431 (2010). https://doi.org/10.1007/s10620-009-0736-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-009-0736-1