Provider Differences in Use of Implanted Ports in Older Adults With XXXX .

@entity5 @entity1 @entity14
BACKGROUND: Identifying unwarranted variation in health care can highlight opportunities to reduce harm. One often discretionary process in oncology is use of implanted ports to administer intravenous chemotherapy. While there are benefits, ports carry risks. This study's objective was to assess provider-driven variation in port use among @entity5 @entity1 receiving chemotherapy. RESEARCH DESIGN: Retrospective assessment using population-based SEER-Medicare data to assess differences in port use across health care providers of older adults with @entity5 . @entity1 included over 18,000 @entity1 ages 66 and older diagnosed with breast, @entity14 in 2005-2007, treated by approximately 2900 providers. We identified port use for @entity1 receiving treatment from hospital outpatient facilities versus physicians' offices. Our main analysis assessed the likelihood of a @entity1 receiving a port given port use by the provider's last @entity1 . For a subset of high-use providers, we examined individual provider-level variation by estimating the risk-adjusted likelihood of insertion. RESULTS: @entity1 receiving chemotherapy in hospital outpatient facilities were significantly less likely to receive a port than those treated in physicians' offices, with adjusted odds ratios (AOR) varying from 0.50 to 0.75 across @entity5 sites. Implanting a port was associated with increased likelihood of port insertion in the provider's next @entity1 (AOR varied from 1.71 to 2.25). Significant between-provider variation was found among providers with at least 10 @entity1 . CONCLUSIONS: Our findings support the idea that there is provider-driven variation in the use of ports for chemotherapy administration. This variation highlights an opportunity to standardize practice and reduce unnecessary use.
