title: Impact of Physician Scorecards on Emergency Department Resource Use, Quality, and Efficiency.
abstract: OBJECTIVE
  Variability in practice patterns and resource use in the emergency department (ED) can affect costs without affecting outcomes. ED quality measures have not included resource use in relation to ED outcomes and efficiency. Our objectives were to develop a tool for comprehensive physician feedback on practice patterns relative to peers and to study its impact on resource use, quality, and efficiency.
  
  
  METHODS
  We evaluated condition-specific resource use (laboratory tests; imaging; antibiotics, intravenous fluids, and ondansetron; admission) by physicians at 2 tertiary pediatric EDs for 4 common conditions (fever, head injury, respiratory illness, gastroenteritis). Resources used, ED length of stay (efficiency measure), and 72-hour return to ED (return rate [RR]) (balancing measure) were reported on scorecards with boxplots showing physicians their practice relative to peers. Quarterly scorecards were distributed for baseline (preintervention, July 2009-August 2010) and postintervention (September 2010-December 2011). Preintervention, postintervention, and trend analyses were performed.
  
  
  RESULTS
  In 51 450 patient visits (24 834 preintervention, 26 616 postintervention) seen by 96 physicians, we observed reduced postintervention use of abdominal and pelvic and head computed tomography scans, chest radiographs, intravenous antibiotics, and ondansetron (P < .01 for all). Hospital admissions decreased from 7.4% to 6.7% (P = .002), length of stay from 112 to 108 minutes (P < .001), and RR from 2.2% to 2.0%. Trends for use of laboratory tests and intravenous antibiotics showed significant reduction (P < .001 and P < .05, respectively); admission trends increased, and trends for use of computed tomography scans and plain abdominal radiographs showed no change.
  
  
  CONCLUSIONS
  Physician feedback on practice patterns relative to peers results in reduction in resource use for several common ED conditions without adversely affecting ED efficiency or quality of care.
authors.affiliation: Department of Pediatrics and Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta, Atlanta, Georgia; and sjain@emory.edu.
authors.forename: Shabnam
authors.initials: S
authors.lastname: Jain
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, Georgia; and.
authors.forename: Gary
authors.initials: G
authors.lastname: Frank
authors.affiliation: Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Kelly
authors.initials: K
authors.lastname: McCormick
authors.affiliation: Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Baohua
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Brent A
authors.initials: BA
authors.lastname: Johnson
mesh_terms: D004636:Emergency Service, Hospital / Q000592:standards* / Q000639:trends; D006295:Health Resources / Q000592:standards* / Q000706:statistics & numerical data* / Q000639:trends; D006776:Hospitals, Pediatric / Q000592:standards / Q000639:trends; D006801:Humans; D017294:Ondansetron; D010343:Patient Admission / Q000592:standards / Q000639:trends; D010359:Patient Readmission / Q000592:standards / Q000639:trends; D010820:Physicians / Q000592:standards* / Q000639:trends; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends
chemical_list: D017294:Ondansetron