Medicare Under Age 65 and Medicaid Patients Have Poorer Bowel Preparations: Implications for Recommendations for an Early Repeat Colonoscopy
Colonoscopy is performed on patients across a broad spectrum of demographic characteristics. These characteristics may aggregate by patient insurance provider and influence bowel preparation quality and the prevalence of adenomas. The purpose of this study was to evaluate the association of insuranc...
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| Veröffentlicht in: | PloS one 2016-05, Vol.11 (5), p.e0155208-e0155208 |
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| description | Colonoscopy is performed on patients across a broad spectrum of demographic characteristics. These characteristics may aggregate by patient insurance provider and influence bowel preparation quality and the prevalence of adenomas. The purpose of this study was to evaluate the association of insurance status and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, adenoma detection rate (ADR), and advanced ADR (AADR).
This is a cohort study of outpatient colonoscopies (n = 3113) at a single academic medical center. Patient insurance status was categorized into five groups: 1) Medicare < 65y; 2) Medicare ≥ 65y; 3) Tricare/VA; 4) Medicaid/Colorado Indigent Care Program (CICP); and 5) commercial insurance. We used multivariable logistic or linear regression modeling to estimate the risks for the association between patient insurance and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, ADR, and AADR. Models were adjusted for appropriate covariates.
Medicare patients < 65y (OR 4.91; 95% CI: 3.25-7.43) and Medicaid/CICP patients (OR 4.23; 95% CI: 2.65-7.65) were more likely to have a suboptimal preparation compared to commercial insurance patients. Medicare patients < 65y (OR 5.58; 95% CI: 2.85-10.92) and Medicaid/CICP patients (OR 3.64; CI: 1.60-8.28) were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients. Medicare patients < 65y had a significantly higher adjusted ADR (OR 1.50; 95% CI: 1.03-2.18) and adjusted AADR (OR 1.99; 95% CI: 1.15-3.44) compared to commercial insurance patients.
Understanding the reasons for the higher rate of a suboptimal bowel preparation in Medicare < 65y and Medicaid/CICP patients and reducing this rate is critical to improving colonoscopy outcomes and reducing healthcare costs in these populations. |
| doi_str_mv | 10.1371/journal.pone.0155208 |
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This is a cohort study of outpatient colonoscopies (n = 3113) at a single academic medical center. Patient insurance status was categorized into five groups: 1) Medicare < 65y; 2) Medicare ≥ 65y; 3) Tricare/VA; 4) Medicaid/Colorado Indigent Care Program (CICP); and 5) commercial insurance. We used multivariable logistic or linear regression modeling to estimate the risks for the association between patient insurance and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, ADR, and AADR. Models were adjusted for appropriate covariates.
Medicare patients < 65y (OR 4.91; 95% CI: 3.25-7.43) and Medicaid/CICP patients (OR 4.23; 95% CI: 2.65-7.65) were more likely to have a suboptimal preparation compared to commercial insurance patients. Medicare patients < 65y (OR 5.58; 95% CI: 2.85-10.92) and Medicaid/CICP patients (OR 3.64; CI: 1.60-8.28) were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients. Medicare patients < 65y had a significantly higher adjusted ADR (OR 1.50; 95% CI: 1.03-2.18) and adjusted AADR (OR 1.99; 95% CI: 1.15-3.44) compared to commercial insurance patients.
Understanding the reasons for the higher rate of a suboptimal bowel preparation in Medicare < 65y and Medicaid/CICP patients and reducing this rate is critical to improving colonoscopy outcomes and reducing healthcare costs in these populations.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0155208</identifier><identifier>PMID: 27187809</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adenoma ; Adenoma - diagnosis ; Adult ; Age ; Age Factors ; Aged ; Ambulatory Care ; Analysis ; Cohort Studies ; Colon ; Colon cancer ; Colonoscopy ; Colonoscopy - methods ; Colonoscopy - standards ; Colonoscopy - statistics & numerical data ; Constipation ; Demographic aspects ; Demographics ; Diagnosis ; Endoscopy ; Engineering and Technology ; Female ; Gastroenterology ; Government programs ; Health care ; Health care facilities ; Health care policy ; Health education ; Health literacy ; Hepatology ; Humans ; Insurance ; Intestine ; Low income groups ; Male ; Medicaid ; Medical diagnosis ; Medicare ; Medicine and Health Sciences ; Middle Aged ; Neoplasm Staging ; Pain ; Patients ; Preoperative Care - standards ; Preoperative Care - statistics & numerical data ; Quality ; Retrospective Studies ; Risk factors ; Social Sciences ; Socioeconomic factors ; Surveillance ; Tumors ; United States</subject><ispartof>PloS one, 2016-05, Vol.11 (5), p.e0155208-e0155208</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Brimhall et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Brimhall et al 2016 Brimhall et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-e8637d446c48c698d6461f76c6b5371e1f052d03a44f5fdd24f388fa7229ef1d3</citedby><cites>FETCH-LOGICAL-c692t-e8637d446c48c698d6461f76c6b5371e1f052d03a44f5fdd24f388fa7229ef1d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871354/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871354/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27187809$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Green, John</contributor><creatorcontrib>Brimhall, Bryan B</creatorcontrib><creatorcontrib>Hankins, Sam C</creatorcontrib><creatorcontrib>Kankanala, Vineel</creatorcontrib><creatorcontrib>Austin, Gregory L</creatorcontrib><title>Medicare Under Age 65 and Medicaid Patients Have Poorer Bowel Preparations: Implications for Recommendations for an Early Repeat Colonoscopy</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Colonoscopy is performed on patients across a broad spectrum of demographic characteristics. These characteristics may aggregate by patient insurance provider and influence bowel preparation quality and the prevalence of adenomas. The purpose of this study was to evaluate the association of insurance status and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, adenoma detection rate (ADR), and advanced ADR (AADR).
