Overuse of colonoscopy widespread in the US

[tabs tab1=”2MM Rundown” tab2= “2MM Full Report”]

[tab]

Image: PD

1. Over 20% of screening colonoscopies among older Medicare beneficiaries may be unnecessary.

2. Rates of colonoscopy overuse vary by provider and geographic region.

Colonoscopy is the primary screening modality for colorectal cancer in the US. Despite its invaluable role in cancer screening, the procedure must be used judiciously to limit risks to individual patients and prevent unnecessary healthcare spending. Current guidelines recommend against screening colonoscopy in the oldest age groups and within 10 years of a negative screening result. However, this study demonstrates that inappropriate screening colonoscopy in Medicare beneficiaries is widespread, with variable rates among physicians and across geographic regions. Further research is necessary to determine the patient- and provider-related factors underlying these differential rates of overuse, which have been documented across other realms of Medicare spending.

Click to read the study in JAMA Internal Medicine

[/tab]

[tab]

Image: PD

1. Over 20% of screening colonoscopies among older Medicare beneficiaries may be unnecessary.

2. Rates of colonoscopy overuse vary by provider and geographic region.

This [retrospective cohort] study evaluated 100% Medicare claims data from Texas and a 5% sample from the US and identified Medicare beneficiaries aged 70 and older who underwent a colonoscopy between October 1, 2008 and September 30, 2009. Colonoscopies were classified as diagnostic or screening, and screening colonoscopies were further sub-classified as potentially inappropriate (on the basis of patient age or occurrence too soon after a colonoscopy with negative findings) or appropriate. The percentage of inappropriate screening colonoscopy was estimated for each colonoscopist and hospital service area. Across the US, 23.5% (range 19.5% to 30.5%) of screening colonoscopies were potentially inappropriate, with similar rates (23.4%, rangie 13.3% to 34.9%) in Texas. These rates varied significantly across colonoscopists, with approximately 6% of the variation in outcome attributable to the physician. Higher rates of potentially inappropriate screening were seen among surgeons, US medical school graduates, higher-volume colonoscopists, and physicians who had been in practice longer.  

In sum: Colonoscopy is the primary screening modality for colorectal cancer in the US. Despite its invaluable role in cancer screening, the procedure must be used judiciously to limit risks to individual patients and prevent unnecessary healthcare spending. Current guidelines recommend against screening colonoscopy in the oldest age groups and within 10 years of a negative screening result. However, this study demonstrates that inappropriate screening colonoscopy in Medicare beneficiaries is widespread, with variable rates among physicians and across geographic regions. Further research is necessary to determine the patient- and provider-related factors underlying these differential rates of overuse, which have been documented across other realms of Medicare spending.

Click to read the study in JAMA Internal Medicine

By Elizabeth Kersten and Andrew Bishara

More from this author: Meta-analysis updates recommendations for C-sections, Shorter telomere length linked with increased risk of common cold, Breastfeeding associated with lower rates of hypertension, Health information technology improves obesity treatment access and screening, Undervaccination becoming more common, associated with increased admission rates

© 2013 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. Disclaimer: We present factual information directly from peer reviewed medical journals. No post should be construed as medical advice and is not intended as such by the authors or by 2minutemedicine.com. PLEASE SEE A HEALTHCARE PROVIDER IN YOUR AREA IF YOU SEEK MEDICAL ADVICE OF ANY SORT. Content is produced in accordance with fair use copyrights solely and strictly for the purpose of teaching, news and criticism. No benefit, monetary or otherwise, is realized by any participants or the owner of this domain.

[/tab]

[/tabs]