Practice variation in PEG tube placement: trends and predictors among providers in the United States

BackgroundEnteral 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.ObjectiveTo examine trends in the incidence of enteral access procedures performed by gastroenterologists in the United States.DesignRetrospective review of upper endoscopic procedures that involved PEG tube placement between 2000 and 2010.SettingEndoscopy sites participating in the Clinical Outcomes Research Initiative (CORI).PatientsPatients undergoing upper endoscopy.InterventionsPEG tube placement.Main outcome measurementsNumber of PEG tubes placed.ResultsOverall 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.LimitationsParticipation in CORI is voluntary and may not capture data on non-gastroenterologist providers.ConclusionSignificant practice variation was noted in PEG tube placement in the United States with respect to patient and provider characteristics, geographic region, and endoscopy settings