Variation in prevalence and patterns of peripherally inserted central catheter use in adults hospitalized with pneumonia

Vineet Chopra, Aruna Priya, Penelope S. Pekow, Rachel Thompson, Scott A. Flanders, Peter K. Lindenauer

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Although peripherally inserted central catheters (PICCs) are often used in adults hospitalized with pneumonia, patterns related to PICC use in this context are unknown. METHODS: Premier's inpatient database was used to identify patients hospitalized with pneumonia between July 1, 2007 and November 30, 2011. PICC placement was identified via billing codes. Generalized estimating equations were used to identify factors associated with PICC placement. Hospital risk-standardized rates of PICC insertion were estimated using hierarchical generalized linear models. RESULTS: There were 545,250 patients (median age: 71 years; range: 57–82 years) included. A total of 41,849 (7.7%) patients received a PICC during hospitalization (median receipt: hospital day 4). PICC recipients were younger (median age: 69 years), had higher levels of comorbidity (Gagne score median: 4 vs 2) and were more often diagnosed with healthcare-associated pneumonia (43.1% vs 29.9%) than those who did not receive PICCs. The 3 patient variables most associated with PICC receipt included weight loss (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.97-2.10), sepsis on admission (OR: 1.80, 95%CI: 1.75-1.85), and intensive care unit status on hospital day 1 or 2 (OR: 1.70, 95%CI: 1.64-1.75). Compared to internal medicine, admission by geriatricians and critical care physicians was associated with PICC placement (OR: 1.81, 95% CI: 1.62-2.03 and OR: 1.14, 95% CI: 1.05-1.24, respectively). Risk-standardized rates of PICC utilization varied from 0.3% to 41.7%. Nearly 70% of the variability in PICC use could not be explained by available data. CONCLUSIONS: In adults hospitalized with pneumonia, PICC use appears directed towards those with severe illness and varies substantially between hospitals. Journal of Hospital Medicine 2016;11:568–575.

Original languageEnglish (US)
Pages (from-to)568-575
Number of pages8
JournalJournal of hospital medicine
Volume11
Issue number8
DOIs
StatePublished - Aug 1 2016

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Pneumonia
Catheters
Odds Ratio
Confidence Intervals
Hospital Medicine
Critical Care
Internal Medicine
Intensive Care Units
Comorbidity
Weight Loss
Inpatients
Linear Models
Sepsis
Hospitalization
Databases
Delivery of Health Care
Physicians

ASJC Scopus subject areas

  • Leadership and Management
  • Internal Medicine
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

Variation in prevalence and patterns of peripherally inserted central catheter use in adults hospitalized with pneumonia. / Chopra, Vineet; Priya, Aruna; Pekow, Penelope S.; Thompson, Rachel; Flanders, Scott A.; Lindenauer, Peter K.

In: Journal of hospital medicine, Vol. 11, No. 8, 01.08.2016, p. 568-575.

Research output: Contribution to journalArticle

Chopra, Vineet ; Priya, Aruna ; Pekow, Penelope S. ; Thompson, Rachel ; Flanders, Scott A. ; Lindenauer, Peter K. / Variation in prevalence and patterns of peripherally inserted central catheter use in adults hospitalized with pneumonia. In: Journal of hospital medicine. 2016 ; Vol. 11, No. 8. pp. 568-575.
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abstract = "BACKGROUND: Although peripherally inserted central catheters (PICCs) are often used in adults hospitalized with pneumonia, patterns related to PICC use in this context are unknown. METHODS: Premier's inpatient database was used to identify patients hospitalized with pneumonia between July 1, 2007 and November 30, 2011. PICC placement was identified via billing codes. Generalized estimating equations were used to identify factors associated with PICC placement. Hospital risk-standardized rates of PICC insertion were estimated using hierarchical generalized linear models. RESULTS: There were 545,250 patients (median age: 71 years; range: 57–82 years) included. A total of 41,849 (7.7{\%}) patients received a PICC during hospitalization (median receipt: hospital day 4). PICC recipients were younger (median age: 69 years), had higher levels of comorbidity (Gagne score median: 4 vs 2) and were more often diagnosed with healthcare-associated pneumonia (43.1{\%} vs 29.9{\%}) than those who did not receive PICCs. The 3 patient variables most associated with PICC receipt included weight loss (odds ratio [OR]: 2.03, 95{\%} confidence interval [CI]: 1.97-2.10), sepsis on admission (OR: 1.80, 95{\%}CI: 1.75-1.85), and intensive care unit status on hospital day 1 or 2 (OR: 1.70, 95{\%}CI: 1.64-1.75). Compared to internal medicine, admission by geriatricians and critical care physicians was associated with PICC placement (OR: 1.81, 95{\%} CI: 1.62-2.03 and OR: 1.14, 95{\%} CI: 1.05-1.24, respectively). Risk-standardized rates of PICC utilization varied from 0.3{\%} to 41.7{\%}. Nearly 70{\%} of the variability in PICC use could not be explained by available data. CONCLUSIONS: In adults hospitalized with pneumonia, PICC use appears directed towards those with severe illness and varies substantially between hospitals. Journal of Hospital Medicine 2016;11:568–575.",
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AU - Chopra, Vineet

