Emergency Department Physician-Level and Hospital-Level Variation in Admission Rates
Emergency Department Physician-Level and Hospital-Level Variation in Admission Rates
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DOI：
10.1016/j.annemergmed.2013.01.016
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发表时间：
2013-06-01
影响因子：
6.2
通讯作者：
Pines, Jesse M.
中科院分区：
文献类型：
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作者：
Abualenain, Jameel;Frohna, William J.;Pines, Jesse M.
研究目的：我们探讨在单一卫生系统中一组急诊医生的医师和医院水平的住院率的变化。方法：这是一项横断面研究，使用不同时期（2005年至2010年）的回顾性数据，以确定同一卫生系统内3个急诊科（EDs）的急诊医生入院率的变化。未就诊或不遵医嘱离开的患者、在快速通道部门接受治疗的患者、有原发性精神疾病的患者、年龄小于18岁的患者以及在研究期间急诊次数少于500次的医生均被排除在外。采用层次逻辑回归估计急诊医师水平和住院率，调整患者年龄、性别、种族、主诉、到达方式、到达日期和时间。结果：共有389,120例急诊科就诊纳入分析，患者由89名主治急诊医生治疗。在对患者和临床特征进行调整后，住院率从27%到41%不等。在医生层面，入院率从21%到49%不等。结论：急诊医师调整住院率差异为2.3倍，医院水平差异为1.7倍。在成本控制的新时代，这一共同的、代价高昂的决策的广泛差异需要进一步探索。
Study objective: We explore the variation in physician- and hospital-level admission rates in a group of emergency physicians in a single health system.Methods: This was a cross-sectional study that used retrospective data during various periods (2005 to 2010) to determine the variation in admission rates among emergency physicians from 3 emergency departments (EDs) within the same health system. Patients who left without being seen or left against medical advice, patients treated in fast-track departments, patients with primary psychiatric complaints, and those younger than 18 years were excluded, as were physicians with fewer than 500 ED encounters during the study period. Emergency physician level and hospital-level admission rates were estimated with hierarchic logistic regression, which adjusted for patient age, sex, race, chief complaint, arrival mode, and arrival day and time.Results: A total of 389,120 ED visits were included in the analysis, and patients were treated by 89 attending emergency physicians. After adjusting for patient and clinical characteristics, the hospital-level admission rate varied from 27% to 41%. At the physician level, admission rates varied from 21% to 49%.Conclusion: There was 2.3-fold variation in emergency physician adjusted admission rates and 1.7-fold variation at the hospital level. In the new era of cost containment, wide variation in this common, costly decision requires further exploration.