Colonoscopy: Practice Patterns and Limitations

结肠镜检查：实践模式和局限性

• 批准号: 7745498
• 负责人: GREGORY S. COOPER
• 金额: $ 26.06万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-01-01 至 2011-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7745498
• 关键词: Age; Age-Years; Area; Benign; Caucasoid Race; Characteristics; Colonic Adenoma; Colonic Polyps; Colonoscopy; Colorectal; Colorectal Cancer; Colorectal Polyp; Data; Databases; Detection; Development; Diagnosis; Diagnostic Neoplasm Staging; Early treatment; Effectiveness; Excision; Frequencies; Future; General Population; Goals; Guidelines; Health Planning; Incidence; Knowledge; Lesion; Link; Malignant - descriptor; Malignant Neoplasms; Measures; Medicare; Medicare claim; Operative Surgical Procedures; Outcome; Patients; Pattern; Phase; Physicians; Policies; Polypectomy; Polyps; Population; Premalignant; Procedures; Randomized Controlled Trials; Recording of previous events; Rectum; Registries; Relative (related person); Risk; Risk Factors; Sampling; Screening procedure; Specialist; Specific qualifier value; Staging; Testing; Time; Treatment outcome; Use Effectiveness; base; beneficiary; cancer recurrence; clinical practice; cohort; colorectal cancer screening; design; follow-up; indexing; medical specialties; population based; prospective; public health relevance; routine practice

DESCRIPTION (provided by applicant): Colonoscopy is considered by many professional and lay groups to be the preferred option for colorectal cancer screening and by virtue of polypectomy, it allows removal of premalignant lesions and possibly curative treatment of early stage cancers. Despite the positive attributes of screening colonoscopy, because of development of interval cancers following colonoscopy, concerns about the accuracy of colonoscopy as currently practiced have been raised. It also appears that there is relative overuse of the procedure for follow up after polyp removal. There is a relative paucity of population-based data regarding colonoscopy utilization and outcomes. The proposed study will include two components, one using a cancer-free population and one using patients with incident colorectal cancer. In the first phase, a cohort of patients undergoing colonoscopy with polypectomy will be identified through a 5% random sample of Medicare claims data. Previous claims will be searched to stratify according to a prior history of colon polyps or other risk factors, or colonic surgery. Following the index polypectomy, claims will be examined to determine the timing and outcome of repeat colonoscopy and other colonic procedures, with a particular focus on colonoscopies performed before the 3-year minimum interval. Practice patterns will be compared between patient, physician and facility characteristics. In the second phase, patients with a first diagnosis of colorectal cancer will be identified through SEER registry files. Among patients with a polyp containing early stage cancer, the outcome of treatment with endoscopic resection will be compared to surgical resection, and delayed outcomes, including the need for subsequent surgery will be measured. Factors that predict the use of endoscopic resection will be identified and propensity scores for treatment will be developed and used to compare outcomes. Among all patients with incident cancer, prior claims data will be searched to determine the use of colonoscopy. A cohort of patients with potentially missed or interval cancer will be identified and compared to other patients according to patient, physician, facility, and small area characteristics. The studies proposed in this application will provide important data about the use and potential effectiveness of colonoscopy in routine practice. Given the increased emphasis on colonoscopy as a preferred screening test in the general population, these data will help inform future policy decisions. PUBLIC HEALTH RELEVANCE: Colorectal cancer, the second most fatal cancer in the U.S., is largely preventable through the removal of polyps. However, there is only limited knowledge about the treatment and outcome of colorectal polyps in routine clinical practice. Using data from a large number of Medicare patients, we will study practice patterns for polyp removal via colonoscopy, evaluate its effectiveness in the treatment of early stage colorectal cancer, and estimate the potential failed detection rate at colonoscopy.

描述（由申请人提供）：许多专业和外行人组认为结肠镜检查是结直肠癌筛查的首选选择，并依靠多型切除术，它允许去除预抗病变的病变，并可能治疗早期阶段癌症的治疗方法。尽管结肠镜检查具有筛查的积极属性，但由于结肠镜检查后间隔癌的发展，人们对目前实践的结肠镜检查的准确性的担忧已经提高。看来，息肉去除后的过程相对过度使用。关于结肠镜检查和结果的基于人群的数据相对匮乏。拟议的研究将包括两个组成部分，一个使用无癌症的人群，另一种使用入射结直肠癌的患者。在第一阶段，将通过5％的Medicare索赔数据进行5％的随机样本来鉴定进行结肠镜检查的患者队列。将根据结肠息肉或其他危险因素或结肠手术的先前史进行以前的索赔进行分层。索引多型切除术后，将检查索赔，以确定重复结肠镜检查和其他结肠手术的时间和结果，并特别关注在最小三年最小间隔之前进行的结肠镜检查。将在患者，医师和设施特征之间比较练习模式。在第二阶段，将通过SEER注册表文件确定有结直肠癌的患者。在含有早期癌症的息肉的患者中，将将内窥镜切除治疗的结果与手术切除术进行比较，并将结局延迟，包括后续手术的需求。将确定预测使用内窥镜切除术的因素，并将开发和用于比较结果的倾向分数。在所有入射癌症患者中，将搜索先验索赔数据以确定结肠镜检查的使用。根据患者，医师，设施和小面积特征，将确定一群潜在丢失或间隔癌症的患者并将其与其他患者进行比较。本应用程序中提出的研究将提供有关结肠镜检查在常规实践中的使用和潜在有效性的重要数据。鉴于对一般人群的首选筛查测试的重视日益强调，这些数据将有助于为未来的政策决策提供信息。 公共卫生相关性：大肠癌是美国第二大致命癌，在很大程度上可以通过去除息肉来预防。但是，在常规临床实践中，关于结直肠息肉的治疗和结果的知识有限。使用来自大量Medicare患者的数据，我们将研究通过结肠镜检查去除息肉的实践模式，评估其在早期结直肠癌治疗中的有效性，并估计结肠镜检查时的潜在检测率失败。