title: Emergency department physician-level and hospital-level variation in admission rates.
abstract: OBJECTIVE
  We explore the variation in physician- and hospital-level admission rates in a group of emergency physicians in a single health system.
  
  
  METHODS
  This was a cross-sectional study that used retrospective data during various periods (2005 to 2010) to determine the variation in admission rates among emergency physicians from 3 emergency departments (EDs) within the same health system. Patients who left without being seen or left against medical advice, patients treated in fast-track departments, patients with primary psychiatric complaints, and those younger than 18 years were excluded, as were physicians with fewer than 500 ED encounters during the study period. Emergency physician-level and hospital-level admission rates were estimated with hierarchic logistic regression, which adjusted for patient age, sex, race, chief complaint, arrival mode, and arrival day and time.
  
  
  RESULTS
  A total of 389,120 ED visits were included in the analysis, and patients were treated by 89 attending emergency physicians. After adjusting for patient and clinical characteristics, the hospital-level admission rate varied from 27% to 41%. At the physician level, admission rates varied from 21% to 49%.
  
  
  CONCLUSIONS
  There was 2.3-fold variation in emergency physician adjusted admission rates and 1.7-fold variation at the hospital level. In the new era of cost containment, wide variation in this common, costly decision requires further exploration.
authors: Department of Emergency Medicine, The George Washington University, Washington, DC, USA. jameelem@gwu.edu
authors: Jameel
authors: J
authors: Abualenain
authors: William J
authors: WJ
authors: Frohna
authors: Robert
authors: R
authors: Shesser
authors: Ru
authors: R
authors: Ding
authors: Mark
authors: M
authors: Smith
authors: Jesse M
authors: JM
authors: Pines
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult