计费代码是否准确反映儿科急诊医生的工作量?横断面研究。

IF 2
CJEM Pub Date : 2025-09-13 DOI:10.1007/s43678-025-01001-5
Erica Qureshi, Kenneth McKinley, Justin Park, Trang Ha, Gord McInnes, Yijinmide Buren, Quynh Doan
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引用次数: 0

摘要

背景:测量儿科急诊科(ED)医生的工作量有助于优化人员配置,提高部门效率,并提供一个指标来评估旨在改善儿科急诊科流量的干预措施。然而,目前还没有公认的衡量医生工作量的方法。账单代码反映了治疗患者的感知复杂性,可以作为医生工作量的替代。我们的目的是评估计费代码是否可以有效地替代儿科急诊科医生的工作量。方法:我们进行了一项健康记录审查,以确定账单代码是否与儿科急诊科医生工作的措施相关。提取了150例儿科急诊科就诊信息。我们使用多变量有序逻辑回归模型来评估儿科急诊科医生分配的计费代码与就诊复杂性和儿科急诊科医生工作之间的关系。我们还完成了考虑账单审计员分配的账单代码的敏感性分析。结果:儿科急诊科医生工作的三个指标与医生分配的账单代码的增加独立相关:接收实验室(OR 5.6, 95% CI 2.2-15.4),订购药物(OR 2.3, 95% CI 1.1-5.1),以及进行专家咨询(OR 4.4, 95% CI 1.6-12.5)。在调整了就诊复杂性、年龄和性别后,我们没有发现医生分配的账单代码和医生工作测量之间有任何统计学上显著的关联。就诊视力(PaedsCTAS 1-3)与计费代码增加相关(aOR为5.1,95% CI为1.9-15.7)。考虑到账单审计员分配的代码,这些结果与我们的敏感性分析基本一致。结论:总的来说,我们发现有限的证据支持账单代码的内容有效性作为儿科急诊科医生工作量的替代。这些结果,再加上跟踪医生工作量的潜在价值,强调了开发一种有效可靠的测量方法的必要性,特别是考虑儿科急诊科医生的工作量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do billing codes accurately reflect pediatric emergency physician workload? A cross-sectional study.

Background: Measuring physician workload in the pediatric emergency department (ED) could help optimize staffing, improve department efficiency, and provide a metric to assess interventions aimed at improving pediatric ED flow. However, no accepted measure of physician workload exists. Billing codes, which reflect the perceived complexity of treating a patient, may serve as a surrogate for physician workload. Our objective was to evaluate whether billing codes are a valid surrogate for pediatric ED physician workload.

Methods: We conducted a health records review to determine if billing codes were associated with measures of pediatric ED physician work. Visit information was extracted for 150 pediatric ED visits. We used multivariable ordinal logistic regression models to assess the association between pediatric ED physician-assigned billing codes, with measures of visit complexity, and measures of pediatric ED physician work. We also completed a sensitivity analysis considering a billing auditors-assigned billing codes.

Results: Three measures of pediatric ED physician work were independently associated with increased physician-assigned billing codes: receiving labs (OR 5.6, 95% CI 2.2-15.4), ordering medications (OR 2.3, 95% CI 1.1-5.1), and having specialist consultation (OR 4.4, 95% CI 1.6-12.5). We did not find any statistically significant associations between physician-assigned billing codes and measures of physician work after adjusting for visit complexity, age, and sex. Visit acuity (PaedsCTAS 1-3) was associated with increased billing codes (aOR 5.1 95% CI 1.9-15.7). These results were largely consistent with our sensitivity analysis considering billing auditor-assigned codes.

Conclusions: Overall, we found limited evidence supporting the content validity of billing code as a surrogate of pediatric ED physician workload. These results, coupled with the potential value of tracking physician workload, highlight the necessity to develop a valid and reliable measure specifically considering pediatric ED physician workload.

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