Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
PLoS One. 2013 Jul 18;8(7):e69312. doi: 10.1371/journal.pone.0069312. Print 2013.
Surveillance is an integral part of the colorectal cancer (CRC) screening process. We aimed to investigate inter-physician variation in follow-up procedures after screening colonoscopy in an opportunistic CRC screening program.
A historical cohort study in the German statutory health insurance system was conducted. 55,301 individuals who underwent screening colonoscopy in 2006 in Bavaria, Germany, and who were not diagnosed with CRC were included. Utilization of follow-up colonoscopies performed by the same physician (328 physicians overall) within 3 years was ascertained. Mixed effects logistic regression modelling was used to assess the effect of physicians and other potential predictors (screening result, age group, and sex) on re-utilization of colonoscopy. Physicians were grouped into quintiles according to individual effects estimated in a preliminary model. Predicted probabilities of follow-up colonoscopy by screening result and physician group were calculated.
The observed rate of follow-up colonoscopy was 6.2% (95% confidence interval: 5.9-6.4%), 18.6% (17.8-19.4%), and 37.0% (35.5-38.4%) after negative colonoscopy, low-risk adenoma and high-risk adenoma detection, respectively. All considered predictors were statistically significantly associated with follow-up colonoscopy. The predicted probabilities of follow-up colonoscopy ranged from 1.7% (1.4-2.0%) to 11.0% (10.2-11.7%), from 7.3% (6.2-8.5%) to 35.1% (32.6-37.7%), and from 17.9% (15.5-20.6%) to 56.9% (53.5-60.3%) in the 1(st) quintile (lowest rates of follow-up) and 5(th) quintile (highest rates of follow-up) of physicians after negative colonoscopy, low-risk adenoma and high-risk adenoma detection, respectively.
This study suggests substantial inter-physician variation in follow-up habits after screening colonoscopy. Interventions, including organizational changes in CRC screening should be considered to reduce this variation.
监测是结直肠癌（CRC）筛查过程的一个组成部分。我们旨在研究在机会性 CRC 筛查计划中，筛查结肠镜检查后医生之间随访程序的差异。
在德国法定健康保险系统中进行了一项历史性队列研究。纳入了 2006 年在德国巴伐利亚州接受筛查结肠镜检查且未被诊断为 CRC 的 55301 名个体。在 3 年内，确定了由同一名医生（共有 328 名医生）进行的随访结肠镜检查的使用情况。使用混合效应逻辑回归模型评估医生和其他潜在预测因素（筛查结果、年龄组和性别）对结肠镜检查再利用的影响。根据初步模型中估计的个体效应，将医生分为五分位组。根据筛查结果和医生组计算了随访结肠镜检查的预测概率。
阴性结肠镜检查、低风险腺瘤和高风险腺瘤检测后的随访结肠镜检查率分别为 6.2%（95%置信区间：5.9-6.4%）、18.6%（17.8-19.4%）和 37.0%（35.5-38.4%）。所有考虑的预测因素与随访结肠镜检查均具有统计学显著相关性。预测的随访结肠镜检查概率范围从 1.7%（1.4-2.0%）到 11.0%（10.2-11.7%），从 7.3%（6.2-8.5%）到 35.1%（32.6-37.7%），以及从 17.9%（15.5-20.6%）到 56.9%（53.5-60.3%），分别为医生五分位组（最低随访率）和五分位组（最高随访率）中阴性结肠镜检查、低风险腺瘤和高风险腺瘤检测后的预测概率。
本研究表明，筛查结肠镜检查后医生之间的随访习惯存在显著差异。应考虑干预措施，包括 CRC 筛查中的组织变革，以减少这种差异。
