Practice variation in PEG tube placement

Trends and predictors among providers in the United States

Lukejohn W. Day, Michelle Nazareth, Justin L. Sewell, J. Lucas Williams, David Lieberman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Enteral access placement is performed among a variety of providers and specialties, yet there is a dearth of literature on trends and factors related to enteral access placement in the United States. Objective To examine trends in the incidence of enteral access procedures performed by gastroenterologists in the United States. Design Retrospective review of upper endoscopic procedures that involved PEG tube placement between 2000 and 2010. Setting Endoscopy sites participating in the Clinical Outcomes Research Initiative (CORI). Patients Patients undergoing upper endoscopy. Interventions PEG tube placement. Main Outcome Measurements Number of PEG tubes placed. Results Overall PEG tube placement by a provider from 2000 to 2010 was 1.7% (number of PEG tubes performed/number of upper endoscopies performed), with the majority of them being performed by gastroenterologists. Very young and very old, non-white racial background (Hispanic: odds ratio [OR] 1.21; 95% CI, 1.13-1.28; black: OR 2.24; 95% CI, 2.12-2.36), and men (OR 1.44; 95% CI, 1.39-1.50) were patient characteristics associated with greater PEG tube placement. In terms of practice setting, PEG tube placement occurred more frequently in community and/or health maintenance organization environments and on the East Coast. With respect to provider characteristics, male providers were less likely than female providers to perform a PEG tube insertion (OR 0.67; 95% CI, 0.64-0.71), and there was a trend that as providers were further out of medical school they were less likely to perform a PEG tube procedure. Interestingly, surgeons (OR 6.69; 95% CI, 6.18-7.24) and other providers (non-pediatric/non-general practice) (OR 3.22; 95% CI, 2.63-3.94) were more likely to perform PEG tube procedures than were gastroenterologists. Limitations Participation in CORI is voluntary and may not capture data on non-gastroenterologist providers. Conclusion Significant practice variation was noted in PEG tube placement in the United States with respect to patient and provider characteristics, geographic region, and endoscopy settings.

Original languageEnglish (US)
Pages (from-to)37-45
Number of pages9
JournalGastrointestinal Endoscopy
Volume82
Issue number1
DOIs
StatePublished - Jul 1 2015

Fingerprint

Odds Ratio
Endoscopy
Small Intestine
Outcome Assessment (Health Care)
Health Maintenance Organizations
Medical Schools
Hispanic Americans
Incidence
Gastroenterologists

ASJC Scopus subject areas

  • Gastroenterology
  • Radiology Nuclear Medicine and imaging

Cite this

Practice variation in PEG tube placement : Trends and predictors among providers in the United States. / Day, Lukejohn W.; Nazareth, Michelle; Sewell, Justin L.; Williams, J. Lucas; Lieberman, David.

In: Gastrointestinal Endoscopy, Vol. 82, No. 1, 01.07.2015, p. 37-45.

Research output: Contribution to journalArticle

Day, Lukejohn W. ; Nazareth, Michelle ; Sewell, Justin L. ; Williams, J. Lucas ; Lieberman, David. / Practice variation in PEG tube placement : Trends and predictors among providers in the United States. In: Gastrointestinal Endoscopy. 2015 ; Vol. 82, No. 1. pp. 37-45.
@article{26e6919502224394baffc763a14e8083,
title = "Practice variation in PEG tube placement: Trends and predictors among providers in the United States",
abstract = "Background Enteral access placement is performed among a variety of providers and specialties, yet there is a dearth of literature on trends and factors related to enteral access placement in the United States. Objective To examine trends in the incidence of enteral access procedures performed by gastroenterologists in the United States. Design Retrospective review of upper endoscopic procedures that involved PEG tube placement between 2000 and 2010. Setting Endoscopy sites participating in the Clinical Outcomes Research Initiative (CORI). Patients Patients undergoing upper endoscopy. Interventions PEG tube placement. Main Outcome Measurements Number of PEG tubes placed. Results Overall PEG tube placement by a provider from 2000 to 2010 was 1.7{\%} (number of PEG tubes performed/number of upper endoscopies performed), with the majority of them being performed by gastroenterologists. Very young and very old, non-white racial background (Hispanic: odds ratio [OR] 1.21; 95{\%} CI, 1.13-1.28; black: OR 2.24; 95{\%} CI, 2.12-2.36), and men (OR 1.44; 95{\%} CI, 1.39-1.50) were patient characteristics associated with greater PEG tube placement. In terms of practice setting, PEG tube placement occurred more frequently in community and/or health maintenance organization environments and on the East Coast. With respect to provider characteristics, male providers were less likely than female providers to perform a PEG tube insertion (OR 0.67; 95{\%} CI, 0.64-0.71), and there was a trend that as providers were further out of medical school they were less likely to perform a PEG tube procedure. Interestingly, surgeons (OR 6.69; 95{\%} CI, 6.18-7.24) and other providers (non-pediatric/non-general practice) (OR 3.22; 95{\%} CI, 2.63-3.94) were more likely to perform PEG tube procedures than were gastroenterologists. Limitations Participation in CORI is voluntary and may not capture data on non-gastroenterologist providers. Conclusion Significant practice variation was noted in PEG tube placement in the United States with respect to patient and provider characteristics, geographic region, and endoscopy settings.",
author = "Day, {Lukejohn W.} and Michelle Nazareth and Sewell, {Justin L.} and Williams, {J. Lucas} and David Lieberman",
year = "2015",
month = "7",
day = "1",
doi = "10.1016/j.gie.2014.12.049",
language = "English (US)",
volume = "82",
pages = "37--45",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Practice variation in PEG tube placement

