Quality of care of children in the emergency department: association with hospital setting and physician training.
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.
Dharmar
Madan
M
Department of Pediatrics, University of California Davis, Sacramento, CA, USA.
Marcin
James P
JP
Romano
Patrick S
PS
Andrada
Emily R
ER
Overly
Frank
F
Valente
Jonathan H
JH
Harvey
Danielle J
DJ
Cole
Stacey L
SL
Kuppermann
Nathan
N
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