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Identifying Nonprovider Factors Affecting Pediatric Emergency Medicine Provider Efficiency
Fareed Saleh1,2, Kristen Breslin1,2, Paul C Mullan3
1From the Emergency Medicine, Children's National Health System.
Pediatric Emergency Care
|November 3, 2017
Summary
Provider efficiency in pediatric emergency departments is influenced by non-provider factors like procedures, season, and shift times. These variables should inform productivity-based incentive designs.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Healthcare Management
Background:
- Provider productivity in pediatric emergency departments (EDs) is crucial for operational efficiency.
- Standardized relative value units (SRVUs) are commonly used to measure physician productivity.
- Factors beyond provider skill can significantly impact measured efficiency.
Purpose of the Study:
- To develop a multivariable model predicting SRVU per hour by accounting for non-provider variables.
- To identify key factors influencing efficiency in pediatric emergency medicine.
Main Methods:
- Utilized billing records for evaluation and management visits and procedures from 16 pediatric emergency medicine providers.
- Employed multivariable linear regression to analyze 2998 eligible shifts over 3 years in an urban academic ED.
- Adjusted for shift and site characteristics (tertiary vs. satellite) to model provider efficiency.
Main Results:
- A combined model identified number of procedures, season, shift start time, and day of week as influencing factors.
- Separate models showed improved explanatory power: academic ED (23% variance) and satellite ED (45% variance).
- Key predictors included procedures billed, shift start time, season, and patient arrivals per hour (satellite site).
Conclusions:
- Non-provider factors demonstrably affect provider efficiency in pediatric EDs.
- These identified factors are essential considerations for designing fair and effective productivity-based incentive systems.
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