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 language | English (US) |
|---|---|
| Journal | Journal of Pediatrics |
| Volume | 153 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2008 |
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ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
Cite this
Quality of Care of Children in the Emergency Department : Association with Hospital Setting and Physician Training. / Dharmar, Madan; Marcin, James P; Romano, Patrick S; Andrada-Brown, Emily R; Overly, Frank; Valente, Jonathan H.; Harvey, Danielle J; Cole, Stacey L.; Kuppermann, Nathan.
In: Journal of Pediatrics, Vol. 153, No. 6, 12.2008.Research output: Contribution to journal › Article
}
TY - JOUR
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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UR - http://www.scopus.com/inward/citedby.url?scp=56049096498&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2008.05.025
DO - 10.1016/j.jpeds.2008.05.025
M3 - Article
VL - 153
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
IS - 6
ER -