TY  - BOOK
AU  - Galarraga, Jessica E
TI  - The Impact of Hospital and Patient Factors on the Emergency Department Decision to Admit
SN  - 0736-4679
PY  - 2018///
KW  - *Decision Making
KW  - *Patient Admission/st [Standards]
KW  - Adolescent
KW  - Adult
KW  - Aged
KW  - Aged, 80 and over
KW  - Child
KW  - Child, Preschool
KW  - Cohort Studies
KW  - Cross-Sectional Studies
KW  - Emergency Service, Hospital/og [Organization & Administration]
KW  - Emergency Service, Hospital/sn [Statistics & Numerical Data]
KW  - Female
KW  - Humans
KW  - Income/sn [Statistics & Numerical Data]
KW  - Infant
KW  - Insurance Coverage/sn [Statistics & Numerical Data]
KW  - Logistic Models
KW  - Male
KW  - Middle Aged
KW  - Odds Ratio
KW  - Patient Admission/sn [Statistics & Numerical Data]
KW  - Practice Patterns, Physicians'/sn [Statistics & Numerical Data]
KW  - Retrospective Studies
KW  - United States
KW  - MedStar Washington Hospital Center
KW  - Emergency Medicine
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
N2  - BACKGROUND: Substantial variation exists in rates of emergency department (ED) admission. We examine this variation after accounting for local and community characteristics; CONCLUSION: Variation in hospital-level admission rates is associated with a number of local and community characteristics. However, the presence of persistent variation after adjustment suggests there are other unmeasured variables that also affect admission rates that deserve further study, particularly in an era of cost containment; Copyright (c) 2017 Elsevier Inc. All rights reserved; METHODS: We conducted a retrospective cross-sectional study of 1,412,340 patient encounters across 18 sites from 2012-2013. We calculated the adjusted hospital-level admission rates using multivariate logistic regression. We adjusted for patient, provider, hospital, and community factors to compare admission rate variation and determine the influence of these characteristics on admission rates; OBJECTIVES: Elucidate the factors that contribute to admission variation that are amenable to intervention with the goal of reducing variation and health care costs; RESULTS: The average adjusted admission rate was 22.9%, ranging from 16.1% (95% confidence interval [CI] 11.5-22%) to 32% (95% CI 26.0-38.8). There were higher odds of hospital admission with advancing age, male sex (odds ratio [OR] 1.20, 95% CI 1.91-1.21), and patients seen by a physician vs. mid-level provider (OR 2.26, 95% CI 2.23-2.30). There were increased odds of admission with rising ED volume, at academic institutions (OR 2.23, 95% CI 2.20-2.26) and at for-profit hospitals (OR 1.15, 95% CI 1.12-1.18). Admission rates were lower in communities with a higher per capita income, a higher rate of uninsured patients, and in more urban hospitals. In communities with the most primary providers, there were lower odds of admission (OR 0.60, 95% CI 0.57-0.68)
UR  - https://dx.doi.org/10.1016/j.jemermed.2017.11.024
ER  -