The Presence of Outcome Bias in Emergency Physician Retrospective Judgments of the Quality of Care Malkeet Gupta, MD, MS, David L. Schriger, MD, MPH,

Slides:

Advertisements

Similar presentations

Young Woman With Abdominal Pain David Jones, MD Annals of Emergency Medicine Volume 64, Issue 4, (October 2014) DOI: /j.annemergmed

Advertisements

An Early Look at Performance on the Emergency Care Measures Included in Medicare's Hospital Inpatient Value-Based Purchasing Program Megan McHugh, PhD,

Colorado Cannabis Legalization and Its Effect on Emergency Care

The Impact of Screening, Brief Intervention, and Referral for Treatment on Emergency Department Patients' Alcohol Use Annals of Emergency Medicine

Woman With Abdominal Pain and Diarrhea

Annals of Emergency Medicine

Female With Right Lower Quadrant Abdominal Pain

Many Emergency Department Patients With Severe Sepsis and Septic Shock Do Not Meet Diagnostic Criteria Within 3 Hours of Arrival Julian Villar, MD, MPH,

Vulvar Lesions Annals of Emergency Medicine

Pacemaker Extrusion Annals of Emergency Medicine

No SIRS; Quick SOFA Instead

Alan E. Jones, MD, Michael A. Puskarich, MD

Isopropyl Alcohol Nasal Inhalation for Nausea in the Emergency Department: A Randomized Controlled Trial Kenneth Lee Beadle, DSc, MPAS, Antonia R. Helbling,

Amandeep Singh, MD, Harrison J. Alter, MS, MD, Amy Littlepage, MD

Insurance Status and Access to Urgent Primary Care Follow-up After an Emergency Department Visit in 2016 Shih-Chuan Chou, MD, MPH, Yanhong Deng, MPH,

Annals of Emergency Medicine

Validation of the Simplified Motor Score in the Out-of-Hospital Setting for the Prediction of Outcomes After Traumatic Brain Injury David O. Thompson,

Structured Clinical Decision Aids Are Seldom Compared With Subjective Physician Judgment, and Are Seldom Superior David L. Schriger, MD, MPH, Joshua.

Evidence Behind the 4-Hour Rule for Initiation of Antibiotic Therapy in Community- Acquired Pneumonia Kenneth T. Yu, MD, MBA, Peter C. Wyer, MD Annals.

Procedural Sedation: Is Two Better Than One?

Maria C. Raven, MD, MPH, Margot Kushel, MD, Michelle J

Managing Nontraumatic Acute Back Pain

Selective Use of Computed Tomography Compared With Routine Whole Body Imaging in Patients With Blunt Trauma Malkeet Gupta, MD, MS, David L. Schriger,

Infant Male With Blood-Colored Stools

Observers in the Medical Setting

Global Emergency Medicine Journal Club: Social Media Responses to the November 2013 Annals of Emergency Medicine Journal Club Ryan P. Radecki, MD, MS,

Michael A. LaMantia, MD, MPH, Frank C. Messina, MD, Cherri D

Measurement Under the Microscope: High Variability and Limited Construct Validity in Emergency Department Patient-Experience Scores Jesse M. Pines, MD,

The Role of Antibiotic Prophylaxis for Prevention of Infection in Patients With Simple Hand Lacerations Shahriar Zehtabchi, MD Annals of Emergency Medicine

Elderly Woman With a Cough

An Infant With Fever and Rash

Andrea W. Thorp, MD, David L. Schriger, MD, MPH

Sangeeta Lamba, MD, Tammie E. Quest, MD Annals of Emergency Medicine

Lee Cearnal Annals of Emergency Medicine

Does “Not Different” Equal “The Same”?

Female With Right Lower Quadrant Abdominal Pain

Levocetirizine and Prednisone Are Not Superior to Levocetirizine Alone for the Treatment of Acute Urticaria: A Randomized Double-Blind Clinical Trial

Emergency Ultrasound Guidelines

Emergency Physician Risk Estimates and Admission Decisions for Chest Pain: A Web- Based Scenario Study David L. Schriger, MD, MPH, Michael Menchine, MD,

William Fleischman, MD, Joseph S. Ross, MD, MHS, Edward R

What Do We Learn From an Equivalence Study Without Statistical Power?

Clinical Features From the History and Physical Examination That Predict the Presence or Absence of Pulmonary Embolism in Symptomatic Emergency Department.

Nupur Garg, MD, Michael Gottlieb, MD Annals of Emergency Medicine

Teenager With Scalp Mass

Measuring and Explaining Computed Tomography Use in the United States and Canada: A Consideration of Health Economics and Use Versus Appropriateness,

Longitudinal Trends in the Performance of Scientific Peer Reviewers

Emergency Department Planning and Resource Guidelines

Anthony Eidelman, MD, Jocelyn M. Weiss, MPH, Joseph Lau, MD, Daniel B

Young Woman With Abdominal Pain

Eric Berger Annals of Emergency Medicine

A Clinical Prediction Model to Estimate Risk for 30-Day Adverse Events in Emergency Department Patients With Symptomatic Atrial Fibrillation Tyler W.

