title: Surveillance for hepatocellular carcinoma in a Medicaid cirrhotic population.
abstract: OBJECTIVE
  To estimate the hepatocellular carcinoma surveillance in the Medicaid cirrhotic population.
  
  
  BACKGROUND
  Most studies predate 2005 American Association for the Study of Liver Diseases surveillance recommendations and do not examine the primary target population, cirrhotics.
  
  
  METHODS
  From 2006 to 2007, we identified adults with at least 1 cirrhosis International Classification of Disease code and 15 months of continuous enrollment in North Carolina Medicaid, recording claims for abdominal ultrasound, computed tomography, magnetic resonance imaging, and α-fetoprotein testing. We used multivariable logistic regression to identify factors independently associated with imaging.
  
  
  RESULTS
  A total of 5061 subjects were identified: mean age 54 years, 54% male patients, 35% African American, 56% white. Cirrhosis risk factors were alcohol (59%), hepatitis C (30%), hepatitis B (4%), others (18%), and unknown (24%). Only 26% underwent at least 1 imaging test. Just 12% of those not hospitalized or seen in an emergency department underwent any imaging test. Care in an academic facility, younger age, female sex, viral hepatitis, and Medicare coinsurance were positively associated with imaging. Twenty-one percent saw a gastroenterologist, which increased the odds of undergoing imaging (odds ratio, 2.81; 95% confidence interval, 2.32-3.41), whereas primary care visits did not (odds ratio, 0.94; 95% confidence interval, 0.76-1.16).
  
  
  CONCLUSIONS
  Only a quarter of North Carolina Medicaid cirrhotics underwent abdominal imaging over a 15-month period, and many tests may have been conducted without surveillance intent. Gastroenterology visits nearly tripled the odds of imaging, but primary-care visits had no effect. Efforts to improve surveillance rates in cirrhotic patients should target primary care and increased access to subspecialty care.
authors: Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA. lpalmer@lumc.edu
authors: Lena B
authors: LB
authors: Palmer
authors: Michael D
authors: MD
authors: Kappelman
authors: Robert S
authors: RS
authors: Sandler
authors: Paul H
authors: PH
authors: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D008484:Medicaid; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina / Q000453:epidemiology; D011159:Population Surveillance; D012307:Risk Factors; D014481:United States