title: The effect of colorectal cancer screening mandates on access to care and clinical outcomes: a retrospective study of patients undergoing operations of the colon and rectum.
abstract: BACKGROUND
  Policies that mandate colorectal screening coverage by private insurers are associated with increased use of screening procedures. We seek to understand whether such mandates have improved access to care and short-term operative outcomes for patients undergoing operations of the colon and rectum (OCR).
  
  
  METHODS
  Privately insured OCR patients, ages 50-64, enrolled in the Nationwide Inpatient Sample (NIS) (2000-2009) were identified. Patients were classified as "exposed" if they underwent OCR in a state that implemented a mandate ≥ 2 years before their procedure. Three outcomes were examined: admission source, postoperative complications, and postoperative mortality. Univariate analyses were performed by the use of logistic regression models. Multivariable logistic regression models were developed to evaluate the relationship between exposure status, admission source, postoperative complications, and postoperative mortality, with adjustment for confounders.
  
  
  RESULTS
  We identified 99,405 patients who underwent OCR during the study period. Of these patients, 39% were "exposed," 23% were admitted from the ED, 32% developed a postoperative complication, and 2% died during the admission. After adjusting for confounders, exposed patients were less likely to access OCR through the emergency department (odds ratio 0.87; 95% confidence interval 0.83-0.91) and less likely to develop postoperative complications (odds ratio 0.94; 95% confidence interval 0.89-0.98). There was no detectable difference in postoperative mortality.
  
  
  CONCLUSIONS
  Implementation of policies mandating coverage of colorectal screening modestly reduced emergent admission for OCR among privately insured patients. Additional studies are required to examine the screening status of patients to determine causality. Remaining states should consider implementing similar policies.
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors.forename: Neha
authors.initials: N
authors.lastname: Bansal
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Sonnenberg
authors.forename: Chelsey K
authors.initials: CK
authors.lastname: Meise
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Reinke
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.forename: Najjia N
authors.initials: NN
authors.lastname: Mahmoud
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
mesh_terms: D003106:Colon / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D055088:Early Detection of Cancer; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000601:surgery*; D012189:Retrospective Studies