Association of Clinical Characteristics With Variation in Emergency Physician Preferences for Patients
| Autor: | Cindy Y. Chang, Ziad Obermeyer |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Cross-sectional study Attitude of Health Personnel MEDLINE Affect (psychology) 03 medical and health sciences 0302 clinical medicine Physicians Health care Medicine Humans 030212 general & internal medicine Practice Patterns Physicians' Health policy Aged Original Investigation business.industry Patient Selection Research Health Policy 030208 emergency & critical care medicine General Medicine Emergency department Middle Aged medicine.disease Comorbidity humanities 3. Good health Emergency Severity Index Online Only Cross-Sectional Studies Family medicine Female business Emergency Service Hospital |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | This cross-sectional study examines whether variations in patient characteristics are associated with physician preferences in self-assigning or selecting patients in the emergency department. Key Points Question Do physicians have measurable preferences for certain kinds of patients, and is preference variation associated with overall practice variation among physicians? Findings In this cross-sectional study of 294 915 emergency department visits, attending physicians’ preference varied significantly in how they selected the patients they saw. Accounting for these individual preferences resulted in substantial reordering of physician performance ranking by care intensity. Meaning This study suggests that overall practice variation among physicians likely reflects preference variation, which is currently not considered in efforts to reduce practice variation. Importance Much of the wide variation in health care has been associated with practice variation among physicians. Physicians choosing to see patients with more (or fewer) care needs could also produce variations in care observed across physicians. Objective To quantify emergency physician preferences by measuring nonrandom variations in patients they choose to see. Design, Setting, and Participants This cross-sectional study used a large, detailed clinical data set from an electronic health record system of a single academic hospital. The data set included all emergency department (ED) encounters of adult patients from January 1, 2010, to May 31, 2015, as well as ED visits information. Data were analyzed from September 1, 2018, to March 31, 2019. Exposure Patient assignment to a particular emergency physician. Main Outcomes and Measures Variation in patient characteristics (age, sex, acuity [Emergency Severity Index score], and comorbidities) seen by emergency physicians before patient selection, adjusted for temporal factors (seasonal, weekly, and hourly variation in patient mix). Results This study analyzed 294 915 visits to the ED seen by 62 attending physicians. Of the 294 915 patients seen, the mean (SD) age was 48.6 (19.8) years and 176 690 patients (59.9%) were women. Many patient characteristics, such as age (F = 2.2; P |
| Databáze: | OpenAIRE |
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