This is a cohort study of outpatient colonoscopies (n = 3113) at a single academic medical center. Patient insurance status was categorized into five groups: 1) Medicare < 65y; 2) Medicare ≥ 65y; 3) Tricare/VA; 4) Medicaid/Colorado Indigent Care Program (CICP); and 5) commercial insurance. We used multivariable logistic or linear regression modeling to estimate the risks for the association between patient insurance and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, ADR, and AADR. Models were adjusted for appropriate covariates.
Medicare patients < 65y (OR 4.91; 95% CI: 3.25-7.43) and Medicaid/CICP patients (OR 4.23; 95% CI: 2.65-7.65) were more likely to have a suboptimal preparation compared to commercial insurance patients. Medicare patients < 65y (OR 5.58; 95% CI: 2.85-10.92) and Medicaid/CICP patients (OR 3.64; CI: 1.60-8.28) were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients. Medicare patients < 65y had a significantly higher adjusted ADR (OR 1.50; 95% CI: 1.03-2.18) and adjusted AADR (OR 1.99; 95% CI: 1.15-3.44) compared to commercial insurance patients.
Understanding the reasons for the higher rate of a suboptimal bowel preparation in Medicare < 65y and Medicaid/CICP patients and reducing this rate is critical to improving colonoscopy outcomes and reducing healthcare costs in these populations.</description><subject>Adenoma</subject><subject>Adenoma - diagnosis</subject><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Ambulatory Care</subject><subject>Analysis</subject><subject>Cohort Studies</subject><subject>Colon</subject><subject>Colon cancer</subject><subject>Colonoscopy</subject><subject>Colonoscopy - methods</subject><subject>Colonoscopy - standards</subject><subject>Colonoscopy - statistics & numerical data</subject><subject>Constipation</subject><subject>Demographic aspects</subject><subject>Demographics</subject><subject>Diagnosis</subject><subject>Endoscopy</subject><subject>Engineering and Technology</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>Government programs</subject><subject>Health care</subject><subject>Health care facilities</subject><subject>Health care policy</subject><subject>Health education</subject><subject>Health literacy</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Insurance</subject><subject>Intestine</subject><subject>Low income groups</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medical diagnosis</subject><subject>Medicare</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Pain</subject><subject>Patients</subject><subject>Preoperative Care - standards</subject><subject>Preoperative Care - statistics & numerical data</subject><subject>Quality</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Social Sciences</subject><subject>Socioeconomic factors</subject><subject>Surveillance</subject><subject>Tumors</subject><subject>United States</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9Fu0zAUhiMEYmPwBggsISG4aLFjx3F2gVSmwSoNbRqMW8uxj7tMThzsdNB34KFx12xq0S5QJCc55_t_28c-WfaS4CmhJflw7ZehU27a-w6mmBRFjsWjbJ9UNJ_wHNPHW9972bMYrzEuqOD8abaXl0SUAlf72Z-vYBqtAqDLzkBAswUgXiDVGbTJNAadq6GBbojoRN0AOvc-JPCT_wUOnQfoVUh538VDNG97lyS3f8j6gC5A-7aFzmzFVIeOVXCrlOxBDejIO9_5qH2_ep49scpFeDG-D7LLz8ffj04mp2df5kez04nmVT5MQHBaGsa4ZiJFhOGME1tyzesiVQaIxUVuMFWM2cIakzNLhbCqzPMKLDH0IHu98e2dj3IsZJSkFBWrCCtwIuYbwnh1LfvQtCqspFeNvA34sJAqDI12IKkoOehaCY2BQVFXZY1tTYTKLa5BlMnr4zjbsm7B6FTKoNyO6W6ma67kwt9IJkpCC5YM3o0Gwf9cQhxk20QNzqkO_HK97grjNPAioW_-QR_e3UgtVNpA01mf5tVrUzljBaUc03K97ukDVHoMtI1Ot842Kb4jeL8jSMwAv4eFWsYo598u_p89-7HLvt1ir0C54Sp6t7y9U7sg24A6-BgD2PsiEyzXTXNXDbluGjk2TZK92j6ge9Fdl9C_uWQShg</recordid><startdate>20160517</startdate><enddate>20160517</enddate><creator>Brimhall, Bryan B</creator><creator>Hankins, Sam C</creator><creator>Kankanala, Vineel</creator><creator>Austin, Gregory L</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20160517</creationdate><title>Medicare Under Age 65 and Medicaid Patients Have Poorer Bowel Preparations: Implications for Recommendations for an Early Repeat Colonoscopy</title><author>Brimhall, Bryan B ; Hankins, Sam C ; Kankanala, Vineel ; Austin, Gregory L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-e8637d446c48c698d6461f76c6b5371e1f052d03a44f5fdd24f388fa7229ef1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adenoma</topic><topic>Adenoma - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brimhall, Bryan B</au><au>Hankins, Sam C</au><au>Kankanala, Vineel</au><au>Austin, Gregory L</au><au>Green, John</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Medicare Under Age 65 and Medicaid Patients Have Poorer Bowel Preparations: Implications for Recommendations for an Early Repeat Colonoscopy</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-05-17</date><risdate>2016</risdate><volume>11</volume><issue>5</issue><spage>e0155208</spage><epage>e0155208</epage><pages>e0155208-e0155208</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Colonoscopy is performed on patients across a broad spectrum of demographic characteristics. These characteristics may aggregate by patient insurance provider and influence bowel preparation quality and the prevalence of adenomas. The purpose of this study was to evaluate the association of insurance status and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, adenoma detection rate (ADR), and advanced ADR (AADR).
This is a cohort study of outpatient colonoscopies (n = 3113) at a single academic medical center. Patient insurance status was categorized into five groups: 1) Medicare < 65y; 2) Medicare ≥ 65y; 3) Tricare/VA; 4) Medicaid/Colorado Indigent Care Program (CICP); and 5) commercial insurance. We used multivariable logistic or linear regression modeling to estimate the risks for the association between patient insurance and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, ADR, and AADR. Models were adjusted for appropriate covariates.
Medicare patients < 65y (OR 4.91; 95% CI: 3.25-7.43) and Medicaid/CICP patients (OR 4.23; 95% CI: 2.65-7.65) were more likely to have a suboptimal preparation compared to commercial insurance patients. Medicare patients < 65y (OR 5.58; 95% CI: 2.85-10.92) and Medicaid/CICP patients (OR 3.64; CI: 1.60-8.28) were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients. Medicare patients < 65y had a significantly higher adjusted ADR (OR 1.50; 95% CI: 1.03-2.18) and adjusted AADR (OR 1.99; 95% CI: 1.15-3.44) compared to commercial insurance patients.
Understanding the reasons for the higher rate of a suboptimal bowel preparation in Medicare < 65y and Medicaid/CICP patients and reducing this rate is critical to improving colonoscopy outcomes and reducing healthcare costs in these populations.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>27187809</pmid><doi>10.1371/journal.pone.0155208</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adenoma Adenoma - diagnosis Adult Age Age Factors Aged Ambulatory Care Analysis Cohort Studies Colon Colon cancer Colonoscopy Colonoscopy - methods Colonoscopy - standards Colonoscopy - statistics & numerical data Constipation Demographic aspects Demographics Diagnosis Endoscopy Engineering and Technology Female Gastroenterology Government programs Health care Health care facilities Health care policy Health education Health literacy Hepatology Humans Insurance Intestine Low income groups Male Medicaid Medical diagnosis Medicare Medicine and Health Sciences Middle Aged Neoplasm Staging Pain Patients Preoperative Care - standards Preoperative Care - statistics & numerical data Quality Retrospective Studies Risk factors Social Sciences Socioeconomic factors Surveillance Tumors United States |
| title | Medicare Under Age 65 and Medicaid Patients Have Poorer Bowel Preparations: Implications for Recommendations for an Early Repeat Colonoscopy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T04%3A38%3A43IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Medicare%20Under%20Age%2065%20and%20Medicaid%20Patients%20Have%20Poorer%20Bowel%20Preparations:%20Implications%20for%20Recommendations%20for%20an%20Early%20Repeat%20Colonoscopy&rft.jtitle=PloS%20one&rft.au=Brimhall,%20Bryan%20B&rft.date=2016-05-17&rft.volume=11&rft.issue=5&rft.spage=e0155208&rft.epage=e0155208&rft.pages=e0155208-e0155208&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0155208&rft_dat=%3Cgale_plos_%3EA453360377%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1789491450&rft_id=info:pmid/27187809&rft_galeid=A453360377&rft_doaj_id=oai_doaj_org_article_3876ecba8c0e4e5b97b0fb18a2f0be87&rfr_iscdi=true |