Department of Surgery, University of Colorado, 12631 E. 17th Avenue, C-305, Aurora, CO, 80045, USA.
Department of Surgery, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA.
Surg Endosc. 2022 Oct;36(10):7673-7678. doi: 10.1007/s00464-022-09083-3. Epub 2022 Jun 21.
Screening colonoscopy is one of the few procedures that can prevent cancer. While the majority of colonoscopies in the USA are performed by gastroenterologists, general surgeons play a key role in at-risk, rural populations. The aim of this study was to examine geographic practice patterns in colonoscopy using a nationwide Medicare claims database.
The 2017 Medicare Provider Utilization and Payment database was used to identify physicians performing colonoscopy. Providers were classified as gastroenterologists, surgeons, ambulatory surgical centers (ASCs), or other. Rural-Urban Commuting Area classification at the zip code level was used to determine whether the practice location for an individual provider was in a rural area/small town (< 10,000 people), micropolitan area (10-50,000 people), or metropolitan area (> 50,000 people).
Claims data from 3,861,187 colonoscopy procedures on Medicare patients were included. The majority of procedures were performed by gastroenterologists (57.2%) and ASCs (32.1%). Surgeons performed 6.8% of cases overall. When examined at a zip code level, surgeons performed 51.6% of procedures in small towns/rural areas and 21.7% of procedures in micropolitan areas. Individual surgeons performed fewer annual procedures as compared to gastroenterologists (median 51 vs. 187, p < 0.001).
Surgeons perform the majority of colonoscopies in rural zip codes on Medicare patients. High-quality, surgical training in endoscopy is essential to ensure access to colonoscopy for patients outside of major metropolitan areas.
筛查结肠镜检查是少数几种可以预防癌症的方法之一。虽然美国大多数结肠镜检查由胃肠病学家进行，但普通外科医生在高危、农村人群中发挥着关键作用。本研究旨在使用全国性医疗保险索赔数据库检查结肠镜检查的地理实践模式。
使用 2017 年医疗保险提供者利用和支付数据库来确定进行结肠镜检查的医生。提供者分为胃肠病学家、外科医生、门诊手术中心（ASC）或其他。邮政编码级别的城乡通勤区分类用于确定个体提供者的执业地点是否在农村/小镇（<10000 人）、小城市/大都市区（10-50000 人）或大都市地区（>50000 人）。
纳入了 3861187 例 Medicare 患者结肠镜检查的索赔数据。大多数程序由胃肠病学家（57.2%）和 ASC（32.1%）进行。外科医生总体上进行了 6.8%的手术。在邮政编码一级进行检查时，外科医生在小镇/农村地区进行了 51.6%的手术，在小城市/大都市区进行了 21.7%的手术。与胃肠病学家相比，个别外科医生每年进行的手术较少（中位数 51 与 187 相比，p < 0.001）。
外科医生在 Medicare 患者的农村邮政编码地区进行了大多数结肠镜检查。高质量的内镜外科培训对于确保大都市地区以外的患者能够获得结肠镜检查至关重要。
