title: Quality of care of children in the emergency department: association with hospital setting and physician training.
abstract: OBJECTIVE
  To investigate differences in the quality of emergency care for children related to differences in hospital setting, physician training, and demographic factors.
  
  
  METHODS
  This was a retrospective cohort study of a consecutive sample of children presenting with high-acuity illnesses or injuries at 4 rural non-children's hospitals (RNCHs) and 1 academic urban children's hospital (UCH). Two of 4 study physicians independently rated quality of care using a validated implicit review instrument. Hierarchical modeling was used to estimate quality of care (scored from 5 to 35) across hospital settings and by physician training.
  
  
  RESULTS
  A total of 304 patients presenting to the RNCHs and the UCH were studied. Quality was lower (difference = -3.23; 95% confidence interval [CI] = -4.48 to -1.98) at the RNCHs compared with the UCH. Pediatric emergency medicine (PEM) physicians provided better care than family medicine (FM) physicians and those in the "other" category (difference = -3.34, 95% CI = -5.40 to -1.27 and -3.12, 95% CI = -5.25 to -0.99, respectively). Quality of care did not differ significantly between PEM and general emergency medicine (GEM) physicians in general, or between GEM and PEM physicians at the UCH; however, GEM physicians at the RNCHs provided care of lesser quality than PEM physicians at the UCH (difference = -2.75; 95% CI = -5.40 to -0.05). Older children received better care.
  
  
  CONCLUSIONS
  The quality of care provided to children is associated with age, hospital setting, and physician training.
authors.affiliation: Department of Pediatrics, University of California Davis, Sacramento, CA, USA.
authors.forename: Madan
authors.initials: M
authors.lastname: Dharmar
authors.forename: James P
authors.initials: JP
authors.lastname: Marcin
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.forename: Emily R
authors.initials: ER
authors.lastname: Andrada
authors.forename: Frank
authors.initials: F
authors.lastname: Overly
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Valente
authors.forename: Danielle J
authors.initials: DJ
authors.lastname: Harvey
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Cole
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002662:Child Health Services / Q000145:classification* / Q000706:statistics & numerical data; D002675:Child, Preschool; D004522:Educational Status; D004636:Emergency Service, Hospital / Q000145:classification* / Q000706:statistics & numerical data; D005260:Female; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008499:Medical Records; D015233:Models, Statistical; D011787:Quality of Health Care / Q000145:classification* / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D014481:United States