Clinical research studySpecialty Differences in Polyp Detection, Removal, and Biopsy during Colonoscopy
Section snippets
Identification of Claims
We conducted a retrospective cohort study using a 20% nationally representative sample of claims in the Medicare Carrier and Medicare Provider Analysis and Review files. We included Medicare beneficiaries aged 66 years and over who had a colonoscopy claim submitted during 2003. Beneficiaries were excluded if they were ineligible for both Medicare Parts A and Part B for the entire 12 months before and after the index colonoscopy or if they enrolled in a Medicare health maintenance organization
Results
We identified 382,426 colonoscopies. After excluding 54,259 inpatient examinations, 328,167 outpatient examinations conducted by 12,910 providers were included in this analysis. Characteristics of eligible patients and providers are shown in Table 2.
Significant differences in practice location of colonoscopies, annual colonoscopy volume, and colonoscopy site of service were found between providers' specialties (Table 3). For example, gastroenterologists had the highest median annual colonoscopy
Discussion
Colonoscopy is a high volume and costly procedure, but the training and facilities to do this procedure are quite variable. In this study, we found significant relationships between diagnostic biopsy, polyp detection, and polyp removal and provider specialty, provider annual colonoscopy volume, and endoscopy site of service. Overall, gastroenterologists were more likely to detect and remove polyps and perform diagnostic biopsies than other specialties. Gastroenterologists generally receive the
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Funding: This work was funded by the American College of Gastroenterology. Dr. Dominitz was supported by the American Society for Gastrointestinal Endoscopy Endoscopic Research Career Development Award. This material is the result of work supported in part by resources from the VA Puget Sound Health Care System, Seattle, Washington. The views and opinions of authors expressed herein do not necessarily state or reflect those of the United States Government or the Department of Veterans Affairs.
Conflict of Interest: The authors have no conflicts of interest.
Authorship: All authors had access to the data and role in writing the manuscript.