Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
J Clin Gastroenterol. 2013 Sep;47(8):713-8. doi: 10.1097/MCG.0b013e318286fd97.
To estimate the hepatocellular carcinoma surveillance in the Medicaid cirrhotic population.
Most studies predate 2005 American Association for the Study of Liver Diseases surveillance recommendations and do not examine the primary target population, cirrhotics.
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.
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).
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.
估计医疗补助肝硬化人群中的肝细胞癌监测情况。
大多数研究都早于 2005 年美国肝病研究协会的监测建议，并且没有检查主要目标人群，即肝硬化患者。
我们从 2006 年到 2007 年，在北卡罗来纳州医疗补助中确定了至少有 1 次肝硬化国际疾病分类代码和 15 个月连续入组的成年人，记录腹部超声、计算机断层扫描、磁共振成像和甲胎蛋白检测的索赔。我们使用多变量逻辑回归来确定与成像独立相关的因素。
共确定了 5061 名受试者：平均年龄 54 岁，54%为男性患者，35%为非裔美国人，56%为白人。肝硬化的危险因素为酒精（59%）、丙型肝炎（30%）、乙型肝炎（4%）、其他（18%）和未知（24%）。只有 26%的患者至少进行了 1 次影像学检查。只有 12%的未住院或未在急诊就诊的患者进行了任何影像学检查。在学术机构接受治疗、年龄较小、女性、病毒性肝炎和医疗保险共付额与影像学检查呈正相关。21%的患者看了胃肠病学家，这增加了进行影像学检查的几率（比值比，2.81；95%置信区间，2.32-3.41），而初级保健就诊没有（比值比，0.94；95%置信区间，0.76-1.16）。
在 15 个月的时间里，只有四分之一的北卡罗来纳州医疗补助肝硬化患者接受了腹部影像学检查，并且许多检查可能是在没有监测目的的情况下进行的。胃肠病学就诊几乎使影像学检查的几率增加了两倍，但初级保健就诊没有影响。为提高肝硬化患者的监测率，应针对初级保健并增加获得专科医疗的机会。
