Format

Send to

Choose Destination
Acad Pediatr. 2019 Nov 21. pii: S1876-2859(19)30459-0. doi: 10.1016/j.acap.2019.11.007. [Epub ahead of print]

Provider-level and Hospital-level Factors and Process Measures of Quality Care Delivered in Pediatric Emergency Departments.

Author information

1
Department of Pediatrics, University of California, Davis School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817, USA. Electronic address: jpmarcin@ucdavis.edu.
2
Department of Pediatrics, University of California, Davis School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817, USA; Department of Internal Medicine, University of California, Davis, School of Medicine, 4150 V St, Sacramento, CA 95817, USA. Electronic address: psromano@ucdavis.edu.
3
Department of Pediatrics, University of California, Davis School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817, USA. Electronic address: pdayal@ucdavis.edu.
4
Department of Pediatrics, University of California, Davis School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817, USA. Electronic address: mdharmar@ucdavis.edu.
5
Division of Emergency Medicine, Children's National Health System, 111 Michigan Ave NW, Washington, DC 20310, USA. Electronic address: jchamber@childrensnational.org.
6
Department of Pediatrics, University of Utah School of Medicine, 100 Mario Capecchi Dr, Salt Lake City, UT 84113, USA. Electronic address: Nanette.Dudley@hsc.utah.edu.
7
Department of Pediatrics and Center for Clinical Effectiveness, Baylor College of Medicine, 6621 Fannin St., Suite A2210, Houston, TX 77030, USA. Electronic address: cgmacias@texaschildrens.org.
8
Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: Lise.Nigrovic@childrens.harvard.edu.
9
Department of Pediatrics, Northwestern University's Feinberg School of Medicine, 225 E Chicago Avenue, Chicago IL 60611, USA. Electronic address: epowell@luriechildrens.org.
10
Departments of Emergency Medicine and Pediatrics, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA. Electronic address: alexroge@med.umich.edu.
11
Department of Pediatrics, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, 1 E 102nd St, 630 West 168th Street, New York, NY 10029, USA. Electronic address: sonnett@nyp.org.
12
Department of Emergency Medicine, University of California, Davis, School of Medicine, 4150 V Street, Suite 2100, Sacramento, CA 95817, USA. Electronic address: lstzimenatos@ucdavis.edu.
13
Work done while at Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA (Present Address: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue #86, Chicago, IL 60611, USA). Electronic address: EAlpern@luriechildrens.org.
14
Department of Emergency Medicine, DeVos Children's Hospital, Michigan State University College of Human Medicine, 100 Michigan St NE, Grand Rapids, MI 49503, USA. Electronic address: andrewsdickert@gmail.com.
15
Department of Emergency Medicine, Hurley Medical Center and University of Michigan, One Hurley Plaza, Flint, MI 48503, USA. Electronic address: dborgia1@hurleymc.com.
16
Division of Emergency Medicine, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Avenue, Aurora, CO 80045, USA. Electronic address: Erika.Sidney@childrenscolorado.org.
17
Department of Pediatrics, University of Utah and PECARN Data Coordinating Center, 295 Chipeta Way, Salt Lake City, UT 84108. Electronic address: Charlie.Casper@hsc.utah.edu.
18
Department of Pediatrics, University of California, Davis School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817, USA; Department of Emergency Medicine, University of California, Davis, School of Medicine, 4150 V Street, Suite 2100, Sacramento, CA 95817, USA. Electronic address: nkuppermann@ucdavis.edu.

Abstract

OBJECTIVE:

Differences in the quality of emergency department (ED) care are often attributed to non-clinical factors such as variations in the structure, systems and processes of care. Few studies have examined these associations among children. We aimed to determine whether process measures of quality of care delivered to patients receiving care in children's hospital EDs were associated with physician-level or hospital-level factors.

METHODS:

We included children (<18 years old ) who presented to any of the twelve EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2011-December 2011. We measured quality of care from medical record reviews using a previously validated implicit review instrument with a summary score ranging from 5-35, and examined associations between process measures of quality and physician- and hospital-level factors using a mixed-effects linear regression model adjusted for patient case-mix, with hospital site as a random effect.

RESULTS:

Among the 620 ED encounters reviewed, we did not find process measures of quality to be associated with any physician-level factors such as physician sex, years since medical school graduation, or physician training. We found, however, that process measures of quality were positively associated with delivery at freestanding children's hospitals (1.96 points higher in quality compared to non-freestanding status, 95% CI: 0.49, 3.43) and negatively associated with higher annual ED patient volume (-0.03 points per thousand patients, 95% CI: -0.05, -0.01).

CONCLUSION:

Process measures of quality of care delivered to children was higher among patients treated at freestanding children's hospitals but lower among patients treated at higher volume EDs.

KEYWORDS:

Emergency Care; Pediatrics; Quality of Care

PMID:
31760173
DOI:
10.1016/j.acap.2019.11.007

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center