Emergency department physician-level and hospital-level variation in admission rates.

MedStar author(s):
Citation: Annals of Emergency Medicine. 61(6):638-43, 2013 Jun.PMID: 23415741Institution: MedStar Washington Hospital CenterDepartment: Emergency MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Emergency Service, Hospital/sn [Statistics & Numerical Data] | *Patient Admission/sn [Statistics & Numerical Data] | *Physicians/sn [Statistics & Numerical Data] | Adolescent | Adult | Aged | Cross-Sectional Studies | Female | Hospitals, Teaching/sn [Statistics & Numerical Data] | Humans | Logistic Models | Male | Middle Aged | Physician's Practice Patterns/sn [Statistics & Numerical Data] | Retrospective Studies | Young AdultLocal holdings: Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1997 - 2006ISSN:
  • 0196-0644
Name of journal: Annals of emergency medicineAbstract: 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. Copyright 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.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%.STUDY OBJECTIVE: We explore the variation in physician- and hospital-level admission rates in a group of emergency physicians in a single health system.All authors: Abualenain J, Ding R, Frohna WJ, Pines JM, Shesser R, Smith MDigital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 23415741

Available online from MWHC library: 1994 - present, Available in print through MWHC library: 1997 - 2006

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. Copyright 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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%.

STUDY OBJECTIVE: We explore the variation in physician- and hospital-level admission rates in a group of emergency physicians in a single health system.

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