title: Use of colonoscopy for polyp surveillance in Medicare beneficiaries.
abstract: BACKGROUND
  Professional society guidelines recommend follow-up colonoscopy for patients with resected colonic adenomas. However, adherence to guideline recommendations in routine clinical practice has not been well characterized.
  
  
  METHODS
  The authors used a population-based sample of Medicare beneficiaries to identify all patients aged ≥70 years who had a claim for colonoscopy with polypectomy or hot biopsy during the period from 2001 to 2004. Medicare claims through 2009 identified colonoscopy within the following 5 years as well as fecal occult blood testing, sigmoidoscopy, and barium enema.
  
  
  RESULTS
  In total, 12,771 patients were included. At 5 years, 45.7% of patients underwent another colonoscopy, and 32.3% of procedures included a polypectomy. The rates of fecal occult blood testing, flexible sigmoidoscopy, and barium enema at 5 years were 54%, 3.8%, and 2.9%, respectively. There was a marked decrease in repeat colonoscopy at 1 year, 3 years, and 5 years with more recent years of index procedures. Other predictors of undergoing repeat colonoscopy were younger age, African American race, and a colonoscopy before the index examination. There was no association with physician specialty. The decreasing use of colonoscopy with time was maintained in a multivariable analysis.
  
  
  CONCLUSIONS
  In a sample of elderly Medicare beneficiaries, there was under use of follow-up colonoscopy at 5 years after polypectomy, and <50% of patients received a repeat examination. In particular, the use of this procedure decreased over the 4-year study period. Coupled with other data indicating the overuse of follow-up colonoscopy in patients without polyps, there appeared to be significant discordance between guidelines and actual practice.
authors: Division of Gastroenterology, University Hospitals Case Medical Center, Case Western Reserve University and Case Comprehensive Cancer Center, Cleveland, Ohio. gregory.cooper@uhhospitals.org
authors: Gregory S
authors: GS
authors: Cooper
authors: Tzuyung D
authors: TD
authors: Kou
authors: Jill S
authors: JS
authors: Barnholtz Sloan
authors: Siran M
authors: SM
authors: Koroukian
authors: Mark D
authors: MD
authors: Schluchter
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D003111:Colonic Polyps / Q000191:economics / Q000453:epidemiology / Q000601:surgery*; D003113:Colonoscopy / Q000191:economics / Q000706:statistics & numerical data*; D055088:Early Detection of Cancer; D004733:Enema; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D009780:Occult Blood; D011159:Population Surveillance / Q000379:methods; D017410:Practice Guidelines as Topic; D018426:SEER Program; D012494:Sampling Studies; D012812:Sigmoidoscopy; D014481:United States / Q000453:epidemiology
chemical_list: D001466:Barium Sulfate