T2 - Trends and predictors among providers in the United States

AU - Day, Lukejohn W.

AU - Nazareth, Michelle

AU - Sewell, Justin L.

AU - Williams, J. Lucas

AU - Lieberman, David

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Background Enteral access placement is performed among a variety of providers and specialties, yet there is a dearth of literature on trends and factors related to enteral access placement in the United States. Objective To examine trends in the incidence of enteral access procedures performed by gastroenterologists in the United States. Design Retrospective review of upper endoscopic procedures that involved PEG tube placement between 2000 and 2010. Setting Endoscopy sites participating in the Clinical Outcomes Research Initiative (CORI). Patients Patients undergoing upper endoscopy. Interventions PEG tube placement. Main Outcome Measurements Number of PEG tubes placed. Results Overall PEG tube placement by a provider from 2000 to 2010 was 1.7% (number of PEG tubes performed/number of upper endoscopies performed), with the majority of them being performed by gastroenterologists. Very young and very old, non-white racial background (Hispanic: odds ratio [OR] 1.21; 95% CI, 1.13-1.28; black: OR 2.24; 95% CI, 2.12-2.36), and men (OR 1.44; 95% CI, 1.39-1.50) were patient characteristics associated with greater PEG tube placement. In terms of practice setting, PEG tube placement occurred more frequently in community and/or health maintenance organization environments and on the East Coast. With respect to provider characteristics, male providers were less likely than female providers to perform a PEG tube insertion (OR 0.67; 95% CI, 0.64-0.71), and there was a trend that as providers were further out of medical school they were less likely to perform a PEG tube procedure. Interestingly, surgeons (OR 6.69; 95% CI, 6.18-7.24) and other providers (non-pediatric/non-general practice) (OR 3.22; 95% CI, 2.63-3.94) were more likely to perform PEG tube procedures than were gastroenterologists. Limitations Participation in CORI is voluntary and may not capture data on non-gastroenterologist providers. Conclusion Significant practice variation was noted in PEG tube placement in the United States with respect to patient and provider characteristics, geographic region, and endoscopy settings.

AB - Background Enteral access placement is performed among a variety of providers and specialties, yet there is a dearth of literature on trends and factors related to enteral access placement in the United States. Objective To examine trends in the incidence of enteral access procedures performed by gastroenterologists in the United States. Design Retrospective review of upper endoscopic procedures that involved PEG tube placement between 2000 and 2010. Setting Endoscopy sites participating in the Clinical Outcomes Research Initiative (CORI). Patients Patients undergoing upper endoscopy. Interventions PEG tube placement. Main Outcome Measurements Number of PEG tubes placed. Results Overall PEG tube placement by a provider from 2000 to 2010 was 1.7% (number of PEG tubes performed/number of upper endoscopies performed), with the majority of them being performed by gastroenterologists. Very young and very old, non-white racial background (Hispanic: odds ratio [OR] 1.21; 95% CI, 1.13-1.28; black: OR 2.24; 95% CI, 2.12-2.36), and men (OR 1.44; 95% CI, 1.39-1.50) were patient characteristics associated with greater PEG tube placement. In terms of practice setting, PEG tube placement occurred more frequently in community and/or health maintenance organization environments and on the East Coast. With respect to provider characteristics, male providers were less likely than female providers to perform a PEG tube insertion (OR 0.67; 95% CI, 0.64-0.71), and there was a trend that as providers were further out of medical school they were less likely to perform a PEG tube procedure. Interestingly, surgeons (OR 6.69; 95% CI, 6.18-7.24) and other providers (non-pediatric/non-general practice) (OR 3.22; 95% CI, 2.63-3.94) were more likely to perform PEG tube procedures than were gastroenterologists. Limitations Participation in CORI is voluntary and may not capture data on non-gastroenterologist providers. Conclusion Significant practice variation was noted in PEG tube placement in the United States with respect to patient and provider characteristics, geographic region, and endoscopy settings.

UR - http://www.scopus.com/inward/record.url?scp=84930929815&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84930929815&partnerID=8YFLogxK

U2 - 10.1016/j.gie.2014.12.049

DO - 10.1016/j.gie.2014.12.049

M3 - Article

VL - 82

SP - 37

EP - 45

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 1

ER -