A new study reveals that emergency department physicians who more frequently admit patients to the hospital don’t achieve better survival outcomes, challenging assumptions about defensive medicine and hospitalization benefits.
Published in JAMA Internal Medicine | Estimated reading time: 4 minutes
When you visit an emergency department, your chance of being admitted to the hospital might depend more on which physician you see than on your medical condition. This finding emerges from an extensive study analyzing over 2.1 million emergency department visits across 105 facilities in the Veterans Affairs health system.
Researchers from UCLA and Abett found striking variations in how different physicians approach hospital admissions. Dr. Dan Ly, assistant professor of medicine at the David Geffen School of Medicine at UCLA, explains: “Physicians, just like professionals in other domains, differ in their abilities and decisions, which has consequences for how much care you might receive, including, in this case, your likelihood of being hospitalized.”
The study revealed that patients seeing physicians with high admission rates (90th percentile) were almost twice as likely to be hospitalized compared to those seeing physicians with low admission rates (10th percentile), despite having similar underlying health conditions. Notably, these increased admissions didn’t lead to improved outcomes – the 30-day mortality rates remained unchanged regardless of the physician’s tendency to admit patients.
Even more telling, patients admitted by high-admitting physicians were more likely to be discharged within 24 hours, suggesting many of these hospitalizations might have been unnecessary. The research team analyzed records from 2011 to 2019, focusing on three common complaints: chest pain, shortness of breath, and abdominal pain.
This research carries significant implications for healthcare costs and resource allocation, suggesting that more conservative admission practices might be equally effective for patient care. However, the study authors note their findings are primarily based on VA hospitals, whose patient population is predominantly male and may not represent the broader U.S. healthcare system.
Glossary
- Admission Propensity
- A physician’s tendency to admit patients to the hospital, measured as a percentage of their emergency department patients who are hospitalized.
- Mortality Rate
- The percentage of patients who die within a specified time period (in this study, measured at 30 days, 7 days, 14 days, 90 days, and one year).
- Elixhauser Comorbidity Index
- A method used to measure patients’ overall health status prior to their emergency department visit, though it doesn’t measure the severity of their presenting condition.
Test Your Knowledge
What percentage of emergency department visits in the study resulted in hospital admission?
41% of visits led to hospital admission.
How many emergency departments and physicians were included in the study?
The study included 105 emergency departments and 2,098 physicians.
What was the difference in admission rates between high-admitting (90th percentile) and low-admitting (10th percentile) physicians for chest pain cases?
High-admitting physicians admitted 56.6% of chest pain cases, while low-admitting physicians admitted 32.6% – a difference of 24.0 percentage points.
What evidence suggests some admissions might have been unnecessary?
Patients admitted by physicians with higher admission rates were more likely to be discharged within 24 hours (31.0% vs 24.8%), while showing no improvement in mortality rates compared to those treated by physicians with lower admission rates.
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