title: Utilization and predictors of early repeat colonoscopy in Medicare beneficiaries.
abstract: OBJECTIVE
  Early repeat colonoscopy after an index examination may be justifiable, but may also reflect quality issues during the first examination. The aims of this study were to examine the use of second colonoscopy within 1 year of an index colonoscopy, and to examine patient and provider factors associated with use of early repeat colonoscopy.
  
  
  METHODS
  We performed a retrospective cohort study using a 20% nationally representative sample of 2003 Medicare claims. Patients aged ≥ 66 years undergoing colonoscopy were included in this study. We identified the use of second colonoscopy and barium enema within 1 year of the index procedure. We used logistic regression analyses to examine the independent predictors of these procedures.
  
  
  RESULTS
  We included 328,167 outpatient colonoscopies. In all, 5% had second colonoscopy and 2.2% had barium enema within 1 year of the index examination. Early repeat colonoscopy was more common if the index examination was performed by a family physician (odds ratio 1.39, 95% confidence interval 1.23-1.56), general surgeon (odds ratio 1.18, 95% confidence interval 1.10-1.27) or internist (odds ratio 1.12, 95% confidence interval 1.02-1.23) compared with a gastroenterologist, or after colonoscopies by an endoscopist in the lower quartiles of colonoscopy volume compared with endoscopists in the highest quartile. Increasing patient age and comorbidity, polyp detection, biopsy, polyp removal, incomplete index examination, and site of service were also significantly associated with early repeat colonoscopy.
  
  
  CONCLUSIONS
  Early repeat colonoscopy is not unusual. The association of specialty and colonoscopy volume with early repeat colonoscopy suggests that there are modifiable processes of care or training that may prevent some of these repeat procedures.
authors.affiliation: Department of Medicine, University of Washington, Seattle, Washington 98195, USA. cwko@u.washington.edu
authors.forename: Cynthia W
authors.initials: CW
authors.lastname: Ko
authors.forename: Jason A
authors.initials: JA
authors.lastname: Dominitz
authors.forename: Pam
authors.initials: P
authors.lastname: Green
authors.forename: William
authors.initials: W
authors.lastname: Kreuter
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D016009:Chi-Square Distribution; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003287:Contrast Media; D004733:Enema; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D019233:Retreatment; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate