Variation In Emergency Department Admission Rates Among Medicare Patients: Does The Physician Matter?
Variation In Emergency Department Admission Rates Among Medicare Patients: Does The Physician Matter?
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DOI：
10.1377/hlthaff.2020.00670
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发表时间：
2021-02-01
期刊：
影响因子：
9.7
通讯作者：
Landon, Bruce E.
中科院分区：
文献类型：
--
作者：
Smulowitz, Peter B.;O'Malley, A. James;Landon, Bruce E.
住院治疗占卫生保健支出的最大份额。新的支付模式越来越多地鼓励医疗保健提供者减少住院人数。虽然急诊科（艾德）医生在决定是否收治病人方面发挥着重要作用，但即使在同一家医院内，艾德医生之间的入院率差异程度仍然知之甚少。在这项研究中，我们检查了医疗保险患者的艾德入院率的医生水平差异。我们发现住院率有意义的变化：平均医生水平调整后的住院率为38.9%，在同一家医院的估计分布中，10岁和90岁的医生的平均住院率分别为32.2%和45.6%。相比之下，根据患者特征预测的入院风险在这些医生中变化不大，这表明入院率的变化不是由于所见患者的差异。我们的研究结果表明，针对医生决策的策略可以修改（在适当的情况下增加或减少）的入院率。
Hospitalizations account for the largest share of health care spending. New payment models increasingly encourage health care providers to reduce hospital admissions. Although emergency department (ED) physicians play a major role in the decision to admit a patient, the extent to which admission rates vary among ED physicians even within the same hospital remains poorly understood. In this study we examined physician-level variation in ED admission rates for Medicare patients. We found meaningful variation in admission rates: The mean physician-level adjusted admission rate was 38.9 percent and ranged from 32.2 percent to 45.6 percent for physicians at the tenth and ninetieth percentiles, respectively, of the estimated distribution within the same hospital. In contrast, the predicted risk for admission based on patient characteristics varied little among these physicians, suggesting that the variation in admission rates was not due to differences in patients seen. Our results suggest that strategies targeting physician decision making could modify (by either increasing or decreasing when appropriate) rates of admissions.