Procedure volume influences adherence to celiac disease guidelines

Benjamin Lebwohl, Robert M. Genta, Robert C. Kapel, Daniel Sheehan, Nina S. Lerner, Peter H. Green, Alfred I. Neugut, Andrew Rundle

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: Although the prevalence of celiac disease in the USA approaches 1%, most cases are undiagnosed, in part, because of low adherence to the recommendation of submitting at least four specimens during duodenal biopsy. We aimed to determine whether physician and practice characteristics are associated with adherence to this recommendation. MATERIALS AND METHODS: We used a large national pathology database to identify all adult patients who underwent duodenal biopsy during 2006-2009. Hierarchical modeling was used to determine whether procedure volume, the number of gastroenterologists per endoscopy suite, and the number of gastroenterologists per capita of the zip code of the practice were associated with adherence. RESULTS: We identified 92 580 patients (67% female, mean age 53.5 years) who met our inclusion/exclusion criteria. Specimens were submitted by 669 gastroenterologists from 200 endoscopy suites, located in 191 zip codes, with a mean of 3.4 gastroenterologists per suite. On multivariate analysis, a higher procedure volume was associated with a decreased adherence [odds ratio (OR) for each additional 100 procedures, 0.92; 95% confidence interval (CI), 0.88-0.97; P=0.002]. An increased adherence was reported for gastroenterologists working at suites with higher numbers of gastroenterologists (OR for each additional gastroenterologist, 1.08; 95% CI, 1.04-1.13; P<0.001) but not for a higher gastroenterologist density in the zip code of the practice (OR for each additional gastroenterologist per capita, 1.01; 95% CI, 0.99-1.03; P=0.21). CONCLUSION: High-volume physicians exhibit lower rates of adherence to biopsy guidelines, possibly because of the additional time required to submit at least four specimens. In contrast, a greater number of endoscopists working in an endoscopy suite are associated with an increased adherence, possibly because of peer education.

Original languageEnglish (US)
Pages (from-to)1273-1278
Number of pages6
JournalEuropean Journal of Gastroenterology and Hepatology
Volume25
Issue number11
DOIs
StatePublished - Nov 2013

Fingerprint

Celiac Disease
Guidelines
Endoscopy
Odds Ratio
Confidence Intervals
Biopsy
Physicians
Gastroenterologists
Multivariate Analysis
Databases
Pathology
Education

Keywords

  • celiac disease
  • endoscopy
  • quality of healthcare

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Procedure volume influences adherence to celiac disease guidelines. / Lebwohl, Benjamin; Genta, Robert M.; Kapel, Robert C.; Sheehan, Daniel; Lerner, Nina S.; Green, Peter H.; Neugut, Alfred I.; Rundle, Andrew.

In: European Journal of Gastroenterology and Hepatology, Vol. 25, No. 11, 11.2013, p. 1273-1278.

Research output: Contribution to journalArticle

Lebwohl, B, Genta, RM, Kapel, RC, Sheehan, D, Lerner, NS, Green, PH, Neugut, AI & Rundle, A 2013, 'Procedure volume influences adherence to celiac disease guidelines', European Journal of Gastroenterology and Hepatology, vol. 25, no. 11, pp. 1273-1278. https://doi.org/10.1097/MEG.0b013e3283643542
Lebwohl, Benjamin ; Genta, Robert M. ; Kapel, Robert C. ; Sheehan, Daniel ; Lerner, Nina S. ; Green, Peter H. ; Neugut, Alfred I. ; Rundle, Andrew. / Procedure volume influences adherence to celiac disease guidelines. In: European Journal of Gastroenterology and Hepatology. 2013 ; Vol. 25, No. 11. pp. 1273-1278.
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abstract = "BACKGROUND: Although the prevalence of celiac disease in the USA approaches 1{\%}, most cases are undiagnosed, in part, because of low adherence to the recommendation of submitting at least four specimens during duodenal biopsy. We aimed to determine whether physician and practice characteristics are associated with adherence to this recommendation. MATERIALS AND METHODS: We used a large national pathology database to identify all adult patients who underwent duodenal biopsy during 2006-2009. Hierarchical modeling was used to determine whether procedure volume, the number of gastroenterologists per endoscopy suite, and the number of gastroenterologists per capita of the zip code of the practice were associated with adherence. RESULTS: We identified 92 580 patients (67{\%} female, mean age 53.5 years) who met our inclusion/exclusion criteria. Specimens were submitted by 669 gastroenterologists from 200 endoscopy suites, located in 191 zip codes, with a mean of 3.4 gastroenterologists per suite. On multivariate analysis, a higher procedure volume was associated with a decreased adherence [odds ratio (OR) for each additional 100 procedures, 0.92; 95{\%} confidence interval (CI), 0.88-0.97; P=0.002]. An increased adherence was reported for gastroenterologists working at suites with higher numbers of gastroenterologists (OR for each additional gastroenterologist, 1.08; 95{\%} CI, 1.04-1.13; P<0.001) but not for a higher gastroenterologist density in the zip code of the practice (OR for each additional gastroenterologist per capita, 1.01; 95{\%} CI, 0.99-1.03; P=0.21). CONCLUSION: High-volume physicians exhibit lower rates of adherence to biopsy guidelines, possibly because of the additional time required to submit at least four specimens. In contrast, a greater number of endoscopists working in an endoscopy suite are associated with an increased adherence, possibly because of peer education.",
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AU - Genta, Robert M.

AU - Kapel, Robert C.

AU - Sheehan, Daniel

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AU - Green, Peter H.

AU - Neugut, Alfred I.

AU - Rundle, Andrew

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AB - BACKGROUND: Although the prevalence of celiac disease in the USA approaches 1%, most cases are undiagnosed, in part, because of low adherence to the recommendation of submitting at least four specimens during duodenal biopsy. We aimed to determine whether physician and practice characteristics are associated with adherence to this recommendation. MATERIALS AND METHODS: We used a large national pathology database to identify all adult patients who underwent duodenal biopsy during 2006-2009. Hierarchical modeling was used to determine whether procedure volume, the number of gastroenterologists per endoscopy suite, and the number of gastroenterologists per capita of the zip code of the practice were associated with adherence. RESULTS: We identified 92 580 patients (67% female, mean age 53.5 years) who met our inclusion/exclusion criteria. Specimens were submitted by 669 gastroenterologists from 200 endoscopy suites, located in 191 zip codes, with a mean of 3.4 gastroenterologists per suite. On multivariate analysis, a higher procedure volume was associated with a decreased adherence [odds ratio (OR) for each additional 100 procedures, 0.92; 95% confidence interval (CI), 0.88-0.97; P=0.002]. An increased adherence was reported for gastroenterologists working at suites with higher numbers of gastroenterologists (OR for each additional gastroenterologist, 1.08; 95% CI, 1.04-1.13; P<0.001) but not for a higher gastroenterologist density in the zip code of the practice (OR for each additional gastroenterologist per capita, 1.01; 95% CI, 0.99-1.03; P=0.21). CONCLUSION: High-volume physicians exhibit lower rates of adherence to biopsy guidelines, possibly because of the additional time required to submit at least four specimens. In contrast, a greater number of endoscopists working in an endoscopy suite are associated with an increased adherence, possibly because of peer education.

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