Woman With Hip Pain Annals of Emergency Medicine

Steven M. Green, MD, Michael L. Callaham, MD

Analysis of Emergency Department Length of Stay for Mental Health Patients at Ten Massachusetts Emergency Departments Mark D. Pearlmutter, MD, Kristin.

CHA2DS2-VASc Scores and Major Bleeding in Patients With Nonvalvular Atrial Fibrillation Who Are Receiving Rivaroxaban W. Frank Peacock, MD, CAPT Sally.

Lack of Association Between Press Ganey Emergency Department Patient Satisfaction Scores and Emergency Department Administration of Analgesic Medications

Chad Kessler, MD, MHPE, Nathaniel L

Kuo-Chen Cheng, MD Annals of Emergency Medicine

Images in Emergency Medicine

Images in Emergency Medicine

Continuing Care for Patients Choosing the Emergency Department as a Site for Primary Care: Feasibility, Benefits, and EMTALA Considerations David L.

Woman With Unresponsiveness

Should Adults With Mild Head Injury Who Are Receiving Direct Oral Anticoagulants Undergo Computed Tomography Scanning? A Systematic Review Gordon W.

Lean Thinking in Emergency Departments: A Critical Review

Vulvar Lesions Annals of Emergency Medicine

Young Boy With Shedding Nails

Safety and Injury Profile of Conducted Electrical Weapons Used by Law Enforcement Officers Against Criminal Suspects William P. Bozeman, MD, William.

Global Emergency Medicine Journal Club: A Social Media Discussion About the Lack of Association Between Press Ganey Scores and Emergency Department Analgesia

D. Stevenson, T. Long, J.P. Green, J. Rose

Young Man with Foreign-Body Sensation in the Right Eye

Presentation transcript:

The Presence of Outcome Bias in Emergency Physician Retrospective Judgments of the Quality of Care Malkeet Gupta, MD, MS, David L. Schriger, MD, MPH, Jeffrey A. Tabas, MD Annals of Emergency Medicine Volume 57, Issue 4, Pages 323-328.e9 (April 2011) DOI: 10.1016/j.annemergmed.2010.10.004 Copyright © 2010 American College of Emergency Physicians Terms and Conditions

Figure 1 This stacked bar graph shows the qualitative ratings of quality of the process of care for each scenario, stratified by whether the patient's outcome was good (g), not stated (n), or bad (b). For each scenario, the percentage of better-quality scores decreases as one moves from good to bad outcomes. Annals of Emergency Medicine 2011 57, 323-328.e9DOI: (10.1016/j.annemergmed.2010.10.004) Copyright © 2010 American College of Emergency Physicians Terms and Conditions

Figure 2 This box plot shows the distribution of ratings of quality of the process of care for each scenario, stratified by whether the patient's outcome was good (g), not stated (n), or bad (b). Each box represents the 25th, 50th, and 75th percentile; the whiskers are the upper and lower adjacent values, and the dots are the outlying values. For each scenario, outcome bias exists as quality ratings increase from bad to neutral to good outcomes. Annals of Emergency Medicine 2011 57, 323-328.e9DOI: (10.1016/j.annemergmed.2010.10.004) Copyright © 2010 American College of Emergency Physicians Terms and Conditions

Figure 3 This scatterplot shows the difference in individual ratings for the below-average quality scenarios (good outcome–bad outcome, x axis) graphed against this difference for the good-quality scenarios (good outcome–bad outcome, y axis). Data from individuals prone to outcome bias should cluster in the upper right because they would rank the scenario with the good outcome more highly for each pair. If correlation were high, individuals' data would fall along the grey diagonal line. The black lines are locally weighted estimating equation (see text) regressions of x on y and y on x and show that knowledge of the difference for one pair tells us very little about the value of the difference for the other pair. Please see the video that accompanies this Figure online, available at http://www.annemergmed.com. Annals of Emergency Medicine 2011 57, 323-328.e9DOI: (10.1016/j.annemergmed.2010.10.004) Copyright © 2010 American College of Emergency Physicians Terms and Conditions

Figure E1 Randomization strategy for assignment of clinical scenario and outcome. Annals of Emergency Medicine 2011 57, 323-328.e9DOI: (10.1016/j.annemergmed.2010.10.004) Copyright © 2010 American College of Emergency Physicians Terms and Conditions

Figure E2 Example of on-screen slider for a scenario in which the participant picked “average” as qualitative descriptor. The slider (red bar) can be moved within the blue zone (26 to 74) to specify the rater's exact quality value. The numeric display shows its current value (34). The “blue zone” changes, depending on the qualitative descriptor selected. Annals of Emergency Medicine 2011 57, 323-328.e9DOI: (10.1016/j.annemergmed.2010.10.004) Copyright © 2010 American College of Emergency Physicians Terms and Conditions