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.
  
  
  METHODS
  Retrospective review of upper endoscopic procedures that involved PEG tube placement between 2000 and 2010.
  
  
  METHODS
  Endoscopy sites participating in the Clinical Outcomes Research Initiative (CORI).
  
  
  METHODS
  Patients undergoing upper endoscopy.
  
  
  METHODS
  PEG tube placement.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Participation in CORI is voluntary and may not capture data on non-gastroenterologist providers.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
authors.forename: Lukejohn W
authors.initials: LW
authors.lastname: Day
authors.affiliation: Division of Gastroenterology, Kaiser Permanente, Modesto, California, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Nazareth
authors.affiliation: Division of Gastroenterology, Department of Medicine, San Francisco General Hospital and Trauma Center, San Francisco, California, USA.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Sewell
authors.affiliation: Division of Gastroenterology, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: J Lucas
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Division of Gastroenterology, Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Lieberman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005762:Gastroenterology / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends; D005774:Gastrostomy / Q000379:methods / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
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