CJEM最新文献

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.

Objectives: Mobile health interventions can enhance post-emergency department (ED) care by improving care transitions and optimizing patient follow-up, yet their utility remains underexplored. Our objective was to review mobile health discharge interventions from the ED and to characterize these interventions by technology types, patient and clinical populations studied, and outcomes assessed.

Methods: We performed a scoping review of mobile health interventions supporting post-ED care following Joanna Briggs Institute and PRISMA Extension for Scoping Reviews guidelines. Four databases (Medline, Embase, Cochrane Central and Systematic Reviews) were searched for studies in English from 2007 to 2024. Included studies were mobile health interventions administered within ED settings focused on the clinical encounter. Abstract and full-text screening were performed by two independent reviewers. Data were charted by technology type, intended clinical use, and outcomes.

Results: Of 4,313 records identified, 43 studies were included. Most articles were published between 2021 and 2024 (28, 65%), were pilot studies (18, 42%) and in single academic site with adult patients. Technologies included text messaging (18, 42%), remote patient monitoring (16, 37%), and mobile phone applications (9, 21%). Common conditions studied included respiratory disease (12, 28%), general post-ED care across all presenting complaints (8, 19%), and infectious disease (6, 14%). Among primary outcomes, health systems outcomes were frequently assessed (18, 42%), followed by feasibility (13, 30%) and clinical outcomes (10, 23%). Across all outcomes, most studies reported improved outpatient follow-up adherence (78%, 7/9) and clinical disease states (54%, 6/11). ED revisit rates varied in the 17 studies that reported it (41% [7] no change, 29% [5] reduced, 29% [5] no comparator group).

Conclusions: Mobile health interventions have been introduced to support post-ED care with emerging, yet limited evidence of their impact on ED revisit rates, follow-up care, and enhanced clinical outcomes.

Objective: To assess inequalities in emergency department utilization during the perinatal period across socioeconomic and rural-urban gradients in Alberta, Canada.

Methods: We conducted a secondary analysis of a population-based cohort study of live-birth pregnancies in Alberta between 2011 and 2017. Emergency department visits during pregnancy and up to 1-year postpartum were analyzed. Socioeconomic position was assessed using 25 combined groups derived from quintiles of material and social deprivation. Rural-urban residence was categorized into seven geographic groups based on Alberta Health Services' classification. Concentration indexes quantified inequalities in emergency department utilization, categorized as low (≤ 0.05), medium (0.06-0.19), or high (≥ 0.20). Multilevel negative binomial regression models estimated adjusted rate ratios and 95% confidence intervals to measure differences in emergency department visit rates across socioeconomic and rural-urban groups, accounting for individual-level covariates.

Results: Among 242,514 pregnancies, 366,241 emergency department visits were identified. Moderate inequality was observed across socioeconomic groups (concentration index = - 0.17, 95% confidence interval - 0.18 to - 0.16). Rates of emergency department visits were 1.7 times higher among the most deprived groups compared to the least deprived groups (adjusted rate ratio = 1.7; 95% confidence interval 1.6 to 1.8). Inequality across the rural-urban continuum was more pronounced (concentration index of - 0.31 (95% confidence interval - 0.32 to - 0.30), with rural residents experiencing significantly higher emergency department use. Compared to metropolitan areas, emergency department visits were nearly three times higher in rural centers (adjusted rate ratio = 2.9; 95% confidence interval 2.8 to 3.0) and near six times higher in rural remote areas (adjusted rate ratio = 5.5; 95% confidence interval 5.3 to 5.7).

Conclusion: Significant inequalities in perinatal emergency department utilization are evident across both socioeconomic and urban-rural gradients. These findings highlight the need for targeted health-system interventions to improve access to appropriate, continuous perinatal care among disadvantaged and rural populations.

Objectives/background: Women are underrepresented in prestigious authorship positions. As per the Canadian Medical Association (CMA), 31.3% of emergency department (ED) physicians identify as women or female. This is the first study to explore whether the corresponding gender/sex proportion of ED physicians in Canada each year is reflected in prestigious authorship in the Canadian Journal of Emergency Medicine (CJEM) between 2000 and 2019.

Methods: A cross-sectional analysis was conducted of the first and last authors of original research articles in the CJEM from 2000 to 2019. Our data collection yielded 623 original research articles. Descriptive statistical techniques were used to analyze authorship in the CJEM and the proportion of women/female emergency physicians in Canada over the twenty-year period.

Results: Of 623 total articles, 64.7% have a man as the first author and 35.3% have a woman as the first author. Of 546 articles with three or more authors, 72.0% have a man as the last author and 28.0% have a woman as the last author. There are several years where the proportion of women in first or last authorship is lower than the proportion of women/females in emergency medicine.

Conclusions: Our study shows that the proportion of women in prestigious authorship positions in the CJEM exceeds the proportion of women/female ED physicians in Canada between the years of 2000 and 2019. As the proportion of women/females has increased in emergency medicine, the proportion of women with prestigious authorship positions has also increased in the CJEM. This suggests that emergency medicine in Canada may be a welcoming field for women who want to publish research at a prestigious level and practice medicine.