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来源类型Publication
The Relative Contribution of Provider and ED-Level Factors to Variation Among the Top 15 Reasons for ED Admission
Imad Khojah; Suhui Li; Qian Luo; Griffin Davis; Jessica E. Galarraga; Michael Granovsky; Ori Litvak; Samuel Davis; Robert Shesser; and Jesse M. Pines
发表日期2017-09-01
出版者American Journal of Emergency Medicine, vol. 35, issue 9
出版年2017
语种英语
概述The authors examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital.",
摘要

Objective. We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital.

Methods. This was a retrospective, cross-sectional study of ED encounters (≥ 18 years) from 19 EDs and 603 providers (January 2012–December 2013), linked to the Area Health Resources File for county-level information on healthcare resources. “Hospital admission” was the outcome, a composite of inpatient, observation, or intra-hospital transfer. We studied the 15 most commonly admitted conditions, and calculated condition-specific risk-standardized hospital admission rates (RSARs) using multi-level hierarchical generalized linear models. We then decomposed the relative contribution of provider-level and hospital-level variation for each condition.

Results. The top 15 conditions made up 34% of encounters and 49% of admissions. After adjustment, the eight conditions with the highest hospital-level variation were: 1) injuries, 2) extremity fracture (except hip fracture), 3) skin infection, 4) lower respiratory disease, 5) asthma/chronic obstructive pulmonary disease (A&C), 6) abdominal pain, 7) fluid/electrolyte disorders, and 8) chest pain. Hospital-level intra-class correlation coefficients (ICC) ranged from 0.042 for A&C to 0.167 for extremity fractures. Provider-level ICCs ranged from 0.026 for abdominal pain to 0.104 for chest pain. Several patient, hospital, and community factors were associated with admission rates, but these varied across conditions.

Conclusion. For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs.

URLhttps://www.mathematica.org/our-publications-and-findings/publications/the-relative-contribution-of-provider-and-ed-level-factors-to-variation-among-the-top-15-reasons
来源智库Mathematica Policy Research (United States)
资源类型智库出版物
条目标识符http://119.78.100.153/handle/2XGU8XDN/489001
推荐引用方式
GB/T 7714
Imad Khojah,Suhui Li,Qian Luo,et al. The Relative Contribution of Provider and ED-Level Factors to Variation Among the Top 15 Reasons for ED Admission. 2017.
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