Faqih A, Broman K K, Huang L-C, Phillips S E, Holzman M D, Pierce R A, Poulose B K, Yachimski P S
Department of Surgery.
Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Dis Esophagus. 2017 Nov 1;30(11):1-8. doi: 10.1093/dote/dox080.
Factors that influence the frequency of surveillance endoscopy for nondysplastic Barrett's esophagus are not well understood. The objective of this study is to assess factors which influence the frequency of endoscopic surveillance for Barrett's esophagus, including health insurance/third-party payer status. Cases of nondysplastic Barrett's esophagus undergoing esophagogastroduodenoscopy with biopsy were identified using longitudinal data from the Healthcare Utilization Project database in 2005-2006 and followed through 2011. The threshold for appropriate surveillance utilization was defined as two to four surveillance esophagogastroduodenoscopies over a standardized 5-year period. Patients' insurance status was designated as either Medicare, Medicaid, private, or noninsured. 36,676 cases of nondysplastic Barrett's esophagus were identified. Among these, 4,632 patients (12.6%) underwent between two and four surveillance esophagogastroduodenoscopies in 5 years of follow-up versus 31,975 patients (87.3%) who underwent fewer than two esophagogastroduodenoscopies during follow-up. Multivariate analysis found that Barrett's patients insured through Medicaid (OR 1.273; 95% CI = 1.065-1.522) or without insurance (OR = 2.453; 95% CI = 1.67-3.603) were at increased likelihood of being under-surveilled. This study identified a difference in frequency of surveillance esophagogastroduodenoscopy for Barrett's esophagus by payer status. Patients without health insurance and those whose primary insurance was Medicaid were at increased odds for under-surveillance. These data suggest that a more robust system for tracking and ensuring longitudinal follow-up of patients with Barrett's esophagus, with attention to the uninsured and underinsured population, may be needed to ensure optimal surveillance.
影响非发育异常性巴雷特食管监测性内镜检查频率的因素尚未完全明确。本研究的目的是评估影响巴雷特食管内镜监测频率的因素，包括医疗保险/第三方支付者状态。利用2005 - 2006年医疗保健利用项目数据库中的纵向数据，确定了接受食管胃十二指肠镜检查并活检的非发育异常性巴雷特食管病例，并随访至2011年。适当监测利用的阈值定义为在标准化的5年期间进行2至4次监测性食管胃十二指肠镜检查。患者的保险状态分为医疗保险、医疗补助、私人保险或无保险。共确定了36,676例非发育异常性巴雷特食管病例。其中，4,632例患者（12.6%）在5年随访期间接受了2至4次监测性食管胃十二指肠镜检查，而31,975例患者（87.3%）在随访期间接受的食管胃十二指肠镜检查少于2次。多变量分析发现，通过医疗补助投保的巴雷特患者（OR 1.273；95% CI = 1.065 - 1.522）或无保险患者（OR = 2.453；95% CI = 1.67 - 3.603）接受监测不足的可能性增加。本研究发现，根据支付者状态，巴雷特食管监测性食管胃十二指肠镜检查的频率存在差异。没有医疗保险的患者以及主要保险为医疗补助的患者接受监测不足的几率增加。这些数据表明，可能需要一个更强大的系统来跟踪和确保巴雷特食管患者的长期随访，并关注未参保和参保不足的人群，以确保最佳监测。
