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

doi:10.1016/j.acap.2019.11.007

. 2020 May-Jun;20(4):524-531.

doi: 10.1016/j.acap.2019.11.007. Epub 2019 Nov 21.

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

James P Marcin¹, Patrick S Romano², Parul Dayal³, Madan Dharmar³, James M Chamberlain⁴, Nanette Dudley⁵, Charles G Macias⁶, Lise E Nigrovic⁷, Elizabeth C Powell⁸, Alexander J Rogers⁹, Meridith Sonnett¹⁰, Leah Tzimenatos¹¹, Elizabeth R Alpern¹², Rebecca Andrews-Dickert¹³, Dominic A Borgialli¹⁴, Erika Sidney¹⁵, T Charles Casper¹⁶, Nathan Kuppermann¹⁷; Pediatric Emergency Care Applied Research Network

Affiliations

¹ Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif. Electronic address: jpmarcin@ucdavis.edu.
² Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif; Department of Internal Medicine, University of California, Davis School of Medicine (PS Romano), Sacramento, Calif.
³ Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif.
⁴ Division of Emergency Medicine, Children's National Health System (JM Chamberlain), Washington, DC.
⁵ Department of Pediatrics, University of Utah School of Medicine (N Dudley), Salt Lake City, Utah.
⁶ Department of Pediatrics and Center for Clinical Effectiveness, Baylor College of Medicine (CG Macias), Houston, Tex.
⁷ Division of Emergency Medicine, Boston Children's Hospital (LE Nigrovic), Boston, Mass.
⁸ Department of Pediatrics, Northwestern University's Feinberg School of Medicine (EC Powell), Chicago Ill.
⁹ Department of Emergency Medicine and Pediatrics, University of Michigan (AJ Rogers), Ann Arbor, Mich.
¹⁰ Department of Pediatrics, Columbia University Medical Center, Columbia University College of Physicians and Surgeons (M Sonnett), New York, NY.
¹¹ Department of Emergency Medicine, University of California, Davis School of Medicine (L Tzimenatos), Sacramento, Calif.
¹² Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine (ER Alpern), Philadelphia, Pa.
¹³ Department of Emergency Medicine, DeVos Children's Hospital, Michigan State University College of Human Medicine (R Andrews-Dickert), Grand Rapids, Mich.
¹⁴ Department of Emergency Medicine, Hurley Medical Center and University of Michigan (DA Borgialli), Flint, Mich.
¹⁵ Division of Emergency Medicine, Children's Hospital Colorado, University of Colorado (E Sidney), Aurora, Colo.
¹⁶ Department of Pediatrics, University of Utah and PECARN Data Coordinating Center (TC Casper), Salt Lake City, Utah. Dr. Alpern is now with the Department of Pediatrics, Ann & Robert H Lurie Children's Hospital, Northwestern University Feinberg School of Medicine.
¹⁷ Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif; Department of Emergency Medicine, University of California, Davis School of Medicine (L Tzimenatos), Sacramento, Calif.

PMID: 31760173
PMCID: PMC9701102
DOI: 10.1016/j.acap.2019.11.007

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

James P Marcin et al. Acad Pediatr. 2020 May-Jun.

. 2020 May-Jun;20(4):524-531.

doi: 10.1016/j.acap.2019.11.007. Epub 2019 Nov 21.

