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Effect of health care system factors on test ordering
S J Scholer1, K Pituch, D P Orr
1Department of Pediatrics, Indiana University School of Medicine, the Regenstrief Institute for Health Care, Indianapolis, USA.
Insights
Healthcare system factors like location or provider experience minimally impact test ordering for pediatric acute abdominal pain. Female physicians were more likely to order tests for children with abdominal pain.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Clinical Decision Making
Background:
- Acute abdominal pain is a common pediatric complaint necessitating diagnostic evaluation.
- Understanding factors influencing diagnostic test ordering is crucial for efficient healthcare delivery.
- Previous research has not fully elucidated the impact of the healthcare environment on test ordering in pediatric acute abdominal pain.
Purpose of the Study:
- To investigate the influence of the emergency department (ED) environment and other health care system factors on diagnostic test ordering for children presenting with acute abdominal pain.
- To analyze the effect of encounter location, resident and student involvement, and faculty experience on test selection.
Main Methods:
- A retrospective review of 1140 pediatric encounter records for acute abdominal pain (<72 hours) was conducted.
- Data collected included encounter location (ED vs. clinic), provider type (student, resident, faculty), and specific tests ordered (throat culture, urinalysis, chest radiograph).
- Multiple logistic regression analysis controlled for initial patient signs and symptoms to assess the impact of healthcare system factors on test ordering.
Main Results:
- Encounter location (ED vs. clinic) did not significantly affect overall test ordering.
- Resident involvement and training level showed no impact on test ordering.
- Student involvement decreased urinalysis/urine culture orders, while experienced faculty (>10 years) decreased throat culture orders.
- Children seen by female physicians were more likely to have at least one test ordered (OR = 2.41).
Conclusions:
- Encounter location, resident involvement, student involvement, and faculty experience had minimal impact on diagnostic test ordering for pediatric acute abdominal pain.
- The sex of the physician was a notable factor influencing test ordering decisions.
- Further research is needed to explore physician-specific factors influencing diagnostic test utilization in pediatric acute abdominal pain.
Objective:
To determine the effect of the emergency department (ED) environment and other health care system factors on test ordering for children with acute abdominal pain.
Methods:
We reviewed the encounter records of 1140 consecutive children seen in either the pediatric clinic or ED of an inner-city teaching hospital with a complaint of acute abdominal pain (< 72 hours). In the ED and the clinic, patients were seen by medical students, pediatric residents, and general pediatric faculty members. Measured data on test ordering included the number of tests ordered and the type of tests ordered; specifically examined were the throat culture, urinalysis or urine culture, and chest radiograph. Measured health care system factors included (1) encounter location; (2) resident involvement and level of training; (3) student involvement; and (4) faculty member's years of experience and sex.
Results:
Of the 1140 children, 117 (10.2%) were seen in the ED, 531 (47.1%) were seen by a resident, 344 (30.2%) were seen by a medical student, and 195 (17.1%) were seen by a faculty member with more than 10 years of clinical pediatric experience. After controlling for initial signs and symptoms in multiple logistic regression, a child treated in the ED was no more likely to have had tests ordered than one who was treated in the clinic. Neither resident involvement nor resident training level affected test ordering. Except for decreasing the likelihood of having a urinalysis or urine culture ordered (odds ratio [OR] = 0.30; 95% confidence interval [CI], 0.15-0.63), student involvement did not affect test ordering. Also, except for decreasing the likelihood of having a throat culture ordered (OR = 0.45; 95% CI, 0.25-0.83), being seen by a pediatrician with more than 10 years of experience did not affect test ordering. Children seen by female physicians were more likely (OR = 2.41; 95% CI, 1.57-3.70) to have at least 1 test ordered.
Conclusions:
For children seen for a complaint of acute abdominal pain, we found little evidence that test ordering is affected by encounter location, resident involvement, student involvement, or faculty member experience.