Medicare Under Age 65 and Medicaid Patients Have Poorer Bowel Preparations: Implications for Recommendations for an Early Repeat Colonoscopy.

Bradley B Brimhall ,Sam C Hankins,Gregory L Austin,Vineel Kankanala

doi:10.1371/journal.pone.0155208

Bradley B Brimhall , Sam C Hankins + Show 2 more

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https://doi.org/10.1371/journal.pone.0155208

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Abstract

Background/AimsColonoscopy is performed on patients across a broad spectrum of demographic characteristics. These characteristics may aggregate by patient insurance provider and influence bowel preparation quality and the prevalence of adenomas. The purpose of this study was to evaluate the association of insurance status and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, adenoma detection rate (ADR), and advanced ADR (AADR).MethodsThis is a cohort study of outpatient colonoscopies (n = 3113) at a single academic medical center. Patient insurance status was categorized into five groups: 1) Medicare < 65y; 2) Medicare ≥ 65y; 3) Tricare/VA; 4) Medicaid/Colorado Indigent Care Program (CICP); and 5) commercial insurance. We used multivariable logistic or linear regression modeling to estimate the risks for the association between patient insurance and suboptimal bowel preparation, recommendation for an early repeat colonoscopy due to suboptimal bowel preparation, ADR, and AADR. Models were adjusted for appropriate covariates.ResultsMedicare patients < 65y (OR 4.91; 95% CI: 3.25–7.43) and Medicaid/CICP patients (OR 4.23; 95% CI: 2.65–7.65) were more likely to have a suboptimal preparation compared to commercial insurance patients. Medicare patients < 65y (OR 5.58; 95% CI: 2.85–10.92) and Medicaid/CICP patients (OR 3.64; CI: 1.60–8.28) were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients. Medicare patients < 65y had a significantly higher adjusted ADR (OR 1.50; 95% CI: 1.03–2.18) and adjusted AADR (OR 1.99; 95% CI: 1.15–3.44) compared to commercial insurance patients.ConclusionsUnderstanding the reasons for the higher rate of a suboptimal bowel preparation in Medicare < 65y and Medicaid/CICP patients and reducing this rate is critical to improving colonoscopy outcomes and reducing healthcare costs in these populations.

Highlights

Colorectal cancer (CRC) is the third leading cause of cancer-related mortality in the United States in both men and women, and is second overall [1]
Medicare patients < 65y and Medicaid/Colorado Indigent Care Program (CICP) patients were more likely to have a suboptimal preparation compared to commercial insurance patients
Medicare patients < 65y and Medicaid/CICP patients were more likely to receive a recommendation for an early repeat colonoscopy compared to commercial insurance patients

Summary

Introduction

Colorectal cancer (CRC) is the third leading cause of cancer-related mortality in the United States in both men and women, and is second overall [1]. An inadequate bowel preparation can result in a recommendation for a shorter screening or surveillance interval than would otherwise be clinically indicated, leading to increased healthcare costs. Patients with Medicare and commercial insurance have been reported as being more likely to have adequate bowel preparations [9]. These studies did not assess other important outcomes, including whether inadequate or suboptimal preparations led to recommendations for a screening or surveillance interval that was shorter than would otherwise be clinically indicated, the ADR, the advanced adenoma detection rate (AADR), and procedure time characteristics. Outcomes for the subset of Medicare patients under the age of 65y have not been reported

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