Authors

Affiliations

¹ Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif. Electronic address: jpmarcin@ucdavis.edu.
² Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif; Department of Internal Medicine, University of California, Davis School of Medicine (PS Romano), Sacramento, Calif.
³ Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif.
⁴ Division of Emergency Medicine, Children's National Health System (JM Chamberlain), Washington, DC.
⁵ Department of Pediatrics, University of Utah School of Medicine (N Dudley), Salt Lake City, Utah.
⁶ Department of Pediatrics and Center for Clinical Effectiveness, Baylor College of Medicine (CG Macias), Houston, Tex.
⁷ Division of Emergency Medicine, Boston Children's Hospital (LE Nigrovic), Boston, Mass.
⁸ Department of Pediatrics, Northwestern University's Feinberg School of Medicine (EC Powell), Chicago Ill.
⁹ Department of Emergency Medicine and Pediatrics, University of Michigan (AJ Rogers), Ann Arbor, Mich.
¹⁰ Department of Pediatrics, Columbia University Medical Center, Columbia University College of Physicians and Surgeons (M Sonnett), New York, NY.
¹¹ Department of Emergency Medicine, University of California, Davis School of Medicine (L Tzimenatos), Sacramento, Calif.
¹² Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine (ER Alpern), Philadelphia, Pa.
¹³ Department of Emergency Medicine, DeVos Children's Hospital, Michigan State University College of Human Medicine (R Andrews-Dickert), Grand Rapids, Mich.
¹⁴ Department of Emergency Medicine, Hurley Medical Center and University of Michigan (DA Borgialli), Flint, Mich.
¹⁵ Division of Emergency Medicine, Children's Hospital Colorado, University of Colorado (E Sidney), Aurora, Colo.
¹⁶ Department of Pediatrics, University of Utah and PECARN Data Coordinating Center (TC Casper), Salt Lake City, Utah. Dr. Alpern is now with the Department of Pediatrics, Ann & Robert H Lurie Children's Hospital, Northwestern University Feinberg School of Medicine.
¹⁷ Department of Pediatrics, University of California, Davis School of Medicine (JP Marcin, PS Romano, P Dayal, M Dharmar, and N Kuppermann), Sacramento, Calif; Department of Emergency Medicine, University of California, Davis School of Medicine (L Tzimenatos), Sacramento, Calif.

PMID: 31760173
PMCID: PMC9701102
DOI: 10.1016/j.acap.2019.11.007

Abstract

Objective: Differences in the quality of emergency department (ED) care are often attributed to nonclinical 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 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2011 and 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 to 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 nonfreestanding status, 95% confidence interval: 0.49, 3.43) and negatively associated with higher annual ED patient volume (-0.03 points per thousand patients, 95% confidence interval: -0.05, -0.01).

Conclusion: Process measures of quality of care delivered to children were 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.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Cited by

Procurement of patient medical records from multiple health care facilities for public health research: feasibility, challenges, and lessons learned.
McMahon JM, Brasch J, Podsiadly E, Torres L, Quiles R, Ramos E, Crean HF, Haberer JE. McMahon JM, et al. JAMIA Open. 2023 Jun 13;6(2):ooad040. doi: 10.1093/jamiaopen/ooad040. eCollection 2023 Jul. JAMIA Open. 2023. PMID: 37323540 Free PMC article.

References

1. 2014 Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ Pub. No. 15–0007.
1. Donabedian A The quality of care—how can it be assessed. JAMA. 1988;260:1743–1748. - PubMed
1. Franca UL, McManus ML. Trends in regionalization of hospital care for common pediatric conditions. Pediatrics. 2018;141:e20171940. - PubMed
1. Remick K, Kaji AH, Olson L, et al. Pediatric readiness and facility verification. Ann Emerg Med. 2016;67. 320–328 e321. - PubMed
1. Tsugawa Y, Jena AB, Figueroa JF, et al. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Inter Med. 2017;177:206–213. - PMC - PubMed

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[1] 2014 Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ Pub. No. 15–0007.

[2] 2014 Healthcare Quality and Disparities Report. Rockville, MD: Agency for Healthcare Research and Quality; 2015. AHRQ Pub. No. 15–0007.

[3] Donabedian A The quality of care—how can it be assessed. JAMA. 1988;260:1743–1748. - PubMed

[4] Donabedian A The quality of care—how can it be assessed. JAMA. 1988;260:1743–1748. - PubMed

[5] Franca UL, McManus ML. Trends in regionalization of hospital care for common pediatric conditions. Pediatrics. 2018;141:e20171940. - PubMed

[6] Franca UL, McManus ML. Trends in regionalization of hospital care for common pediatric conditions. Pediatrics. 2018;141:e20171940. - PubMed

[7] Remick K, Kaji AH, Olson L, et al. Pediatric readiness and facility verification. Ann Emerg Med. 2016;67. 320–328 e321. - PubMed

[8] Remick K, Kaji AH, Olson L, et al. Pediatric readiness and facility verification. Ann Emerg Med. 2016;67. 320–328 e321. - PubMed

[9] Tsugawa Y, Jena AB, Figueroa JF, et al. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Inter Med. 2017;177:206–213. - PMC - PubMed

[10] Tsugawa Y, Jena AB, Figueroa JF, et al. Comparison of hospital mortality and readmission rates for Medicare patients treated by male vs female physicians. JAMA Inter Med. 2017;177:206–213. - PMC - PubMed

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical