Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database
Background and Aims: Barrett’s esophagus (BE) screening is not highly utilized in the United States, and there are few data describing providers’ approach to screening. To fill this gap and guide the implementation of future BE screening strategies, we studied evaluation practice patterns for gastro...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2022-01-01
|
| Series: | Gastro Hep Advances |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772572322000474 |
| _version_ | 1828808229594857472 |
|---|---|
| author | Ravy K. Vajravelu Jennifer M. Kolb Walid F. Gellad Frank I. Scott Anna Tavakkoli Amit G. Singal David A. Katzka Gary W. Falk Sachin Wani |
| author_facet | Ravy K. Vajravelu Jennifer M. Kolb Walid F. Gellad Frank I. Scott Anna Tavakkoli Amit G. Singal David A. Katzka Gary W. Falk Sachin Wani |
| author_sort | Ravy K. Vajravelu |
| collection | DOAJ |
| description | Background and Aims: Barrett’s esophagus (BE) screening is not highly utilized in the United States, and there are few data describing providers’ approach to screening. To fill this gap and guide the implementation of future BE screening strategies, we studied evaluation practice patterns for gastroesophageal reflux disease (GERD) by nongastroenterologists. Methods: We performed a retrospective cohort study of patients with chronic GERD using health claims data from the United States between 2005 and 2019. We used up to 5 years of data after the diagnosis of chronic GERD to determine patient factors associated with completion of a gastroenterology encounter. We also identified patient factors associated with whether the first gastroenterology encounter was a direct-access upper endoscopy or an office visit. Results: We identified 484,023 patients diagnosed with chronic GERD by a nongastroenterology provider. The cumulative incidence of completing a gastroenterology encounter within 5 years was 38.7%. Gastrointestinal symptoms, such as dysphagia (adjusted hazard ratio [aHR] = 2.11, 95% confidence interval [CI] = 1.94–2.30), abdominal pain (aHR = 1.89, 95% CI = 1.85–1.94), and melena (aHR = 1.73, 95% CI = 1.65–1.82), were strongly associated with completion of a gastroenterology encounter. The patient factors strongly associated with direct-access upper endoscopy included dysphagia (aHR = 1.68, 95% CI = 1.52–1.85), weight loss (aHR = 1.46, 95% CI = 1.28–1.63), and melena (aHR = 1.42, 95% CI = 1.28–1.56). Conclusion: A total of 38.7% of patients with chronic GERD complete a gastroenterology encounter within 5 years of diagnosis, and gastrointestinal alarm symptoms are the most strongly associated factors for receiving gastroenterology care. These findings highlight the importance of incorporating primary care providers in the development of new BE screening programs. |
| first_indexed | 2024-12-12T08:38:00Z |
| format | Article |
| id | doaj.art-33850e7070d64edeb85717d56c5ad8e3 |
| institution | Directory Open Access Journal |
| issn | 2772-5723 |
| language | English |
| last_indexed | 2024-12-12T08:38:00Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gastro Hep Advances |
| spelling | doaj.art-33850e7070d64edeb85717d56c5ad8e32022-12-22T00:30:52ZengElsevierGastro Hep Advances2772-57232022-01-0114563572Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims DatabaseRavy K. Vajravelu0Jennifer M. Kolb1Walid F. Gellad2Frank I. Scott3Anna Tavakkoli4Amit G. Singal5David A. Katzka6Gary W. Falk7Sachin Wani8Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Health Equity Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Correspondence Address correspondence to: Ravy K. Vajravelu, MD, MSCE, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, 200 Lothrop Street, PUH, M2, C Wing, Pittsburgh, Pennsylvania 15213.Division of Gastroenterology, Hepatology and Parenteral Nutrition, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CaliforniaCenter for Health Equity Research Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PennsylvaniaDivision of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, ColoradoDivision of Gastroenterology and Hepatology, University of Texas Southwestern Medical School, Dallas, TexasDivision of Gastroenterology and Hepatology, University of Texas Southwestern Medical School, Dallas, TexasDivision of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MinnesotaDivision of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PennsylvaniaDivision of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, ColoradoBackground and Aims: Barrett’s esophagus (BE) screening is not highly utilized in the United States, and there are few data describing providers’ approach to screening. To fill this gap and guide the implementation of future BE screening strategies, we studied evaluation practice patterns for gastroesophageal reflux disease (GERD) by nongastroenterologists. Methods: We performed a retrospective cohort study of patients with chronic GERD using health claims data from the United States between 2005 and 2019. We used up to 5 years of data after the diagnosis of chronic GERD to determine patient factors associated with completion of a gastroenterology encounter. We also identified patient factors associated with whether the first gastroenterology encounter was a direct-access upper endoscopy or an office visit. Results: We identified 484,023 patients diagnosed with chronic GERD by a nongastroenterology provider. The cumulative incidence of completing a gastroenterology encounter within 5 years was 38.7%. Gastrointestinal symptoms, such as dysphagia (adjusted hazard ratio [aHR] = 2.11, 95% confidence interval [CI] = 1.94–2.30), abdominal pain (aHR = 1.89, 95% CI = 1.85–1.94), and melena (aHR = 1.73, 95% CI = 1.65–1.82), were strongly associated with completion of a gastroenterology encounter. The patient factors strongly associated with direct-access upper endoscopy included dysphagia (aHR = 1.68, 95% CI = 1.52–1.85), weight loss (aHR = 1.46, 95% CI = 1.28–1.63), and melena (aHR = 1.42, 95% CI = 1.28–1.56). Conclusion: A total of 38.7% of patients with chronic GERD complete a gastroenterology encounter within 5 years of diagnosis, and gastrointestinal alarm symptoms are the most strongly associated factors for receiving gastroenterology care. These findings highlight the importance of incorporating primary care providers in the development of new BE screening programs.http://www.sciencedirect.com/science/article/pii/S2772572322000474Barrett’s EsophagusEsophageal AdenocarcinomaUpper EndoscopyHealth Care Utilization |
| spellingShingle | Ravy K. Vajravelu Jennifer M. Kolb Walid F. Gellad Frank I. Scott Anna Tavakkoli Amit G. Singal David A. Katzka Gary W. Falk Sachin Wani Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database Gastro Hep Advances Barrett’s Esophagus Esophageal Adenocarcinoma Upper Endoscopy Health Care Utilization |
| title | Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database |
| title_full | Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database |
| title_fullStr | Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database |
| title_full_unstemmed | Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database |
| title_short | Patient Factors Associated With Gastroesophageal Reflux Disease Diagnostic Evaluation Strategies: A Retrospective Cohort Study Using Real-World Evidence From a Large U.S. Medical Claims Database |
| title_sort | patient factors associated with gastroesophageal reflux disease diagnostic evaluation strategies a retrospective cohort study using real world evidence from a large u s medical claims database |
| topic | Barrett’s Esophagus Esophageal Adenocarcinoma Upper Endoscopy Health Care Utilization |
| url | http://www.sciencedirect.com/science/article/pii/S2772572322000474 |
| work_keys_str_mv | AT ravykvajravelu patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT jennifermkolb patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT walidfgellad patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT frankiscott patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT annatavakkoli patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT amitgsingal patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT davidakatzka patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT garywfalk patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase AT sachinwani patientfactorsassociatedwithgastroesophagealrefluxdiseasediagnosticevaluationstrategiesaretrospectivecohortstudyusingrealworldevidencefromalargeusmedicalclaimsdatabase |