1
|
Removing anonymity protection and utilization review decisions: a real-world case under a single-payer health system. Sci Rep 2022; 12:12195. [PMID: 35842541 PMCID: PMC9288443 DOI: 10.1038/s41598-022-16536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022] Open
Abstract
The effects of anonymity on utilization review has never been examined in the real world. This study aimed to evaluate the impact of removing anonymity protection for claims reviewers on their review decisions. Using a single-blinded repeated measures design, we randomly selected 1457 claims cases (with 12,237 orders) that had been anonymously reviewed and reimbursed in 2016 and had them re-reviewed in a signed review program in 2017 under the Taiwanese National Health Insurance scheme. The signed review policy significantly decreased the likelihood of a deduction decision at the case and the order level (P < 0.001). Furthermore, signed reviewers tended to make more "too lenient" decisions, and were less likely to make "too harsh" decisions. Removing anonymity protection dramatically reduced the deduction rate and overturned the tendency of decisions from "too harsh" to "too lenient". However, whether to maintain the anonymity of utilization reviews is a challenge for health authorities around the globe.
Collapse
|
2
|
Abulebda K, Whitfill T, Mustafa M, Montgomery EE, Lutfi R, Abu-Sultaneh S, Nitu ME, Auerbach MA. Improving Pediatric Readiness and Clinical Care in General Emergency Departments: A Multicenter Retrospective Cohort Study. J Pediatr 2022; 240:241-248.e1. [PMID: 34499944 DOI: 10.1016/j.jpeds.2021.08.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the impact of a collaborative initiative between general emergency departments (EDs) and the pediatric academic medical center on the process of clinical care in a group of general EDs. STUDY DESIGN This retrospective cohort study assessed the process of clinical care delivered to critically ill children presenting to 3 general EDs. Our previous multifaceted intervention included the following components: postsimulation debriefing, designation of a pediatric champion, customized performance reports, pediatric resources toolkit, and ongoing interactions. Five pediatric emergency care physicians conducted chart reviews and scored encounters using the Pediatric Emergency Care Research Network's Quality of Care Implicit Review Instrument, which assigns scores between 5 and 35 across 5 domains. In addition, safety metrics were collected for medication, imaging, and laboratory orders. RESULTS A total of 179 ED encounters were reviewed, including 103 preintervention and 76 postintervention encounters, with an improvement in mean total quality score from 23.30 (SD 5.1) to 24.80 (4.0). In the domain of physician initial treatment plan and initial orders, scores increased from a mean of 4.18 (0.13) to 4.61 (0.15). In the category of safety, administration of wrong medications decreased from 28.2% to 11.8% after the intervention. CONCLUSION A multifaceted collaborative initiative involving simulation and enhanced pediatric readiness was associated with improvement in the processes of care in general EDs. This work provides evidence that innovative collaborations between academic medical centers and general EDs may serve as an effective strategy to improve pediatric care.
Collapse
Affiliation(s)
- Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
| | - Travis Whitfill
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Manahil Mustafa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Erin E Montgomery
- LifeLine Critical Care Transport, Indiana University Health, Indianapolis, IN
| | - Riad Lutfi
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Samer Abu-Sultaneh
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Mara E Nitu
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Marc A Auerbach
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | | |
Collapse
|
3
|
Marcin JP, Romano PS, Dayal P, Dharmar M, Chamberlain JM, Dudley N, Macias CG, Nigrovic LE, Powell EC, Rogers AJ, Sonnett M, Tzimenatos L, Alpern ER, Andrews-Dickert R, Borgialli DA, Sidney E, Casper TC, Kuppermann N. Provider-Level and Hospital-Level Factors and Process Measures of Quality Care Delivered in Pediatric Emergency Departments. Acad Pediatr 2020; 20:524-531. [PMID: 31760173 PMCID: PMC9701102 DOI: 10.1016/j.acap.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Differences in the quality of emergency department (ED) care are often attributed to nonclinical factors such as variations in the structure, systems, and processes of care. Few studies have examined these associations among children. We aimed to determine whether process measures of quality of care delivered to patients receiving care in children's hospital EDs were associated with physician-level or hospital-level factors. METHODS We included children (<18 years old) who presented to any of the 12 EDs participating in the Pediatric Emergency Care Applied Research Network (PECARN) between January 2011 and December 2011. We measured quality of care from medical record reviews using a previously validated implicit review instrument with a summary score ranging from 5 to 35, and examined associations between process measures of quality and physician- and hospital-level factors using a mixed-effects linear regression model adjusted for patient case-mix, with hospital site as a random effect. RESULTS Among the 620 ED encounters reviewed, we did not find process measures of quality to be associated with any physician-level factors such as physician sex, years since medical school graduation, or physician training. We found, however, that process measures of quality were positively associated with delivery at freestanding children's hospitals (1.96 points higher in quality compared to nonfreestanding status, 95% confidence interval: 0.49, 3.43) and negatively associated with higher annual ED patient volume (-0.03 points per thousand patients, 95% confidence interval: -0.05, -0.01). CONCLUSION Process measures of quality of care delivered to children were higher among patients treated at freestanding children's hospitals but lower among patients treated at higher volume EDs.
