Mojica Cynthia M, Lind Bonnie, Gu Yifan, Coronado Gloria D, Davis Melinda M
College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.
Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon.
Am J Prev Med. 2021 Jan;60(1):72-79. doi: 10.1016/j.amepre.2020.08.003. Epub 2020 Nov 19.
This study examines individual- and practice-level predictors of screening modality among 1,484 Medicaid enrollees who initiated colorectal cancer screening (fecal immunochemical test/fecal occult blood tests or colonoscopy) within a year of turning age 50 years. Understanding screening modality patterns for patients and health systems can help optimize colorectal cancer screening initiatives that will lead to high screening completion rates.
Multivariable logistic regression was conducted in 2019 to analyze Medicaid claims data (January 2013-June 2015) to explore predictors of colonoscopy screening (versus fecal testing).
Overall, 64% of enrollees received a colonoscopy and 36% received a fecal immunochemical test/fecal occult blood test. Male (OR=1.21, 95% CI=1.08, 1.37) compared with female enrollees and those with 4-6 (OR=1.57, 95% CI=1.15, 2.15), 7-10 (OR=2.23, 95% CI=1.64, 3.03), and ≥11 (OR=1.79, 95% CI=1.22, 2.65) primary care visits compared with 0-3 visits had higher odds of colonoscopy screening. Non-White, non-Hispanic enrollees (OR=0.71, 95% CI=0.58, 0.87) compared with White, non-Hispanics Whites had lower odds of colonoscopy screening. Practices with an endoscopy facility within their ZIP code (OR=1.50, 95% CI=1.08, 2.08) compared with practices without a nearby endoscopy facility had higher odds of colonoscopy screening.
Among newly age-eligible Medicaid enrollees who received colorectal cancer screening, non-White, non-Hispanic individuals were less likely and male enrollees and those with ≥4 primary care visits were more likely to undergo colonoscopy versus fecal immunochemical test/fecal occult blood test. Colonoscopy also was the more common modality among adults whose primary care clinic had an endoscopy facility in the same ZIP code. Future research is needed to fully understand patient, provider, and practice preferences regarding screening modality.
本研究调查了1484名医疗补助计划参保者的个体及医疗机构层面的筛查方式预测因素，这些参保者在年满50岁后的一年内开始进行结直肠癌筛查（粪便免疫化学检测/粪便潜血检测或结肠镜检查）。了解患者和医疗系统的筛查方式模式有助于优化结直肠癌筛查计划，从而提高筛查完成率。
2019年进行了多变量逻辑回归分析，以分析医疗补助计划理赔数据（2013年1月至2015年6月），探索结肠镜检查筛查（相对于粪便检测）的预测因素。
总体而言，64%的参保者接受了结肠镜检查，36%的参保者接受了粪便免疫化学检测/粪便潜血检测。与女性参保者相比，男性参保者接受结肠镜检查的几率更高（OR=1.21，95%CI=1.08，1.37）；与0至3次初级保健就诊的参保者相比，有4至6次（OR=1.57，95%CI=1.15，2.15）、7至10次（OR=2.23，95%CI=1.64，3.03）以及≥11次初级保健就诊的参保者接受结肠镜检查的几率更高。与非西班牙裔白人参保者相比，非白人、非西班牙裔参保者接受结肠镜检查的几率更低（OR=0.71，95%CI=0.58，0.87）。与所在邮政编码区域内没有内镜检查设施的医疗机构相比，所在邮政编码区域内有内镜检查设施的医疗机构的参保者接受结肠镜检查的几率更高（OR=1.50，95%CI=1.08，2.08）。
在符合年龄条件且接受了结直肠癌筛查的新参保医疗补助计划者中，非白人、非西班牙裔个体接受结肠镜检查的可能性低于粪便免疫化学检测/粪便潜血检测，而男性参保者以及有≥4次初级保健就诊的参保者接受结肠镜检查的可能性更高。对于其初级保健诊所所在邮政编码区域内有内镜检查设施的成年人来说，结肠镜检查也是更常见的筛查方式。需要进一步开展研究，以全面了解患者、医疗服务提供者以及医疗机构在筛查方式方面的偏好。
