Quality of Care of Children in the Emergency Department

Association with Hospital Setting and Physician Training

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: To investigate differences in the quality of emergency care for children related to differences in hospital setting, physician training, and demographic factors. Study design: This was a retrospective cohort study of a consecutive sample of children presenting with high-acuity illnesses or injuries at 4 rural non-children's hospitals (RNCHs) and 1 academic urban children's hospital (UCH). Two of 4 study physicians independently rated quality of care using a validated implicit review instrument. Hierarchical modeling was used to estimate quality of care (scored from 5 to 35) across hospital settings and by physician training. Results: A total of 304 patients presenting to the RNCHs and the UCH were studied. Quality was lower (difference = -3.23; 95% confidence interval [CI] = -4.48 to -1.98) at the RNCHs compared with the UCH. Pediatric emergency medicine (PEM) physicians provided better care than family medicine (FM) physicians and those in the "other" category (difference = -3.34, 95% CI = -5.40 to -1.27 and -3.12, 95% CI = -5.25 to -0.99, respectively). Quality of care did not differ significantly between PEM and general emergency medicine (GEM) physicians in general, or between GEM and PEM physicians at the UCH; however, GEM physicians at the RNCHs provided care of lesser quality than PEM physicians at the UCH (difference = -2.75; 95% CI = -5.40 to -0.05). Older children received better care. Conclusions: The quality of care provided to children is associated with age, hospital setting, and physician training.

Original languageEnglish (US)
JournalJournal of Pediatrics
Volume153
Issue number6
DOIs
StatePublished - Dec 2008

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Quality of Health Care
Hospital Emergency Service
Physicians
Urban Hospitals
Emergency Medicine
Confidence Intervals
Family Physicians
Emergency Medical Services
Cohort Studies
Retrospective Studies
Medicine
Demography
Pediatric Emergency Medicine
Wounds and Injuries

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

@article{49efdf7def184336be0cffefc6029c24,
title = "Quality of Care of Children in the Emergency Department: Association with Hospital Setting and Physician Training",
abstract = "Objective: To investigate differences in the quality of emergency care for children related to differences in hospital setting, physician training, and demographic factors. Study design: This was a retrospective cohort study of a consecutive sample of children presenting with high-acuity illnesses or injuries at 4 rural non-children's hospitals (RNCHs) and 1 academic urban children's hospital (UCH). Two of 4 study physicians independently rated quality of care using a validated implicit review instrument. Hierarchical modeling was used to estimate quality of care (scored from 5 to 35) across hospital settings and by physician training. Results: A total of 304 patients presenting to the RNCHs and the UCH were studied. Quality was lower (difference = -3.23; 95{\%} confidence interval [CI] = -4.48 to -1.98) at the RNCHs compared with the UCH. Pediatric emergency medicine (PEM) physicians provided better care than family medicine (FM) physicians and those in the {"}other{"} category (difference = -3.34, 95{\%} CI = -5.40 to -1.27 and -3.12, 95{\%} CI = -5.25 to -0.99, respectively). Quality of care did not differ significantly between PEM and general emergency medicine (GEM) physicians in general, or between GEM and PEM physicians at the UCH; however, GEM physicians at the RNCHs provided care of lesser quality than PEM physicians at the UCH (difference = -2.75; 95{\%} CI = -5.40 to -0.05). Older children received better care. Conclusions: The quality of care provided to children is associated with age, hospital setting, and physician training.",
author = "Madan Dharmar and Marcin, {James P} and Romano, {Patrick S} and Andrada-Brown, {Emily R} and Frank Overly and Valente, {Jonathan H.} and Harvey, {Danielle J} and Cole, {Stacey L.} and Nathan Kuppermann",
year = "2008",
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journal = "Journal of Pediatrics",
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T1 - Quality of Care of Children in the Emergency Department

T2 - Association with Hospital Setting and Physician Training

AU - Dharmar, Madan

AU - Marcin, James P

AU - Romano, Patrick S

AU - Andrada-Brown, Emily R

AU - Overly, Frank

AU - Valente, Jonathan H.

AU - Harvey, Danielle J

AU - Cole, Stacey L.

AU - Kuppermann, Nathan

PY - 2008/12

Y1 - 2008/12

N2 - Objective: To investigate differences in the quality of emergency care for children related to differences in hospital setting, physician training, and demographic factors. Study design: This was a retrospective cohort study of a consecutive sample of children presenting with high-acuity illnesses or injuries at 4 rural non-children's hospitals (RNCHs) and 1 academic urban children's hospital (UCH). Two of 4 study physicians independently rated quality of care using a validated implicit review instrument. Hierarchical modeling was used to estimate quality of care (scored from 5 to 35) across hospital settings and by physician training. Results: A total of 304 patients presenting to the RNCHs and the UCH were studied. Quality was lower (difference = -3.23; 95% confidence interval [CI] = -4.48 to -1.98) at the RNCHs compared with the UCH. Pediatric emergency medicine (PEM) physicians provided better care than family medicine (FM) physicians and those in the "other" category (difference = -3.34, 95% CI = -5.40 to -1.27 and -3.12, 95% CI = -5.25 to -0.99, respectively). Quality of care did not differ significantly between PEM and general emergency medicine (GEM) physicians in general, or between GEM and PEM physicians at the UCH; however, GEM physicians at the RNCHs provided care of lesser quality than PEM physicians at the UCH (difference = -2.75; 95% CI = -5.40 to -0.05). Older children received better care. Conclusions: The quality of care provided to children is associated with age, hospital setting, and physician training.

AB - Objective: To investigate differences in the quality of emergency care for children related to differences in hospital setting, physician training, and demographic factors. Study design: This was a retrospective cohort study of a consecutive sample of children presenting with high-acuity illnesses or injuries at 4 rural non-children's hospitals (RNCHs) and 1 academic urban children's hospital (UCH). Two of 4 study physicians independently rated quality of care using a validated implicit review instrument. Hierarchical modeling was used to estimate quality of care (scored from 5 to 35) across hospital settings and by physician training. Results: A total of 304 patients presenting to the RNCHs and the UCH were studied. Quality was lower (difference = -3.23; 95% confidence interval [CI] = -4.48 to -1.98) at the RNCHs compared with the UCH. Pediatric emergency medicine (PEM) physicians provided better care than family medicine (FM) physicians and those in the "other" category (difference = -3.34, 95% CI = -5.40 to -1.27 and -3.12, 95% CI = -5.25 to -0.99, respectively). Quality of care did not differ significantly between PEM and general emergency medicine (GEM) physicians in general, or between GEM and PEM physicians at the UCH; however, GEM physicians at the RNCHs provided care of lesser quality than PEM physicians at the UCH (difference = -2.75; 95% CI = -5.40 to -0.05). Older children received better care. Conclusions: The quality of care provided to children is associated with age, hospital setting, and physician training.

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