Abstract
Objective: Quality of care delivered to adult patients in the emergency department (ED) is often associated with demographic and clinical factors such as a patient's race/ethnicity and insurance status. We sought to determine whether the quality of care delivered to children in the ED was associated with a variety of patient-level factors. Methods: This was a retrospective, observational cohort study. Pediatric patients (<18 years) who received care between January 2011 and December 2011 at one of 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) were included. We analyzed demographic factors (including age, sex, and payment source) and clinical factors (including triage, chief complaint, and severity of illness). We measured quality of care using a previously validated implicit review instrument using chart review with a summary score that ranged from 5 to 35. We examined associations between demographic and clinical factors and quality of care using a hierarchical multivariable linear regression model with hospital site as a random effect. Results: In the multivariable model, among the 620 ED encounters reviewed, we did not find any association between patient age, sex, race/ethnicity, and payment source and the quality of care delivered. However, we did find that some chief complaint categories were significantly associated with lower than average quality of care, including fever (–0.65 points in quality, 95% confidence interval [CI] = –1.24 to –0.06) and upper respiratory symptoms (–0.68 points in quality, 95% CI = –1.30 to –0.07). Conclusion: We found that quality of ED care delivered to children among a cohort of 12 EDs participating in the PECARN was high and did not differ by patient age, sex, race/ethnicity, and payment source, but did vary by the presenting chief complaint.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 301-309 |
| Number of pages | 9 |
| Journal | Academic Emergency Medicine |
| Volume | 25 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 2018 |
Funding
From the Department of Pediatrics (JPM, PSR, PD, MD, NK), the Department of Internal Medicine (PSR), and the Department of Emergency Medicine (LT, NK), University of California, Davis, School of Medicine, Sacramento, CA; the Division of Emergency Medicine, Children’s National Health System (JMC), Washington, DC; the Department of Pediatrics, University of Utah School of Medicine (ND), and the Department of Pediatrics, University of Utah and PECARN Data Coordinating Center (TCC, JMD), Salt Lake City, UT; the Department of Pediatrics and Center for Clinical Effectiveness, Baylor College of Medicine (CGM), Houston, TX; the Division of Emergency Medicine, Boston Children’s Hospital (LEN), Boston, MA; the Department of Pediatrics, Northwestern University’s Feinberg School of Medicine (ECP), Chicago IL; the Departments of Emergency Medicine and Pediatrics, University of Michigan (AJR), Ann Arbor, MI; the Department of Pediatrics, Columbia University Medical Center, Columbia University College of Physicians and Surgeons (MS), New York, NY; the Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine (ERA), Philadelphia, PA; Department of Emergency Medicine, DeVos Children’s Hospital, Michigan State University College of Human Medicine (RAD), Grand Rapids, MI; the Department of Emergency Medicine, Hurley Medical Center and University of Michigan (DAB), Flint, MI; and the Division of Emergency Medicine, Children’s Hospital Colorado, University of Colorado (ES), Aurora, CO. Dr. Alpern is currently with the Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL. Received June 22, 2017; revision received November 6, 2017; accepted November 12, 2017. Preliminary results of this study were presented at the poster session of the 6th Annual UC Davis Healthcare Quality Forum at the University of California Davis School of Medicine, Sacramento, CA, Mar 16, 2016. Funded by grant 1R01HS019712 from the Agency for Healthcare Research and Quality. This project was also supported in part by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Emergency Medical Services for Children (EMSC) Network Development Demonstration Program under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U. S. Government. The authors have no potential conflicts to disclose. Supervising Editor: Michelle L. Macy, MD, MS. Address for correspondence and reprints: James P. Marcin, MD, MPH; e-mail: [email protected]. ACADEMIC EMERGENCY MEDICINE 2018;25:301–309.
ASJC Scopus subject areas
- Emergency Medicine