Emergency Department Physician-Level and Hospital-Level Variation in Admission Rates

作者：Abualenain Jameel^*; Frohna William J; Shesser Robert; Ding Ru; Smith Mark; Pines Jesse M

来源：Annals of Emergency Medicine, 2013, 61(6): 638-643.

DOI：10.1016/j.annemergmed.2013.01.016

Study objective: We explore the variation in physician- and hospital-level admission rates in a group of emergency physicians in a single health system. %26lt;br%26gt;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. %26lt;br%26gt;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%. %26lt;br%26gt;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.

• 出版日期2013-6