Benjamin C Sun1, Amber Laurie2, Lela Prewitt2, Rongwei Fu2, Anna M Chang2, James Augustine3, Charles Reese4, K John McConnell2. 1. Department of Emergency Medicine, Oregon Health and Science University, Portland, OR. Electronic address: sunb@ohsu.edu. 2. Department of Emergency Medicine, Oregon Health and Science University, Portland, OR. 3. Emergency Medicine Physicians. 4. Department of Emergency Medicine, Christiana Care Health System, Wilmington, DE.
Abstract
STUDY OBJECTIVE: The Centers for Medicare & Medicaid Services (CMS) recently published emergency department (ED) timeliness measures. These data show substantial variation in hospital performance and suggest the need for process improvement initiatives. However, the CMS measures are not risk adjusted and may provide misleading information about hospital performance and variation. We hypothesize that substantial hospital-level variation will persist after risk adjustment. METHODS: This cross-sectional study included hospitals that participated in the Emergency Department Benchmarking Alliance and CMS ED measure reporting in 2012. Outcomes included the CMS measures corresponding to median annual boarding time, length of stay of admitted patients, length of stay of discharged patients, and waiting time of discharged patients. Covariates included hospital structural characteristics and case-mix information from the American Hospital Association Survey, CMS cost reports, and the Emergency Department Benchmarking Alliance. We used a γ regression with a log link to model the skewed outcomes. We used indirect standardization to create risk-adjusted measures. We defined "substantial" variation as coefficient of variation greater than 0.15. RESULTS: The study cohort included 723 hospitals. Risk-adjusted performance on the CMS measures varied substantially across hospitals, with coefficient of variation greater than 0.15 for all measures. Ratios between the 10th and 90th percentiles of performance ranged from 1.5-fold for length of stay of discharged patients to 3-fold for waiting time of discharged patients. CONCLUSION: Policy-relevant variations in publicly reported CMS ED timeliness measures persist after risk adjustment for nonmodifiable hospital and case-mix characteristics. Future "positive deviance" studies should identify modifiable process measures associated with high performance.
STUDY OBJECTIVE: The Centers for Medicare & Medicaid Services (CMS) recently published emergency department (ED) timeliness measures. These data show substantial variation in hospital performance and suggest the need for process improvement initiatives. However, the CMS measures are not risk adjusted and may provide misleading information about hospital performance and variation. We hypothesize that substantial hospital-level variation will persist after risk adjustment. METHODS: This cross-sectional study included hospitals that participated in the Emergency Department Benchmarking Alliance and CMS ED measure reporting in 2012. Outcomes included the CMS measures corresponding to median annual boarding time, length of stay of admitted patients, length of stay of discharged patients, and waiting time of discharged patients. Covariates included hospital structural characteristics and case-mix information from the American Hospital Association Survey, CMS cost reports, and the Emergency Department Benchmarking Alliance. We used a γ regression with a log link to model the skewed outcomes. We used indirect standardization to create risk-adjusted measures. We defined "substantial" variation as coefficient of variation greater than 0.15. RESULTS: The study cohort included 723 hospitals. Risk-adjusted performance on the CMS measures varied substantially across hospitals, with coefficient of variation greater than 0.15 for all measures. Ratios between the 10th and 90th percentiles of performance ranged from 1.5-fold for length of stay of discharged patients to 3-fold for waiting time of discharged patients. CONCLUSION: Policy-relevant variations in publicly reported CMS ED timeliness measures persist after risk adjustment for nonmodifiable hospital and case-mix characteristics. Future "positive deviance" studies should identify modifiable process measures associated with high performance.
Authors: Daniel A Handel; Rongwei Fu; Eugene Vu; James J Augustine; Renee Y Hsia; Charles M Shufflebarger; Benjamin Sun Journal: J Emerg Med Date: 2014-01-22 Impact factor: 1.484
Authors: Elizabeth H Bradley; Leslie A Curry; Tashonna R Webster; Jennifer A Mattera; Sarah A Roumanis; Martha J Radford; Robert L McNamara; Barbara A Barton; David N Berg; Harlan M Krumholz Journal: Circulation Date: 2006-02-20 Impact factor: 29.690
Authors: Kimon L H Ioannides; Avi Baehr; David N Karp; Douglas J Wiebe; Brendan G Carr; Daniel N Holena; M Kit Delgado Journal: Acad Emerg Med Date: 2018-05-31 Impact factor: 3.451
Authors: Anna Marie Chang; Deborah J Cohen; Amber Lin; James Augustine; Daniel A Handel; Eric Howell; Hyunjee Kim; Jesse M Pines; Jeremiah D Schuur; K John McConnell; Benjamin C Sun Journal: Ann Emerg Med Date: 2017-08-26 Impact factor: 5.721
Authors: Arjun Venkatesh; Shashank Ravi; Craig Rothenberg; Jeremiah Kinsman; Jean Sun; Pawan Goyal; James Augustine; Stephen K Epstein Journal: Ann Emerg Med Date: 2021-01-15 Impact factor: 6.762