AU - Priya, Aruna

AU - Pekow, Penelope S.

AU - Thompson, Rachel

AU - Flanders, Scott A.

AU - Lindenauer, Peter K.

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N2 - BACKGROUND: Although peripherally inserted central catheters (PICCs) are often used in adults hospitalized with pneumonia, patterns related to PICC use in this context are unknown. METHODS: Premier's inpatient database was used to identify patients hospitalized with pneumonia between July 1, 2007 and November 30, 2011. PICC placement was identified via billing codes. Generalized estimating equations were used to identify factors associated with PICC placement. Hospital risk-standardized rates of PICC insertion were estimated using hierarchical generalized linear models. RESULTS: There were 545,250 patients (median age: 71 years; range: 57–82 years) included. A total of 41,849 (7.7%) patients received a PICC during hospitalization (median receipt: hospital day 4). PICC recipients were younger (median age: 69 years), had higher levels of comorbidity (Gagne score median: 4 vs 2) and were more often diagnosed with healthcare-associated pneumonia (43.1% vs 29.9%) than those who did not receive PICCs. The 3 patient variables most associated with PICC receipt included weight loss (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.97-2.10), sepsis on admission (OR: 1.80, 95%CI: 1.75-1.85), and intensive care unit status on hospital day 1 or 2 (OR: 1.70, 95%CI: 1.64-1.75). Compared to internal medicine, admission by geriatricians and critical care physicians was associated with PICC placement (OR: 1.81, 95% CI: 1.62-2.03 and OR: 1.14, 95% CI: 1.05-1.24, respectively). Risk-standardized rates of PICC utilization varied from 0.3% to 41.7%. Nearly 70% of the variability in PICC use could not be explained by available data. CONCLUSIONS: In adults hospitalized with pneumonia, PICC use appears directed towards those with severe illness and varies substantially between hospitals. Journal of Hospital Medicine 2016;11:568–575.

AB - BACKGROUND: Although peripherally inserted central catheters (PICCs) are often used in adults hospitalized with pneumonia, patterns related to PICC use in this context are unknown. METHODS: Premier's inpatient database was used to identify patients hospitalized with pneumonia between July 1, 2007 and November 30, 2011. PICC placement was identified via billing codes. Generalized estimating equations were used to identify factors associated with PICC placement. Hospital risk-standardized rates of PICC insertion were estimated using hierarchical generalized linear models. RESULTS: There were 545,250 patients (median age: 71 years; range: 57–82 years) included. A total of 41,849 (7.7%) patients received a PICC during hospitalization (median receipt: hospital day 4). PICC recipients were younger (median age: 69 years), had higher levels of comorbidity (Gagne score median: 4 vs 2) and were more often diagnosed with healthcare-associated pneumonia (43.1% vs 29.9%) than those who did not receive PICCs. The 3 patient variables most associated with PICC receipt included weight loss (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.97-2.10), sepsis on admission (OR: 1.80, 95%CI: 1.75-1.85), and intensive care unit status on hospital day 1 or 2 (OR: 1.70, 95%CI: 1.64-1.75). Compared to internal medicine, admission by geriatricians and critical care physicians was associated with PICC placement (OR: 1.81, 95% CI: 1.62-2.03 and OR: 1.14, 95% CI: 1.05-1.24, respectively). Risk-standardized rates of PICC utilization varied from 0.3% to 41.7%. Nearly 70% of the variability in PICC use could not be explained by available data. CONCLUSIONS: In adults hospitalized with pneumonia, PICC use appears directed towards those with severe illness and varies substantially between hospitals. Journal of Hospital Medicine 2016;11:568–575.

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