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Published on: March 12, 2020
Physician risk attitudes and hospitalization of infants with bronchiolitis
Ronald L Baldwin1, Jerril W Green, Jennifer L Shaw
1Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, 800 Marshall Street, Little Rock, AR 72202, USA. robbinsjamesm@uams.edu
Insights
Pediatric emergency physician risk attitudes did not influence infant bronchiolitis admission rates. Physician intolerance for uncertainty does not explain rising admissions for this common pediatric condition.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Management
Background:
- Rising per-capita admissions for infant bronchiolitis present a healthcare challenge.
- Understanding factors influencing inpatient admission decisions is crucial for optimizing pediatric care.
Purpose of the Study:
- To investigate the relationship between pediatric emergency physicians' risk attitudes and infant bronchiolitis admission likelihood.
- To determine if physician risk aversion or discomfort with uncertainty impacts decisions for otherwise healthy infants.
Main Methods:
- Assessed risk aversion and diagnostic uncertainty in 46 pediatric emergency physicians.
- Analyzed admission rates for 397 infants (0-12 months) with bronchiolitis, controlling for illness severity.
- Compared risk attitude scores across physician demographics and experience levels.
Main Results:
- Physician risk attitudes were not associated with infant bronchiolitis admission rates, even after adjusting for illness severity.
- Risk aversion scores were higher in physicians with 15+ years of experience.
- No significant differences in risk aversion or uncertainty scores were found based on physician gender or fellowship training.
Conclusions:
- Physician intolerance for diagnostic uncertainty does not account for increased bronchiolitis admissions.
- Physician risk attitudes may play a role in admissions for other pediatric conditions with uncertain prognoses.
- Further research is needed to explore physician decision-making in pediatric hospital admissions.
Objectives:
To determine whether the risk attitudes of pediatric emergency physicians are related to the likelihood that otherwise healthy infants with bronchiolitis will be admitted for inpatient care.
Methods:
Risk aversion and discomfort with diagnostic uncertainty were assessed among 46 pediatric emergency physicians from three hospitals participating in the Child Health Accountability Initiative. Study physicians managed 397 otherwise healthy infants ages 0 to 12 months presenting to their hospital emergency departments with bronchiolitis. Mean risk aversion and discomfort with diagnostic uncertainty scores were compared across physician gender, years of experience, and formal training in emergency medicine. Additional analyses based on infants as the analytic unit determined admission rates of physicians scoring high and low on risk attitude measures. This model was controlled for severity of illness.
Results:
Scores on measures of risk aversion and discomfort with uncertainty were similar for male and female physicians and for physicians who had completed pediatric emergency medicine fellowship training and those without such training. Risk aversion scores were significantly higher for physicians with 15 or more years of experience. Admission rates for infants with bronchiolitis were no higher among physicians scoring above the median on risk attitude measures. When adjusted for severity of illness, physicians' risk attitudes were not associated with admission rates.
Conclusions:
Recent growth in per-capita admissions for bronchiolitis is not accounted for by physician intolerance for diagnostic uncertainty. Physician risk attitudes should be considered in the context of hospital admissions for other pediatric conditions with unclear prognoses.
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