title: Hospital variation in risk-standardized hospital admission rates from US EDs among adults.
abstract: BACKGROUND
  Variation in hospital admission rates of patients presenting to the emergency department (ED) may represent an opportunity to improve practice. We seek to describe national variation in hospital admission rates from the ED and to determine the degree to which variation is not explained by patient characteristics or hospital factors.
  
  
  METHODS
  We conducted a cross-sectional analysis of a nationally representative sample of ED visits among adults within the 2010 National Hospital Ambulatory Care Survey ED data of hospitals with admission rates from the ED between 5% and 50%. We calculated risk-standardized hospital admission rates (RSARs) from the ED using contemporary hospital profiling methodology, accounting for patients' sociodemographic and clinical characteristics.
  
  
  RESULTS
  Among 19831 adult ED visits in 252 hospitals, there were 4148 hospital admissions from the ED. After accounting for patients' sociodemographic and clinical factors, the median RSAR from the ED was 16.9% (interquartile range, 15.0%-20.4%), and 8.1% of the variation in RSARs was attributable to an institution-specific effect. Even after accounting for hospital teaching status, ownership, urban/rural location, and geographical location, 7.0% of the variation in RSARs from the ED was still attributable to an institution-specific effect.
  
  
  CONCLUSIONS
  There was variation in hospital admission rates from the ED in the United States, even after adjusting for patients' sociodemographic and clinical characteristics and accounting for hospital factors. Our findings suggest that suggesting that the likelihood of being admitted from the ED is not only dependent on clinical factors but also at which hospital the patient seeks care.
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT; University of Colorado, Medical School, Department of Emergency Medicine, Aurora, CO. Electronic address: roberta.capp@ucdenver.edu.
authors.forename: Roberta
authors.initials: R
authors.lastname: Capp
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Ross
authors.affiliation: Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH.
authors.forename: Justin P
authors.initials: JP
authors.lastname: Fox
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Arjun K
authors.initials: AK
authors.lastname: Venkatesh
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D018570:Risk Assessment; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology