Adams Megan A, Rubenstein Joel H, Lipson Rachel, Holleman Robert G, Saini Sameer D
Center for Clinical Management Research, Department of Veterans Affairs, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
J Gen Intern Med. 2020 Jun;35(6):1776-1782. doi: 10.1007/s11606-020-05776-4. Epub 2020 Mar 24.
The Veterans Health Administration (VA) recently has been scrutinized for prolonged wait times for routine medical care, including elective outpatient procedures such as colonoscopy. Wait times for colonoscopy following positive fecal occult blood test (FOBT) are associated with worse clinical outcomes only if greater than 6 months.
We aimed to investigate time trends in wait time for outpatient colonoscopy in VA and factors influencing wait time.
Retrospective cohort study using mixed-effects regression of VA administrative data from the Corporate Data Warehouse.
Veterans who underwent outpatient colonoscopy for positive FOBT in 2008-2015 at 124 VA endoscopy facilities.
The main outcome measure was wait time (in days) between positive FOBT and colonoscopy completion, stratified by year and adjusted for sedation type, year, and potentially influential patient- and facility-level factors.
In total, 125,866 outpatient colonoscopy encounters for positive FOBT occurred during the study period. The number of colonoscopies for this indication declined slightly over time (17,586 in 2008 vs. 13,245 in 2015; range 13,425-19,814). In 2008, median wait time across sites was 50 days (interquartile range [IQR] = 33, 75). There was no secular trend in wait times (2015 median = 52 days, IQR = 34, 77). Examining the adjusted effect of patient- and facility-level factors on wait time, no clinically meaningful difference was found.
Wait times for colonoscopy for positive FOBT have been stable over time. Despite the perception of prolonged VA wait times, wait times for outpatient colonoscopy for positive FOBT are well below the threshold at which clinically meaningful differences in patient outcomes have been observed.
退伍军人健康管理局（VA）最近因常规医疗护理等待时间过长而受到审查，包括结肠镜检查等择期门诊手术。粪便潜血试验（FOBT）呈阳性后进行结肠镜检查的等待时间只有在超过6个月时才会与更差的临床结果相关。
我们旨在调查VA门诊结肠镜检查等待时间的时间趋势以及影响等待时间的因素。
使用来自企业数据仓库的VA行政数据进行混合效应回归的回顾性队列研究。
2008年至2015年期间在124个VA内窥镜检查设施接受门诊结肠镜检查且FOBT呈阳性的退伍军人。
主要结局指标是FOBT呈阳性与结肠镜检查完成之间的等待时间（以天为单位），按年份分层，并根据镇静类型、年份以及潜在的有影响的患者和机构层面因素进行调整。
在研究期间，总共发生了125,866次因FOBT呈阳性而进行的门诊结肠镜检查。该适应症的结肠镜检查数量随时间略有下降（2008年为17,586例，2015年为13,245例；范围为13,425 - 19,814例）。2008年，各机构的中位等待时间为50天（四分位间距[IQR] = 33, 75）。等待时间没有长期趋势（2015年中位值 = 52天，IQR = 34, 77）。检查患者和机构层面因素对等待时间的调整效应，未发现有临床意义的差异。
FOBT呈阳性的结肠镜检查等待时间随时间一直保持稳定。尽管人们认为VA的等待时间过长，但FOBT呈阳性的门诊结肠镜检查等待时间远低于观察到患者结局有临床意义差异的阈值。
