Qureshi Erica, McKinley Kenneth, Park Justin, Ha Trang, McInnes Gord, Buren Yijinmide, Doan Quynh
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
BC Children's Hospital Research Institute, Vancouver, BC, Canada.
CJEM. 2025 Sep 13. doi: 10.1007/s43678-025-01001-5.
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.
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.
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.
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.
衡量儿科急诊科医生的工作量有助于优化人员配置、提高科室效率，并提供一个指标来评估旨在改善儿科急诊流程的干预措施。然而，目前尚无被广泛接受的医生工作量衡量方法。反映治疗患者感知复杂性的计费代码，可能作为医生工作量的替代指标。我们的目的是评估计费代码是否是儿科急诊科医生工作量的有效替代指标。
我们进行了一项健康记录审查，以确定计费代码是否与儿科急诊科医生工作的指标相关。提取了150例儿科急诊就诊的信息。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指定的计费代码与就诊复杂性指标以及儿科急诊科医生工作指标之间的关联。我们还进行了一项敏感性分析，考虑了计费审核员指定的计费代码。
儿科急诊科医生工作的三项指标与医生指定的计费代码增加独立相关：接收实验室检查（比值比5.6，95%置信区间2.2 - 15.4）、开具药物（比值比2.3，95%置信区间1.1 - 5.1）以及进行专科会诊（比值比4.4，95%置信区间1.6 - 12.5）。在调整就诊复杂性、年龄和性别后，我们未发现医生指定的计费代码与医生工作指标之间存在任何统计学上的显著关联。就诊 acuity（儿科CTAS 1 - 3）与计费代码增加相关（调整后比值比5.1，95%置信区间1.9 - 15.7）。这些结果在很大程度上与我们考虑计费审核员指定代码的敏感性分析一致。
总体而言，我们发现支持计费代码作为儿科急诊科医生工作量替代指标的内容效度的证据有限。这些结果，再加上跟踪医生工作量的潜在价值，凸显了开发一种专门考虑儿科急诊科医生工作量的有效且可靠衡量方法的必要性。
