Patient-level Factors and the Quality of Care Delivered in Pediatric Emergency Departments.
Patient-level Factors and the Quality of Care Delivered in Pediatric Emergency Departments.
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患者层面的因素和儿科急诊科提供的护理质量。
DOI：
10.1111/acem.13347
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Andrews-Dicke
中科院分区：
文献类型：
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作者：
Marcin,JamesP;Romano,PatrickS;Dayal,Parul;Dharmar,Madan;Chamberlain,JamesM;Dudley,Nanette;Macias,CharlesG;Nigrovic,LiseE;Powell,ElizabethC;Rogers,AlexanderJ;Sonnett,Meridith;Tzimenatos,Leah;Alpern,ElizabethR;Andrews-Dicke
目的急诊科成人患者的护理质量往往与人口学和临床因素有关，如患者的种族/民族和保险状况。我们试图确定急诊室为儿童提供的护理质量是否与各种患者水平的因素有关。方法：这是一项回顾性的观察性队列研究。2011年1月至2011年12月期间在参加儿科急救应用研究网络(PECARN)的12家急诊室之一接受护理的儿科患者(18岁)被纳入其中。我们分析了人口统计学因素(包括年龄、性别和支付来源)和临床因素(包括分诊、主诉和疾病严重程度)。我们使用先前验证过的隐含回顾工具来衡量护理质量，该工具使用图表回顾，其总分从5到35。结果在多变量模型中，在620例急诊就诊中，我们没有发现患者的年龄、性别、种族/民族、支付来源与所提供的医疗质量之间存在任何关联。然而，我们确实发现一些主要投诉类别与低于平均水平的护理质量显著相关，包括发热(质量-0.65分，95%可信区间[CI]=-1.24至-0.06)和上呼吸道症状(质量-0.68分，95%可信区间=-1.30至-0.07)。结论我们发现，在参加PECARN的12名急诊科医生中，为儿童提供的急诊护理质量很高，并且没有因患者的年龄、性别、种族/民族和支付来源而有所差异，但确实因提出的主要投诉而有所不同。
ObjectiveQuality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient‐level factors.MethodsThis was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hierarchical multivariable linear regression model with hospital site as a random effect.ResultsIn the multivariable model, among the 620 ED encounters reviewed, we did not find any association between patient age, sex, race/ethnicity, and payment source and the quality of care delivered. However, we did find that some chief complaint categories were significantly associated with lower than average quality of care, including fever (–0.65 points in quality, 95% confidence interval [CI] = –1.24 to –0.06) and upper respiratory symptoms (–0.68 points in quality, 95% CI = –1.30 to –0.07).ConclusionWe found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.