Digestive Diseases and Sciences

, Volume 55, Issue 2, pp 421–431 | Cite as

The Frequency of Early Repeat Tests After Colonoscopy in Elderly Medicare Recipients

  • Robert J. Richards
  • Stephen Crystal
Original Article


Background The frequency of early repeat and follow-up tests (RAFTs) occurring after colonoscopy has not been previously examined in the literature. RAFTs incur cost, discomfort, and inconvenience to patients who have undergone colonoscopic examination; therefore, it is important to identify factors associated with their use. Methods We identified elderly Medicare recipients who had colonoscopy performed in 1999 from the 5% Medicare administrative files (N = 69,282). We determined the number of early RAFTs (repeat colonoscopy, barium enema, flexible sigmoidoscopy) occurring within the year of initial colonoscopy. Results Of the study sample, 8.3% required at least one RAFT during the year. Using multivariable analysis, we found that RAFTs varied significantly with age, race, sex, income, comorbidity, provider type, and place of service. RAFTs were 22% higher in African Americans compared to whites. Gastroenterologists used 20–35% fewer RAFTs than the other provider types performing colonoscopy. Conclusions The frequency of early RAFTs after colonoscopy occurs in 8.3% of the Medicare population. Important differences exist in the frequency of RAFTs by race and provider type.


