Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments

Abstract

The quality of care instrument demonstrated good internal consistency, moderate inter-rater reliability, high inter-rater agreement, and evidence supporting validity. The instrument could be useful for systems' assessment and research in evaluating the care delivered to children in the ED.

A Research Agenda to Advance Pediatric Emergency Care Through Enhanced Collaboration Across Emergency Departments

“…It is important to integrate these initiatives within the broader scope of emergency medicine care. The PECARN has developed and validated instruments to evaluate the quality of care delivery in pediatric care by using implicit review methods that can be used for diverse groups of patients . A recent study used this implicit review methods tool to look at patient‐level factors and the quality of care in 12 PECARN EDs and found that some chief complaint categories were associated with significantly lower than average quality of care, including fever (–0.65 points in quality, 95% CI = –1.24 to –0.06) and upper respiratory symptoms (–0.68 points in quality, 95% CI = –1.30 to –0.07) .…”

Regarding “Implicit Review Instrument to Evaluate Quality of Care Delivered by Physicians to Children in Emergency Departments”

“…For pediatric emergency medicine, and pediatric care in general, there is no one measure that truly captures the care delivered by hospitals in total. Broad-based measures, such as the one proposed by Marcin et al (2018), likely better summarize the overall care of health care provider without providing the details needed to implement quality improvement projects or identify dimensions of care for further evaluation and rootcause analyses. Narrow-based measures, while generally easier to implement and monitor, may only truly assess care delivery for the dimension that the measure assesses.…”

“…Compared with these measures, the implicit review tool developed by Marcin et al. () is much more complicated. For this project, the authors employed eight pediatric emergency medicine physicians to examine over 300 medical records each, each of whom spent 1 day in in‐person training and additional electronic meetings and chart review.…”

“…Within this framework, other groups have developed additional quality measures, such as the instrument developed by Marcin et al (2018) and the PECARN research network. Unlike most other quality measures, this study provides a thorough overview of the consistency, reliability, and validity of an implicit measure of overall emergency department care.…”

“…• Easy to classify • Easy to measure • High reliability and reproducibility • Face and construct validity • Present in sufficient numbers to minimize loss of statistical power to detect significant differences between health care providers and facilities • Adequate risk adjustment if necessary As stated above, most quality measures focus on outcome measures such as medical complications, infection rates, or readmission rates, which are easy to measure within an administrative dataset and thus available for health care organizations within that dataset. Compared with these measures, the implicit review tool developed by Marcin et al (2018) is much more complicated. For this project, the authors employed eight pediatric emergency medicine physicians to examine over 300 medical records each, each of whom spent 1 day in in-person training and additional electronic meetings and chart review.…”