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{
    "pk": 9791,
    "title": "Wide Variability in Emergency Physician Admission Rates: A Target to Reduce Costs Without Compromising Quality",
    "subtitle": null,
    "abstract": "Introduction: \nAttending physician judgment is the traditional standard of care for emergency department (ED) admission decisions. The extent to which variability in admission decisions affect cost and quality is not well understood.\n \nWe sought to determine the impact of variability in admission decisions on cost and quality\n.\n \n \n \n \nMethods: \nWe performed a retrospective observational study of patients presenting to a university-affiliated, urban ED from October 1, 2007, through September 30, 2008. The main outcome measures were admission rate, fiscal indicators (Medicaid-denied payment days), and quality indicators (15- and 30-day ED returns; delayed hospital admissions). We asked each attending to estimate his/her inpatient admission rate and correlated his personal assessment with actual admission rates.\n \nResults: \nAdmission rates, even after adjusting for known confounders, were highly variable (15.2%-32.0%) and correlated with Medicaid denied-payment day rates (p=0.038). There was no correlation with quality outcome measures (30-day ED return or delayed hospital admission). There was no significant correlation between actual and self-described admission rate; the range of mis-estimation was 0% to 117%.\n \nConclusion: \nEmergency medicine attending admission rates at this institution are highly variable, unexplained by known confounding variables, and unrelated to quality of care, as measured by 30-day ED return or delayed hospital admission. Admission optimization represents an important untapped potential for cost reduction through avoidable hospitalizations, with no apparent adverse effects on quality. [West JEmerg Med. 2016;17(5)561-566.]",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "ED admission rate"
        },
        {
            "word": "ED quality of care"
        },
        {
            "word": "variability"
        },
        {
            "word": "Medicaid"
        },
        {
            "word": "utilization review"
        }
    ],
    "section": "Emergency Department Operations",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/24g8g0gn",
    "frozenauthors": [
        {
            "first_name": "Mark",
            "middle_name": "J.",
            "last_name": "Richman, MD, MPH",
            "name_suffix": "",
            "institution": "David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California\nNorthwell Health Long Island Jewish Medical Center, Department of Emergency Medicine, New Hyde Park, New York \nHofstra University School of Medicine, Department of Emergency Medicine, Hempstead, New York",
            "department": "None"
        },
        {
            "first_name": "Jeffrey",
            "middle_name": "J.",
            "last_name": "Guterman, MD, MS",
            "name_suffix": "",
            "institution": "David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California\nLos Angeles Department of Health Services, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Scott",
            "middle_name": "R.",
            "last_name": "Lundberg, MD",
            "name_suffix": "",
            "institution": "David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California\nLos Angeles Department of Health Services, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "David",
            "middle_name": "A.",
            "last_name": "Talan, MD",
            "name_suffix": "",
            "institution": "David Geffen School of Medicine at UCLA, Department of Medicine, Los Angeles, California\nOlive View- UCLA Medical Center, Department of Emergency Medicine, Sylmar, California \nLos Angeles County Department of Health Services, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Sandra",
            "middle_name": "G.",
            "last_name": "Gross-Schulman, MD, MPH",
            "name_suffix": "",
            "institution": "Los Angeles County Department of Health Services, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Chien-Ju",
            "middle_name": "",
            "last_name": "Wang, MS",
            "name_suffix": "",
            "institution": "Los Angeles County Department of Public Health, Los Angeles, California",
            "department": "None"
        },
        {
            "first_name": "Geoffrey",
            "middle_name": "P.",
            "last_name": "Scheib, BS",
            "name_suffix": "",
            "institution": "Los Angeles County Department of Health Services, Los Angeles, California",
            "department": "None"
        }
    ],
    "date_submitted": "2016-05-19T14:55:10-04:00",
    "date_accepted": "2016-05-19T14:55:10-04:00",
    "date_published": "2016-08-08T18:59:07-04:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9791/galley/5404/download/"
        }
    ]
}