Collapse
|
4
|
Barata I, Auerbach M, Badaki‐Makun O, Benjamin L, Joseph MM, Lee MO, Mears K, Petrack E, Wallin D, Ishimine P, Denninghoff KR. A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments. Acad Emerg Med 2018; 25:1415-1426. [PMID: 30353946 DOI: 10.1111/acem.13642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/06/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
In 2018, the Society for Academic Emergency Medicine and the journal Academic Emergency Medicine (AEM) convened a consensus conference entitled, "Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps." This article is the product of the breakout session, "Emergency Department Collaboration-Pediatric Emergency Medicine in Non-Children's Hospital"). This subcommittee consisting of emergency medicine, pediatric emergency medicine, and quality improvement (QI) experts, as well as a patient advocate, identified main outcome gaps in the care of children in the emergency departments (EDs) in the following areas: variations in pediatric care and outcomes, pediatric readiness, and gaps in knowledge translation. The goal for this session was to create a research agenda that facilitates collaboration and partnering of diverse stakeholders to develop a system of care across all ED settings with the aim of improving quality and increasing safe medical care for children. The following recommended research strategies emerged: explore the use of technology as well as collaborative networks for education, research, and advocacy to develop and implement patient care guidelines, pediatric knowledge generation and dissemination, and pediatric QI and prepare all EDs to care for the acutely ill and injured pediatric patients. In conclusion, collaboration between general EDs and academic pediatric centers on research, dissemination, and implementation of evidence into clinical practice is a solution to improving the quality of pediatric care across the continuum.
Collapse
Affiliation(s)
- Isabel Barata
- Department of Pediatrics and Emergency Medicine Northwell Health System Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Manhasset NY
| | - Marc Auerbach
- Pediatrics and Emergency Medicine Yale University School of Medicine New Haven CT
| | | | - Lee Benjamin
- Pediatric Emergency Center Saint Joseph Mercy Health System Department of Emergency Medicine University of Michigan Ann Arbor MI
| | - Madeline M. Joseph
- Department of Emergency Medicine University of Florida College of Medicine–Jacksonville Jacksonville FL
| | - Moon O. Lee
- Department of Emergency Medicine Stanford University School of Medicine Stanford CA
| | | | | | - Dina Wallin
- Division of Pediatric Emergency Medicine Department of Emergency Medicine University of California at San Francisco San Francisco CA
| | | | - Kurt R. Denninghoff
- Department of Emergency Medicine University of Arizona College of Medicine Tucson AZ
| |
Collapse
|
5
|
Hale AT, Stonko DP, Lim J, Guillamondegui OD, Shannon CN, Patel MB. Using an artificial neural network to predict traumatic brain injury. J Neurosurg Pediatr 2018; 23:219-226. [PMID: 30485240 PMCID: PMC9549179 DOI: 10.3171/2018.8.peds18370] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 01/23/2023]
Abstract
In BriefPediatric traumatic brain injury (TBI) is common, but not all injuries require hospitalization. A computational tool for ruling-in patients who will have clinically relevant TBI (CRTBI) would be valuable, providing an evidence-based mechanism for safe discharge. Here, using data from 12,902 patients from the Pediatric Emergency Care Applied Research Network (PECARN) TBI data set, the authors utilize artificial intelligence to predict CRTBI using radiologist-interpreted CT information with > 99% sensitivity and an AUC of 0.99.
Collapse
Affiliation(s)
- Andrew T. Hale
- Vanderbilt University School of Medicine, Medical Scientist Training Program, Nashville, TN, USA.,Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David P. Stonko
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jaims Lim
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Oscar D. Guillamondegui
- Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Departments of Surgery and Hearing & Speech Sciences, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurosurgery, Vanderbilt University Medical Center; Division of Pediatric Neurosurgery, Monroe Carell Jr. Children’s Hospital of Vanderbilt University, Nashville, TN, USA
| | - Chevis N. Shannon
- Vanderbilt University School of Medicine, Nashville, TN, USA.,Department of Neurosurgery, Vanderbilt University Medical Center; Division of Pediatric Neurosurgery, Monroe Carell Jr. Children’s Hospital of Vanderbilt University, Nashville, TN, USA.,Surgical Outcomes Center for Kids, Monroe Carell Jr. Children’s Hospital of Vanderbilt University, Nashville, TN, USA
| | - Mayur B. Patel
- Vanderbilt University School of Medicine, Nashville, TN, USA.,Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Departments of Surgery and Hearing & Speech Sciences, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.,Center for Health Services Research, Vanderbilt Brain Institute, Vanderbilt University Medical Center; Geriatric Research, Education and Clinical Center Service, Surgical Service, Department of Veterans Affairs Medical Center, Tennessee Valley Health Care System, Nashville, TN, USA.,Department of Neurosurgery, Vanderbilt University Medical Center; Division of Pediatric Neurosurgery, Monroe Carell Jr. Children’s Hospital of Vanderbilt University, Nashville, TN, USA
| |
Collapse
|
6
|
Lorch SA. Regarding "Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments". Health Serv Res 2018; 53:1303-1307. [PMID: 29143323 PMCID: PMC5980172 DOI: 10.1111/1475-6773.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Scott A. Lorch
- Department of PediatricsDivision of NeonatologyThe Children's Hospital of PhiladelphiaPhiladelphiaPA
- Center for Pediatric and Perinatal Health Disparities Research and PolicyLabThe Children's Hospital of PhiladelphiaPhiladelphiaPA
- Leonard Davis InstituteUniversity of PennsylvaniaPhiladelphiaPA
- Center for Clinical Epidemiology and BiostatisticsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| |
Collapse
|