دورية أكاديمية
أعرض في EDS

Fair Play: Application of Normalized Scoring to Emergency Department Throughput Quality Measures in a National Registry.

التفاصيل البيبلوغرافية
العنوان: Fair Play: Application of Normalized Scoring to Emergency Department Throughput Quality Measures in a National Registry.
المؤلفون: Venkatesh A; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale New Haven Health System, New Haven, CT. Electronic address: arjun.venkatesh@yale.edu., Ravi S; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT., Rothenberg C; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT., Kinsman J; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT., Sun J; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT., Goyal P; American College of Emergency Physicians, Washington, DC., Augustine J; National Clinical Governance Board, US Acute Care Solutions, Canton, OH., Epstein SK; Department of Emergency Medicine, Harvard Medical School, Boston, MA; Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
المصدر: Annals of emergency medicine [Ann Emerg Med] 2021 May; Vol. 77 (5), pp. 501-510. Date of Electronic Publication: 2021 Jan 15.
نوع المنشور: Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.
اللغة: English
بيانات الدورية: Publisher: Mosby Country of Publication: United States NLM ID: 8002646 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6760 (Electronic) Linking ISSN: 01960644 NLM ISO Abbreviation: Ann Emerg Med Subsets: MEDLINE
أسماء مطبوعة: Publication: St. Louis, MO : Mosby
Original Publication: [Lansing, Mich., American College of Emergency Physicians]
مواضيع طبية MeSH: Quality Indicators, Health Care*, Emergency Service, Hospital/*statistics & numerical data, Centers for Medicare and Medicaid Services, U.S. ; Emergency Service, Hospital/classification ; Emergency Service, Hospital/standards ; Humans ; Length of Stay/statistics & numerical data ; Qualitative Research ; Registries ; Reimbursement, Incentive ; United States
مستخلص: Study Objective: The measurement of emergency department (ED) throughput as a patient-centered quality measure is ubiquitous; however, marked heterogeneity exists between EDs, complicating comparisons for payment purposes. We evaluate 4 scoring methodologies for accommodating differences in ED visit volume and heterogeneity among ED groups that staff multiple EDs to improve the validity and "fairness" of ED throughput quality measurement in a national registry, with the goal of developing a volume-adjusted throughput measure that balances variation at the ED group level.
Methods: We conducted an ED group-level analysis using the 2017 American College of Emergency Physicians Clinical Emergency Data Registry data set, which included 548 ED groups inclusive of 889 unique EDs. We calculated ED throughput performance scores for each ED group by using 4 scoring approaches: plurality, simple average, weighted average, and a weighted standardized score. For comparison, ED groups (ie, taxpayer identification numbers) were grouped into 3 types: taxpayer identification numbers with only 1 ED; those with multiple EDs, but no ED with greater than 60,000 visits; and those with multiple EDs and at least 1 ED with greater than 60,000 visits.
Results: We found marked differences in the classification of ED throughput performance between scoring approaches. The weighted standardized score (z score) approach resulted in the least skewed and most uniform distribution across the majority of ED types, with a kurtosis of 12.91 for taxpayer identification numbers composed of 1 ED, 2.58 for those with multiple EDs without any supercenter, and 3.56 for those with multiple EDs with at least 1 supercenter, all lower than comparable scoring methods. The plurality and simple average scoring approaches appeared to disproportionally penalize ED groups that staff a single ED or multiple large-volume EDs.
Conclusion: Application of a weighted standardized (z score) approach to ED throughput measurement resulted in a more balanced variation between different ED group types and reduced distortions in the length-of-stay measurement among ED groups staffing high-volume EDs. This approach may be a more accurate and acceptable method of profiling ED group throughput pay-for-performance programs.
(Copyright © 2020 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: KL2 TR001862 United States TR NCATS NIH HHS
تواريخ الأحداث: Date Created: 20210118 Date Completed: 20210517 Latest Revision: 20220716
رمز التحديث: 20240628
مُعرف محوري في PubMed: PMC9103009
DOI: 10.1016/j.annemergmed.2020.10.021
PMID: 33455841
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-6760
DOI:10.1016/j.annemergmed.2020.10.021