Shaw Natsui1,2, Benjamin C Sun3, Ernest Shen4, Rita F Redberg5, Maros Ferencik6, Ming-Sum Lee7, Visanee Musigdilok4, Yi-Lin Wu4, Chengyi Zheng4, Aniket A Kawatkar4, Adam L Sharp4. 1. National Clinician Scholars Program, University of California, Los Angeles (S.N.). 2. Department of Emergency Medicine. Los Angeles, CA (S.N.). 3. Department of Emergency Medicine, University of Pennsylvania, Philadelphia (B.C.S.). 4. Kaiser Permanente Southern California, Research and Evaluation Department. Pasadena (E.S., V.M., Y.-L.W., C.Z., A.A.K., A.L.S.). 5. Division of Cardiology, University of California, San Francisco (R.F.R.). 6. Oregon Health and Science University, Knight Cardiovascular Institute, Portland (M.F.). 7. Division of Cardiology, Kaiser Permanente Southern California, Los Angeles Medical Center (M.-S.L.).
Abstract
BACKGROUND: Wide variation exists for hospital admission rates for the evaluation of possible acute coronary syndrome, but there are limited data on physician-level variation. Our aim is to describe physicians' rates of admission for suspected acute coronary syndrome and associated 30-day major adverse events. METHODS: We conducted a retrospective analysis of adult emergency department chest pain encounters from January 2016 to December 2017 across 15 community emergency departments within an integrated health system in Southern California. The unit of analysis was the Emergency physician. The primary outcome was the proportion of patients admitted/observed in the hospital. Secondary analysis described the 30-day incidence of death or acute myocardial infarction. RESULTS: Thirty-eight thousand seven hundred seventy-eight patients encounters were included among 327 managing physicians. The median number of encounters per physician was 123 (interquartile range, 82-157) with an overall admission/observation rate of 14.0%. Wide variation in individual physician admission rates were observed (unadjusted, 1.5%-68.9%) and persisted after case-mix adjustments (adjusted, 5.5%-27.8%). More clinical experience was associated with a higher likelihood of hospital care. There was no difference in 30-day death or acute myocardial infarction between high- and low-admitting physician quartiles (unadjusted, 1.70% versus 0.82% and adjusted, 1.33% versus 1.29%). CONCLUSIONS: Wide variation persists in physician-level admission rates for emergency department chest pain evaluation, even in a well-integrated health system. There was no associated benefit in 30-day death or acute myocardial infarction for patients evaluated by high-admitting physicians. This suggests an additional opportunity to investigate the safe reduction of physician-level variation in the use of hospital care.
BACKGROUND: Wide variation exists for hospital admission rates for the evaluation of possible acute coronary syndrome, but there are limited data on physician-level variation. Our aim is to describe physicians' rates of admission for suspected acute coronary syndrome and associated 30-day major adverse events. METHODS: We conducted a retrospective analysis of adult emergency department chest pain encounters from January 2016 to December 2017 across 15 community emergency departments within an integrated health system in Southern California. The unit of analysis was the Emergency physician. The primary outcome was the proportion of patients admitted/observed in the hospital. Secondary analysis described the 30-day incidence of death or acute myocardial infarction. RESULTS: Thirty-eight thousand seven hundred seventy-eight patients encounters were included among 327 managing physicians. The median number of encounters per physician was 123 (interquartile range, 82-157) with an overall admission/observation rate of 14.0%. Wide variation in individual physician admission rates were observed (unadjusted, 1.5%-68.9%) and persisted after case-mix adjustments (adjusted, 5.5%-27.8%). More clinical experience was associated with a higher likelihood of hospital care. There was no difference in 30-day death or acute myocardial infarction between high- and low-admitting physician quartiles (unadjusted, 1.70% versus 0.82% and adjusted, 1.33% versus 1.29%). CONCLUSIONS: Wide variation persists in physician-level admission rates for emergency department chest pain evaluation, even in a well-integrated health system. There was no associated benefit in 30-day death or acute myocardial infarction for patients evaluated by high-admitting physicians. This suggests an additional opportunity to investigate the safe reduction of physician-level variation in the use of hospital care.
Authors: Jameel Abualenain; William J Frohna; Robert Shesser; Ru Ding; Mark Smith; Jesse M Pines Journal: Ann Emerg Med Date: 2013-02-15 Impact factor: 5.721
Authors: Adam L Sharp; Aileen S Baecker; Ernest Shen; Rita Redberg; Ming-Sum Lee; Maros Ferencik; Shaw Natsui; Chengyi Zheng; Aniket Kawatkar; Michael K Gould; Benjamin C Sun Journal: Ann Emerg Med Date: 2019-02-21 Impact factor: 5.721
Authors: Adam L Sharp; Yi-Lin Wu; Ernest Shen; Rita Redberg; Ming-Sum Lee; Maros Ferencik; Shaw Natsui; Chengyi Zheng; Aniket Kawatkar; Michael K Gould; Benjamin C Sun Journal: J Am Coll Cardiol Date: 2018-10-09 Impact factor: 24.094