Reliability of a Measure of Admission Intensity for Emergency Physicians
Authors: Alexander T Janke, Jonathan J Oskvarek, Mark S Zocchi, Angela G Cai, Ori Litvak, Jesse M Pines, Arjun K Venkatesh
Published in: Annals of Emergency Medicine, 2024 March 3
Conclusion:
- The admission intensity measure shows stable performance in characterizing ED-level admission rates and is effective in identifying physicians with consistently high or low admission rates.
Methods:
- Analysis of data from 358 EDs across 41 states from January 2018 to December 2021, using ED admission rate per 100 visits for specific clinical conditions and associated diagnosis codes.
- Stability assessment over time was performed using descriptive plots and multilevel linear probability models.
Results:
- Average admission rate across 3,571 ED-quarters was 27.6%, with a between-facility standard deviation of 9.7% and within-facility standard deviation of 3.0%. The intraclass correlation coefficient (ICC) was 0.91, indicating high stability at the facility level.
- At the physician-quarter level, among 7,002 physicians, the average admission rate was 28.3%. The between-physician standard deviation was 6.7%, and the within-physician standard deviation was 5.5%, with an ICC of 0.59, demonstrating moderate reliability among individual physicians.
- Approximately 2.9% of physicians consistently admitted patients at a high rate in 80% or more of their practice quarters, while 3.9% were consistently low-admitters.