ABSTRACT
BACKGROUND: Guidelines suggest that patients with nondysplastic Barrett's esophagus (BE) undergo endoscopic surveillance every 3 to 5 years, but actual use of surveillance endoscopy and the determinants of variation in surveillance intervals are not known. OBJECTIVE: To measure use of surveillance endoscopy and its variation in patients with nondysplastic BE. DESIGN: Multicenter, cross-sectional study. SETTING: Three sites in Arizona, Minnesota, and North Carolina. PATIENTS: This study involved patients who had prevalent BE without a history of high-grade dysplasia or esophageal adenocarcinoma. INTERVENTION: Participants were given validated measures of quality of life, numeracy, and cancer risk perception, and the total number of prior endoscopic surveillance examinations was measured. MAIN OUTCOME MEASUREMENTS: Oversurveillance was defined as >1 surveillance examination per 3-year period. RESULTS: Among 235 patients with nondysplastic BE, 76% were male and 94% were white. The average (± standard deviation [SD]) duration of BE was 6.5 ± 5.9 years. The mean (± SD) number of endoscopies per 3-year period was 2.7 ± 2.6. Oversurveillance was present in 65% of participants, resulting in a mean of 2.3 excess endoscopies per patient. Neither numeracy skills nor patient perception of cancer risk were associated with oversurveillance. LIMITATIONS: Endoscopies were measured by patient report, which is subject to error. Results may be generalizable only to patients seen in academic centers. CONCLUSION: Most patients with nondysplastic BE had more surveillance endoscopic examinations than is recommended by published guidelines. Patient factors did not predict oversurveillance, indicating that other factors may influence decisions about the interval and frequency of surveillance examinations.
Subject(s)
Adenocarcinoma/diagnosis , Barrett Esophagus/pathology , Esophageal Neoplasms/diagnosis , Esophagoscopy/statistics & numerical data , Precancerous Conditions/pathology , Unnecessary Procedures/statistics & numerical data , Adenocarcinoma/pathology , Aged , Aged, 80 and over , Barrett Esophagus/psychology , Chi-Square Distribution , Cross-Sectional Studies , Esophageal Neoplasms/pathology , Female , Guideline Adherence , Heartburn , Humans , Insurance, Health , Logistic Models , Male , Middle Aged , Multivariate Analysis , Patient Acceptance of Health Care/psychology , Perception , Practice Guidelines as Topic , Precancerous Conditions/psychology , Quality of Life , Sentinel Surveillance , Severity of Illness Index , Time FactorsABSTRACT
OBJECTIVES: The American College of Gastroenterology (ACG) has awarded research grants for 25 years. We assessed the characteristics of grant recipients, their current academic status, and the likelihood of publication resulting from the grant. METHODS: Demographic data, the year and amount of award, title of project, and recipient's institution were extracted from ACG databases. Using ACG reports and medical literature search engines, we assessed publication based on grant-funded research, as well as career publication record. We also determined the current position of awardees. A similar analysis was performed for recipients of junior investigator awards. RESULTS: A total of 396 clinical research awards totaling $5,374,497 ($6,867,937 in 2008 dollars) were awarded to 341 recipients in the 25 years between 1983 and 2008. The most commonly funded areas of research were endoscopy (22% of awards) and motility/functional disorders (21%). At least one peer-reviewed publication based on grant-funded research occurred with 255 of the 368 awards (69%) for 1983-2006 [corrected]. Higher award value was associated with subsequent publication. Of the 313 awardees over the same period, 195 (62%) are currently in academic positions [corrected]. Factors associated with staying in academics included higher award value (P < 0.01), a Master's degree (P = 0.02), and publishing grant-funded research (P < 0.01). The junior faculty career development award was granted to 27 individuals for a total of $3,000,000 (3,398,004 in 2008 dollars). Publication resulted from 90% of the funded projects, and 95% of awardees have remained in academics. Overall, the mean cost in grant dollars per published paper based on the research was $14,875. CONCLUSIONS: The majority of ACG grant recipients published the results of their research and remained in academics. Higher amount of award, holding an advanced degree, and publication were associated with careers in academics. The ACG research grant award program is an important engine of investigation, publication, and academic career development in the field of gastroenterology.
