Provider-level and Hospital-level Factors and Process Measures of Quality Care Delivered in Pediatric Emergency Departments

ABSTRACT Objective Differences in the quality of emergency department (ED) care are often attributed to non-clinical factors such as variations in the structure, systems and processes of care. Few studies have examined these associations among children. We aimed to determine whether process measures of quality of care delivered to patients receiving care in children's hospital EDs were associated with physician-level or hospital-level factors. Methods We included children ( Results Among the 620 ED encounters reviewed, we did not find process measures of quality to be associated with any physician-level factors such as physician sex, years since medical school graduation, or physician training. We found, however, that process measures of quality were positively associated with delivery at freestanding children's hospitals (1.96 points higher in quality compared to non-freestanding status, 95% CI: 0.49, 3.43) and negatively associated with higher annual ED patient volume (-0.03 points per thousand patients, 95% CI: -0.05, -0.01). Conclusion Process measures of quality of care delivered to children was higher among patients treated at freestanding children's hospitals but lower among patients treated at higher volume EDs.