• Ann Emerg Med · Sep 2024

    Multicenter Study

    Reliability of a Measure of Admission Intensity for Emergency Physicians.

    • Alexander T Janke, Jonathan J Oskvarek, Mark S Zocchi, Angela G Cai, Ori Litvak, Jesse M Pines, and Arjun K Venkatesh.
    • VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy/Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Department of Emergency Medicine, Yale School of Medicine, New Haven, CT. Electronic address: atjanke@med.umich.edu.
    • Ann Emerg Med. 2024 Sep 1; 84 (3): 295304295-304.

    Study ObjectiveWe assess the stability of a measure of emergency department (ED) admission intensity for value-based care programs designed to reduce variation in ED admission rates. Measure stability is important to accurately assess admission rates across sites and among physicians.MethodsWe sampled data from 358 EDs in 41 states (January 2018 to December 2021), separate from sites where the measure was derived. The measure is the ED admission rate per 100 ED visits for 16 clinical conditions and 535 included International Classification of Disease 10 diagnosis codes. We used descriptive plots and multilevel linear probability models to assess stability over time across EDs and among physicians.ResultsAcross included 3,571 ED-quarters, the average admission rate was 27.6% (95% confidence interval [CI] 26.0% to 28.2%). The between-facility standard deviation was 9.7% (95% CI 9.0% to 10.6%), and the within-facility standard deviation was 3.0% (95% CI 2.95% to 3.10%), with an intraclass correlation coefficient of 0.91. At the physician-quarter level, the average admission rate was 28.3% (95% CI 28.0% to 28.5%) among 7,002 physicians. Relative to their site's mean in each quarter, the between-physician standard deviation was 6.7% (95% CI 6.6% to 6.8%), and the within-physician standard deviation was 5.5% (95% CI 5.5% to 5.6%), with an intraclass correlation coefficient of 0.59. Moreover, 2.9% of physicians were high-admitting in 80%+ of their practice quarters relative to their peers in the same ED and in the same quarter, whereas 3.9% were low-admitting.ConclusionThe measure exhibits stability in characterizing ED-level admission rates and reliably identifies high- and low-admitting physicians.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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