Document Detail


Provider Variation in Fast Track Treatment Time.
MedLine Citation:
PMID:  22182923     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE:: To examine the degree to which fast track (FT) treatment time varies among providers. METHODS:: A retrospective cohort study that included 105,783 FT visits at 3 emergency departments (EDs) during a 3-year period. We calculated the median treatment time for 80 primary providers (physicians and physician extenders) and 109 nurses (2 sites only). We used a hierarchical linear regression model that accounted for the clustering of patient visits to the same provider to estimate each provider's median treatment time controlling for patient, clinical, temporal, and ED demand (ie, number of arrivals) characteristics. RESULTS:: Median FT treatment time across the 3 sites ranged from 48 to 134 minutes. Adjusted for other factors, the median FT treatment time of providers at the 90th versus 10th percentiles was 1.4 to 2.6 times longer across the 3 sites. The variation by FT nurses was also large. The median FT treatment time of nurses at the 90th versus 10th percentiles was 1.5 and 1.4 times longer at sites A and C, respectively. At all sites, provider and clinical factors explained more variation in FT treatment time than patient, ED demand, or temporal factors. CONCLUSIONS:: There were clinically meaningful differences in FT treatment time among the providers at all sites. Given that the providers share the same environment and patient population, understanding why such large provider variation in FT treatment time exists warrants further investigation.
Authors:
Melissa L McCarthy; Ru Ding; Jesse M Pines; Christian Terwiesch; Mehdi Sattarian; Joshua A Hilton; Jennifer Lee; Scott L Zeger
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Publication Detail:
Type:  JOURNAL ARTICLE    
Journal Detail:
Title:  Medical care     Volume:  50     ISSN:  1537-1948     ISO Abbreviation:  -     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0230027     Medline TA:  Med Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  43-49     Citation Subset:  -    
Affiliation:
*Departments of Health Policy and Emergency Medicine, George Washington University, Washington, DC †Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD ‡Department of Health Policy, Center for Health Care Quality, School of Public Health and Health Services, The George Washington University, Washington, DC §The Wharton School, University of Pennsylvania, Philadelphia, PA ∥George Washington University, Washington, DC ¶Department of Emergency Medicine, University of Pennsylvania, Ground Ravdin, Philadelphia, PA #Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
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