title: A Systematic Review of Factors Associated With Utilization of Monitored Anesthesia Care for Gastrointestinal Endoscopy.
abstract: Utilization of monitored anesthesia care (MAC) for gastrointestinal endoscopy has increased markedly over the past decade, leading to significant additional health care expenditures. However, the extent to which certain patient-, provider-, and facility-level factors lead to MAC utilization is unclear. A systematic review of 13 studies evaluating influential factors associated with MAC utilization for colonoscopy and/or esophagogastroduodenoscopy was conducted. Multiple studies revealed significant increases in MAC utilization since the early 2000s, with substantial regional variation. The most influential patient-related factors associated with MAC utilization include female sex and diagnostic procedural indication. Other patient-related factors with weaker associations or conflicting evidence include older age, comorbidity, higher patient income, and white/non-Hispanic race. The impact of patient substance use and/or prescription medication use has been minimally studied. The strongest provider- and facility-level factors associated with MAC use are a surgeon endoscopist and nonhospital site of service. Other factors with weaker associations include facility endoscopy volume and endoscopist years of experience. Further qualitative and quantitative health services research is needed to better understand the root cause of the rising trend of MAC utilization and to develop policies for encouraging appropriate use of MAC.
authors: Dr Adams is a research investigator at the VA Center for Clinical Management Research in the VA Ann Arbor Healthcare System, a clinical lecturer in the Division of Gastroenterology at the University of Michigan Health System, and a member of the Institute for Healthcare Policy and Innovation in Ann Arbor, Michigan. Dr Saleh is a house officer in the Division of General Medicine at the University of Michigan Health System. Dr Rubenstein is a research investigator at the VA Center for Clinical Management Research in the VA Ann Arbor Healthcare System, an associate professor in the Division of Gastroenterology at the University of Michigan Health System, and a member of the Institute for Healthcare Policy and Innovation.
authors: Megan A
authors: MA
authors: Adams
authors: Dr Adams is a research investigator at the VA Center for Clinical Management Research in the VA Ann Arbor Healthcare System, a clinical lecturer in the Division of Gastroenterology at the University of Michigan Health System, and a member of the Institute for Healthcare Policy and Innovation in Ann Arbor, Michigan. Dr Saleh is a house officer in the Division of General Medicine at the University of Michigan Health System. Dr Rubenstein is a research investigator at the VA Center for Clinical Management Research in the VA Ann Arbor Healthcare System, an associate professor in the Division of Gastroenterology at the University of Michigan Health System, and a member of the Institute for Healthcare Policy and Innovation.
authors: Ashraf
authors: A
authors: Saleh
authors: Dr Adams is a research investigator at the VA Center for Clinical Management Research in the VA Ann Arbor Healthcare System, a clinical lecturer in the Division of Gastroenterology at the University of Michigan Health System, and a member of the Institute for Healthcare Policy and Innovation in Ann Arbor, Michigan. Dr Saleh is a house officer in the Division of General Medicine at the University of Michigan Health System. Dr Rubenstein is a research investigator at the VA Center for Clinical Management Research in the VA Ann Arbor Healthcare System, an associate professor in the Division of Gastroenterology at the University of Michigan Health System, and a member of the Institute for Healthcare Policy and Innovation.
authors: Joel H
authors: JH
authors: Rubenstein
keywords: Gastrointestinal endoscopy; monitored anesthesia care; sedation; utilization