Who Performs Colonoscopy? Workforce Trends Over Space and Time

Eberth, Jan M.; Josey, Michele J.; Mobley, Lee; Nicholas, Davidson O.; Jeffe, Donna B.; Odahowski, Cassie L.; Probst, Janice C.; Schootman, Mario

doi:10.1111/jrh.12286

Cited by 11 publications

(15 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In South Carolina, 63% of GEs work primarily in ambulatory surgery centers and nonspecialists comprise a larger proportion of outpatient hospital-based endoscopy services. 24 Our finding that Medicaid patients used a nonspecialist more than patients with commercial/HMO insurance may relate to the costs of performing the procedure. Unlike Medicare, coverage for Medicaid is not federally guaranteed for individuals not experiencing CRC-related symptoms.…”

Section: Discussionmentioning

confidence: 91%

See 1 more Smart Citation

Disparities in Utilization of Medical Specialists for Colonoscopy

et al. 2019

Self Cite

View full text Add to dashboard Cite

Purpose: Colonoscopy is the preferred screening modality for colorectal cancer (CRC) prevention. The quality of the procedure varies although medical specialists such as gastroenterologists and colorectal surgeons tend to have better outcomes. We aimed to determine whether there are demographic and clinical differences between those who received a colonoscopy from a specialist versus those who received a colonoscopy from a nonspecialist. Methods: Using the population-based South Carolina Outpatient Ambulatory Surgery Database, we looked retrospectively to obtain patient-level endoscopy records from 2010 to 2014. We used multilevel logistic regression to model whether patients saw a specialist for their colonoscopy. The primary variables were patient race and insurance type, and an interaction by rurality was tested. Results: Of the 392,285 patients included in the analysis, 81% saw a specialist for their colonoscopy. County of residence explained 30% of the variability in the outcome. Non-Hispanic black (OR=0.65; confidence interval [95% CI]: 0.64–0.67) and Hispanic patients (OR=0.75; 95% CI: 0.67–0.84) were significantly less likely than non-Hispanic white patients to see a specialist. Compared with commercial/HMO insurance, all other types were less likely to see a specialist, and even more so for rural patients. The interaction of race by rurality was not significant. Conclusions: Specialists play a key role in CRC screening and can affect later downstream outcomes. This study has shown that ethnic minorities and adults with public or other insurance, particularly in rural areas, are most likely not to see a specialist. These results are consistent with disparities in CRC incidence, mortality, and survival.

show abstract

Section: Discussionmentioning

confidence: 91%

“…23 Likewise, GEs are located predominately in urban counties in South Carolina, whereas all the CRSs in the state were located in urban counties. 24 Studies have shown that rural racial minority patients are often disadvantaged in the quality of cancer care they receive. 25,26…”

Section: Introductionmentioning

confidence: 99%

Disparities in Utilization of Medical Specialists for Colonoscopy

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Despite the documented concerns regarding the reduced density of general surgeons and radiation oncologists in rural areas, we found that approximately one‐half of the rural residents were able to reach a general surgeon or a radiation oncologist within 22 miles. The greatest concern regarding geographic access to cancer care is for rural individuals residing in isolated areas.…”

Section: Discussionmentioning

confidence: 99%

Geographic disparities in residential proximity to colorectal and cervical cancer care providers

Hung

Deng

Zahnd

et al. 2019

Cancer

Self Cite

View full text Add to dashboard Cite

Background Persistent rural‐urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural‐urban differences in residential proximity to cancer specialists. Methods Using the 2018 Physician Compare data concerning physician practice locations and the 2012 to 2016 American Community Survey, the current study estimated the driving distance from each residential zip code tabulation area (ZCTA) centroid to the nearest cancer provider of the following medical specialties involved in treating patients with colorectal and cervical cancer: medical oncology, radiation oncology, surgical oncology, general surgery, gynecological oncology, and colorectal surgery. Using population‐weighted multivariable logistic regression, the authors analyzed the associations between ZCTA‐level characteristics and driving distances >60 miles to each type of specialist. ZCTA‐level residential rurality was defined using rural‐urban commuting area codes. Results Nearly 1 in 5 rural Americans lives >60 miles from a medical oncologist. Rural‐urban differences in travel distances to the nearest cancer care provider(s) increased substantially for cancer surgeons; greater than one‐half of rural residents were required to travel 60 miles to reach a gynecological oncologist, compared with 8 miles for their urban counterparts. Individuals residing within ZCTAs with a higher poverty rate, those of American Indian/Alaska Native ethnicity, and/or were located in the South and West regions were more likely than their counterparts to be >60 miles away from any of the aforementioned providers. Conclusions The substantial travel distances required for rural, low‐income residents to reach a cancer specialist should prompt a policy action to increase access to specialized cancer care for millions of rural residents.

show abstract

“…30 Additionally, volume varies by provider specialty and rural-urban location of the provider, as gastroenterologists and providers in urban areas perform higher volumes of procedures. 19 Further, with appropriate available data, an additional nuance that could be considered in "supply" of colonoscopy providers is that of…”

Section: Discussionmentioning

confidence: 99%

“…ZAHND et Al.insurance coverage 19. While a provider may be spatially accessible to a patient, insurance markets may affect the realized access to that provider or preferred modality of CRC screening.…”

mentioning

confidence: 99%