Differences between generalists and specialists in characteristics of patients receiving gastrointestinal procedures
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BACKGROUND: As a result of market forces and maturing technology, generalists are currently providing services, such as colonoscopy, that in the past were deemed the realm of specialists.
OBJECTIVE: To determine whether there were differences in patient characteristics, procedure complexity, and clinical indications when gastrointestinal endoscopic procedures were provided by generalists versus specialists.
DESIGN: Retrospective cohort study.
PATIENTS: A random 5% sample of aged Medicare beneficiaries who underwent rigid and flexible sigmoidoscopy, colonoscopy, and esophagogastroduodenoscopy (EGD) performed by specialists (gastroenterologists, general surgeons, and colorectal surgeons) or generalists (general practitioners, family practitioners, and general internists).
MEASUREMENTS: Characteristics of patients, indications for the procedure, procedural complexity, and place of service were compared between generalists and specialists using descriptive statistics and logistic regression.
MAIN RESULTS: Our sample population had 167,347 gastrointestinal endoscopies. Generalists performed 7.7% of the 57,221 colonoscopies, 8.7% of the 62,469 EGDs, 42.7% of the 38,261 flexible sigmoidoscopies, and 35.2% of the 9,396 rigid sigmoidoscopies. Age and gender of patients were similar between generalists and specialists, but white patients were more likely to receive complex endoscopy from specialists. After adjusting for patient differences in age, race, and gender, generalists were more likely to have provided a simple diagnostic procedure (odds ratio [OR] 4.2; 95% confidence interval [95% CI] 4.0, 4.4), perform the procedure for examination and screening purposes (OR 4.9; 95% CI, 4.3 to 5.6), and provide these procedures in rural areas (OR 1.5; 95% CI 1.4 to 1.6).
CONCLUSIONS: Although generalists perform the full spectrum of gastrointestinal endoscopies, their procedures are often of lower complexity and less likely to have been performed for investigating severe morbidities.
Key wordscolonoscopy esophagogastroduodenoscopy sigmoidoscopy generalist physician specialist physician practice patterns
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- 4.Hocutt JE, Rodney WM, Zurad EG, Tucker RS, Norris T. Esophagogastroduodenoscopy for the family physician. Am Fam Phys. 1994;49:109–16.Google Scholar
- 13.Hocutt JE, Rodney WM, Zurad EG, Tucker RS, Norris T. Esophagogastroduodenoscopy for the family physician. Am Fam Phys. 1994;49:109–16.Google Scholar
- 16.Pierzhajlo RP, Ackerman RJ, Vogel RL. Colonoscopy performed by a family physician. J Fam Pract. 1997;44:473–80.Google Scholar
- 21.Physicians’ Current Procedural Terminology (CPT). 4th ed. Chicago, Ill: American Medical Association; 1992.Google Scholar
- 22.International Classification of Diseases, 9th Revision, Clinical Modification. Salt Lake City, Utah: Medicode Publications; 1995.Google Scholar
- 23.Health Care Financing Administration Privacy Act of 1974; systems of records. Fed Reg. 1990;55:18179–81.Google Scholar
- 24.Elixhauser A. Clinical Classifications for Health Policy Research, Version 2: Software and User’s Guide. Healthcare Cost and Utilization Project (HCUP-3) Research Note 2. Rockville, Md: Agency for Health Care Policy and Research; 1996. AHCPR publication 96-0046.Google Scholar
- 25.User documentation for the Area Resource File. Rockville, Md. Office of Research and Planning Bureau of Heath Professions, Health Resources and Services Administration; February 1993. Rockville, Md.Google Scholar
- 27.Roback C, Randolph L, Seidman G. Physician Characteristics and Distribution in the United States. Chicago, Ill: American Medical Association; 1992.Google Scholar
- 28.Stata Reference Manual, Version 5.0. College Station, Tex: Stata Corp; 1996.Google Scholar
- 32.Rodney WM. Procedural skills in flexible sigmoidoscopy and colonoscopy for the family physician. Prim Care Clin. 1988;15:79–91.Google Scholar