Colonoscopy Quality Disparities Race Colon cancer Screening 


  1. 1.
    The Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press; 2001.Google Scholar
  2. 2.
    Quality and outcomes assessment in gastrointestinal endoscopy. American Society for Gastrointestinal Endoscopy. Gastrointest Endosc. 2000;52:827–830.Google Scholar
  3. 3.
    ASGE (American Society for Gastrointestinal Endoscopy). Principles of training in gastrointestinal endoscopy. Gastrointest Endosc. 1999;49:845–853. doi: 10.1016/S0016-5107(99)70316-0.CrossRefGoogle Scholar
  4. 4.
    Freeman ML. Training and competence in gastrointestinal endoscopy. Rev Gastroenterol Disord. 2001;1:73–86.PubMedGoogle Scholar
  5. 5.
    Medicare Utilization for Part B (Supplemental Insurance SMI). Physician/Supplier Data. Available at: Centers for Medicare and Medicaid Services, 2000.
  6. 6.
    Begg CB, Cramer LD, Hoskins WJ, Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280:1747–1751. doi: 10.1001/jama.280.20.1747.CrossRefPubMedGoogle Scholar
  7. 7.
    US Public Health Services. International Classification of Diseases, 9th revision: Clinical modification. Los Angeles: PMIC; 1996.Google Scholar
  8. 8.
    Nattinger AB, McAuliffe TL, Schapira MM. Generalizability of the Surveillance, Epidemiology, and End Results registry population: factors relevant to epidemiologic and health care research. J Clin Epidemiol. 1997;50:939–945. doi: 10.1016/S0895-4356(97)00099-1.CrossRefPubMedGoogle Scholar
  9. 9.
    Blustein J, Hanson K, Shea S. Preventable hospitalizations and socioeconomic status. Health Affairs. 1998;17:177–189. doi: 10.1377/hlthaff.17.2.177.CrossRefPubMedGoogle Scholar
  10. 10.
    Current Procedure Terminology. Chicago: American Medical Association; 1999.Google Scholar
  11. 11.
    Meyer GS, Cheng EY, Elting J. Differences between generalists and specialists in characteristics of patients receiving gastrointestinal procedures. J Gen Intern Med. 2000;15:188–194. doi: 10.1046/j.1525-1497.2000.06039.x.CrossRefPubMedGoogle Scholar
  12. 12.
    Gornick ME, Eggers PW, Reilly TW, et al. Effects of race and income on mortality and use of services among Medicare beneficiaries. N Engl J Med. 1996;335:791–799. doi: 10.1056/NEJM199609123351106.CrossRefPubMedGoogle Scholar
  13. 13.
    Burns RB, McCarthy EP, Freund KM, et al. Black women receive less mammography even with similar use of primary care. Ann Intern Med. 1996;125:173–182.PubMedGoogle Scholar
  14. 14.
    Alter DA, Naylor CD, Austin P, Tu JV. Effects of socioeconomic status on access to invasive cardiac procedures and on mortality after acute myocardial infarction. N Engl J Med. 1999;341:1359–1367. doi: 10.1056/NEJM199910283411806.CrossRefPubMedGoogle Scholar
  15. 15.
    Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med. 1999;341:1198–1205. doi: 10.1056/NEJM199910143411606.CrossRefPubMedGoogle Scholar
  16. 16.
    McMahon LF, Wolfe RA, Huang S, Tedeschi P, Manning W, Edlund MJ. Racial and gender variation in use of diagnostic colonic procedures in the Michigan Medicare population. Med Care. 1999;37:712–717. doi: 10.1097/00005650-199907000-00011.CrossRefPubMedGoogle Scholar
  17. 17.
    Mayberry R, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000;57(Supplement 1):108–145.PubMedGoogle Scholar
  18. 18.
    Charlson ME. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: a response. J Clin Epidemiol. 1993;46:1083–1084. doi: 10.1016/0895-4356(93)90105-A.CrossRefGoogle Scholar
  19. 19.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619. doi: 10.1016/0895-4356(92)90133-8.CrossRefPubMedGoogle Scholar
  20. 20.
    Cox DR. Regression models and life-tables. J R Stat Soc [Ser A]. 1972;34:187–220.Google Scholar
  21. 21.
    American Medical Association. Physicians’ current procedure terminology: CPT 94. Chicago, IL: American Medical Association; 1993.Google Scholar
  22. 22.
    Du X, Freeman JL, Warren JL, Nattinger AB, Zhang D, Goodwin JS. Accuracy and completeness of Medicare claims data for surgical treatment of breast cancer. Med Care. 2000;38:719–727. doi: 10.1097/00005650-200007000-00004.CrossRefPubMedGoogle Scholar
  23. 23.
    Javitt JC, McBean M, DiPaolo F. Accuracy of coding in Medicare Part B claims. Arch Ophthal. 1993;111:605–607.PubMedGoogle Scholar
  24. 24.
    Richards RJ, Reker DM. Racial differences in the use of colonoscopy, sigmoidoscopy and barium enema in Medicare beneficiaries. Dig Dis Sci. 2002;47:2715–2719. doi: 10.1023/A:1021001121026.CrossRefPubMedGoogle Scholar
  25. 25.
    Ristikankare M, Hartikainen J, Heikkinen M, Janatuinen E, Julkunen R. The effects of gender and age on the colonoscopic examination. J Clin Gastroenterol. 2001;32:69–75. doi: 10.1097/00004836-200101000-00016.CrossRefPubMedGoogle Scholar
  26. 26.
    Walter LC, de Garmo P, Covinsky KE. Association of older age and female sex with inadequate reach of screening flexible sigmoidoscopy. Am J Med. 2004;116:174–178. doi: 10.1016/j.amjmed.2003.09.030.CrossRefPubMedGoogle Scholar
  27. 27.
    Anderson JC, Messina CR, Cohn W, et al. Factors predictive of difficult colonoscopy. Gastrointest Endosc. 2001;54:558–562. doi: 10.1067/mge.2001.118950.CrossRefPubMedGoogle Scholar
  28. 28.
    Anderson JC, Gonzalez JD, Messina CR, Pollack BJ. Factors that predict incomplete colonoscopy: thinner is not always better. Am J Gastroenterol. 2000;95:2784–2787. doi: 10.1111/j.1572-0241.2000.03186.x.CrossRefPubMedGoogle Scholar
  29. 29.
    Mitchell RM, McCallion K, Gardiner KR, Watson RG, Collins JS. Successful colonoscopy; completion rates and reasons for incompletion. Ulster Med J. 2002;71:34–37.PubMedGoogle Scholar
  30. 30.
    Worthington DV. Colonoscopy: procedural skills. Am Fam Physician. 2000;62:1177–1182.Google Scholar
  31. 31.
    Wexner SD, Garbus JE, Singh JJ. A prospective analysis of 13, 580 colonoscopies. Reevaluation of credentialing guidelines. Surg Endosc. 2001;15:251–261. doi: 10.1007/s004640080147.CrossRefPubMedGoogle Scholar
  32. 32.
    Edwards JK, Norris TE. Colonoscopy in rural communities: can family physicians perform the procedure with safe and efficacious results? J Am Board of Fam Pract. 2004;17:353–358.CrossRefGoogle Scholar
  33. 33.
    Nelson DB, McQuaid KR, Bond JH, Lieberman DA, Weiss DG, Johnston TK. Procedural success and complications of large-scale screening colonoscopy. Gastrointest Endosc. 2002;55:307–314. doi: 10.1067/mge.2002.121883.CrossRefPubMedGoogle Scholar
  34. 34.
    Rodney WM, Dabov G, Orientale E, Reeves WP. Sedation associated with a more complete colonoscopy. J Fam Pract. 1993;36:394–400.PubMedGoogle Scholar
  35. 35.
    Pierzchajlo RP, Ackermann RJ, Vogel RL. Colonoscopy performed by a family physician. A case series of 751 procedures. J Fam Pract. 1997;44:473–480.PubMedGoogle Scholar
  36. 36.
    Cancer facts and figures for African Americans 2000–2001. Atlanta: American Cancer Society; 2000.Google Scholar
  37. 37.
    Chen VW, Fenoglio-Preiser CM, Wickerham DL, et al. Aggressiveness of colon carcinoma in blacks and whites. Cancer Epidemiol Biomarkers Prev. 1997;6:1087–1093.PubMedGoogle Scholar
  38. 38.
    Dayal H, Polissar L, Yang CY, Dahlberg S. Race, socioeconomic status, and other prognostic factors for survival from colo-rectal cancer. J Chronic Dis. 1987;40:857–864. doi: 10.1016/0021-9681(87)90185-8.CrossRefPubMedGoogle Scholar
  39. 39.
    Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351:575–584. doi: 10.1056/NEJMsa040609.CrossRefPubMedGoogle Scholar
  40. 40.
    Auerbach J, Krimgold B, eds. Income, Socioeconomic Status, and Health: Exploring the Relationships. Washington DC: National Policy Association; 2001. Report #299.Google Scholar
  41. 41.
    Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate bowel preparation for colonoscopy. Am J Gastroenterol. 2001;96:1797–1802. doi: 10.1111/j.1572-0241.2001.03874.x.CrossRefPubMedGoogle Scholar
  42. 42.
    Taylor C, Schubert ML. Decreased efficacy of polyethylene glycol lavage solution (golytely) in the preparation of diabetic patients for outpatient colonoscopy: a prospective and blinded study. Am J Gastroenterol. 2001;96:710–714. doi: 10.1111/j.1572-0241.2001.03610.x.CrossRefPubMedGoogle Scholar
  43. 43.
    Robertson DJ, Lawrence LB, Shaheen N, et al. Quality of colonoscopy reporting: A process of care study. Am J Gastroenterol. 2002;97:2651–2656. doi: 10.1111/j.1572-0241.2002.06044.x.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyStony Brook University, Health Science CenterStony BrookUSA
  2. 2.Health Care Policy, and Aging ResearchRutgers University–Institute For HealthNew BrunswickUSA

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