Physician Practice Variation in the Pediatric Emergency Department and Its Impact on Resource Use and Quality of Care
Physician Practice Variation in the Pediatric Emergency Department and Its Impact on Resource Use and Quality of Care
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DOI：
10.1097/pec.0b013e3181fe9108
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发表时间：
2010-12-01
影响因子：
1.4
通讯作者：
DeGuzman, Michael
中科院分区：
文献类型：
--
作者：
Jain, Shabnam;Elon, Lisa K.;DeGuzman, Michael
目的：评估儿科急诊科（艾德）医生病例组合调整后资源使用的变化及其与艾德住院时间（LOS）和返回率的相关性。36名学术医生在2个ED时的资源使用模式（ED 1时163，669名患者）和45名私人医生从2003年至2006年（ED 2时为289，199例患者）中抽取了常规实验室检查、影像学研究、静脉治疗（液体/抗生素），出院患者的LOS和72小时返回率，以及所有患者的住院率。病例组合调整基于分诊敏锐度、诊断类别、人口统计学和时间测量。结局指标：结果：ED 1和ED 2的住院医师的住院率在病例组合调整后分别为3倍（6.3%-18%）和8倍（2.5%-19.4%）。静脉治疗使用在ED 1时变化2倍（4.9%-10.4%），在ED 2时变化3倍（3.6%-11.4%）。急诊科2名医生在成像使用方面的差异几乎为2倍（10.9%-20.6%）。ED 1时头部计算机断层扫描使用的变化为2倍（1.1%-2.5%），ED 2时为5倍（0.9%-4.8%）。如果医生使用的实验室检查（r，0.41; 95%置信区间[CI]，0.09Y0.65; P < 0.05）和影像学检查（r，0.48; 95% CI，0.17Y0.69; P < 0.01）高于预期，则他们的LOS长于预期。回报率与任何类别的资源使用都没有显着相关性。实验室检查使用率高于预期的医生使用影像学检查的比例高于预期（r，0.62; 95% CI，0.36 Y 0.78; P < 0.001），头部CT结论：普通艾德资源的使用存在显著差异。较高的资源使用与增加LOS，但没有减少返回ED。实践的变化，如这可能是一个机会，以提高医疗质量和降低成本。
Objective: To evaluate variation in case-mix adjusted resource use among pediatric emergency department (ED) physicians and its correlation with ED length of stay (LOS) and return rates.Methods: Resource use patterns at 2 EDs for 36 academic physicians (163,669 patients at ED1) and 45 private physicians (289,199 patients at ED2) from 2003 to 2006 were abstracted for common laboratory tests, imaging studies, intravenous therapy (fluids/antibiotics), LOS and 72-hour return rate for discharged patients, and hospital admissions for all patients. Case-mix adjustment was based on triage acuity, diagnostic category, demographics, and temporal measures. Outcome measures: (1) adjusted overall resource use for ED1 and ED2 physicians and (2) observed-to-expected ratios for ED1 physicians.Results: Case-mix adjusted hospital admission rates among physicians varied nearly 3-fold (6.3%-18%) for ED1 and 8-fold (2.5%-19.4%) for ED2. Intravenous therapy use varied 2-fold (4.9%-10.4%) at ED1 and 3-fold (3.6%-11.4%) at ED2. Emergency department 2 physicians had an almost 2-fold (10.9%-20.6%) variation in imaging use. Variation in head computed tomography use was 2-fold (1.1%-2.5%) at ED1 and 5-fold (0.9%-4.8%) at ED2. Physicians had longer than expected LOS if they had higher than expected use of laboratory tests (r, 0.41; 95% confidence interval [CI], 0.09Y0.65; P < 0.05) and imaging (r, 0.48; 95% CI, 0.17Y0.69; P < 0.01). Return rate was not significantly correlated with resource use in any category. Physicians with higher than expected use of laboratory tests had higher than expected use of imaging (r, 0.62; 95% CI, 0.36Y0.78; P < 0.001), head computed tomography (r, 0.49; 95% CI, 0.19Y0.70; P < 0.01), and intravenous therapy (r, 0.51; 95% CI, 0.20Y0.71; P < 0.01).Conclusions: Significant variation exists in physician use of common ED resources. Higher resource use was associated with increased LOS but did not reduce return to ED. Practice variation such as this may represent an opportunity to improve health care quality and decrease costs.