Department of Epidemiology and Biostatistics, Statewide Cancer Prevention and Control Program, and South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
Department of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, Georgia.
J Rural Health. 2018 Mar;34(2):138-147. doi: 10.1111/jrh.12286. Epub 2017 Nov 16.
With the increased availability of colonoscopy to average risk persons due to insurance coverage benefit changes, we sought to identify changes in the colonoscopy workforce. We used outpatient discharge records from South Carolina between 2001 and 2010 to examine shifts over time and in urban versus rural areas in the types of medical providers who perform colonoscopy, and the practice settings in which they occur, and to explore variation in colonoscopy volume across facility and provider types.
Using an all-payer outpatient discharge records database from South Carolina, we conducted a retrospective analysis of all colonoscopy procedures performed between 2001 and 2010.
We identified a major shift in the type of facilities performing colonoscopy in South Carolina since 2001, with substantial gains in ambulatory surgery settings (2001: 15, 2010: 34, +127%) versus hospitals (2001: 58, 2010: 59, +2%), particularly in urban areas (2001: 12, 2010: 27, +125%). The number of internists (2001: 46, 2010: 76) and family physicians (2001: 34, 2010: 106) performing colonoscopies also increased (+65% and +212%, respectively), while their annual procedures volumes stayed fairly constant. Significant variation in annual colonoscopy volume was observed across medical specialties (P < .001), with nongastroenterologists having lower volumes versus gastroenterologists and colon and rectal surgeons.
There have been substantial changes over time in the number of facilities and physicians performing colonoscopy in South Carolina since 2001, particularly in urban counties. Findings suggest nongastroenterologists are meeting a need for colonoscopies in rural areas.
由于保险覆盖范围的变化，普通风险人群可获得结肠镜检查，我们试图确定结肠镜检查人员的变化。我们利用 2001 年至 2010 年南卡罗来纳州的门诊出院记录，研究了随时间推移和城乡地区在进行结肠镜检查的医疗服务提供者类型方面的转变，以及这些服务的发生场所，并探讨了设施和提供者类型的结肠镜检查量的差异。
我们使用南卡罗来纳州的全支付门诊出院记录数据库，对 2001 年至 2010 年间进行的所有结肠镜检查程序进行了回顾性分析。
我们发现，自 2001 年以来，南卡罗来纳州进行结肠镜检查的设施类型发生了重大转变，在门诊手术环境中的收益显著增加（2001 年：15 个，2010 年：34 个，增加 127%），而在医院中的收益则略有增加（2001 年：58 个，2010 年：59 个，增加 2%），特别是在城市地区（2001 年：12 个，2010 年：27 个，增加 125%）。进行结肠镜检查的内科医生（2001 年：46 人，2010 年：76 人）和家庭医生（2001 年：34 人，2010 年：106 人）的数量也有所增加（分别增加 65%和 212%），而他们的年度手术量则保持相对稳定。不同医疗专业的年度结肠镜检查量存在显著差异（P <.001），非胃肠病学家的数量低于胃肠病学家和结肠直肠外科医生。
自 2001 年以来，南卡罗来纳州进行结肠镜检查的设施和医生数量发生了重大变化，特别是在城市县。调查结果表明，非胃肠病学家正在满足农村地区结肠镜检查的需求。
