We assess the stability of a measure of emergency department (ED) admission intensity for value-based care programs designed to reduce variation in ED admission rates. Measure stability is important to accurately assess admission rates across sites and among physicians. We sampled data from 358 EDs in 41 states (January 2018 to December 2021), separate from sites where the measure was derived. The measure is the ED admission rate per 100 ED visits for 16 clinical conditions and 535 included International Classification of Disease 10 diagnosis codes. We used descriptive plots and multilevel linear probability models to assess stability over time across EDs and among physicians. Across included 3,571 ED-quarters, the average admission rate was 27.6% (95% confidence interval [CI] 26.0% to 28.2%). The between-facility standard deviation was 9.7% (95% CI 9.0% to 10.6%), and the within-facility standard deviation was 3.0% (95% CI 2.95% to 3.10%), with an intraclass correlation coefficient of 0.91. At the physician-quarter level, the average admission rate was 28.3% (95% CI 28.0% to 28.5%) among 7,002 physicians. Relative to their site’s mean in each quarter, the between-physician standard deviation was 6.7% (95% CI 6.6% to 6.8%), and the within-physician standard deviation was 5.5% (95% CI 5.5% to 5.6%), with an intraclass correlation coefficient of 0.59. Moreover, 2.9% of physicians were high-admitting in 80%+ of their practice quarters relative to their peers in the same ED and in the same quarter, whereas 3.9% were low-admitting. The measure exhibits stability in characterizing ED-level admission rates and reliably identifies high- and low-admitting physicians.

中文翻译：

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急诊医生入院强度测量的可靠性

我们评估了旨在减少急诊科入院率变化的基于价值的护理计划的急诊科 (ED) 入院强度指标的稳定性。测量稳定性对于准确评估跨站点和医生之间的入院率非常重要。我们从 41 个州（2018 年 1 月至 2021 年 12 月）的 358 个 ED 中采样了数据，这些数据与得出该指标的站点分开。该指标是针对 16 种临床病症和 535 种包含国际疾病分类 10 诊断代码的每 100 次急诊就诊的急诊入院率。我们使用描述性图和多级线性概率模型来评估急诊科和医生之间随时间的稳定性。在 3,571 个 ED 季度中，平均入院率为 27.6%（95% 置信区间 [CI] 26.0% 至 28.2%）。机构间标准差为 9.7%（95% CI 9.0% 至 10.6%），机构内标准差为 3.0%（95% CI 2.95% 至 3.10%），组内相关系数为 0.91。在医师季度水平上，7,002 名医师的平均入院率为 28.3%（95% CI 28.0% 至 28.5%）。相对于每个季度的站点平均值，医生间标准差为 6.7%（95% CI 6.6% 至 6.8%），医生内标准差为 5.5%（95% CI 5.5% 至 5.6%），组内相关系数为 0.59。此外，与同一急诊室和同一​​季度的同行相比，2.9% 的医生在 80% 以上的执业季度中的入院率较高，而 3.9% 的医生入院率较低。该指标在描述 ED 级别入院率方面表现出稳定性，并可靠地识别高和低入院医生。