10:46pm Monday 11 December 2017

Pregnancy Testing as a Quality Indicator in Emergency Departments May not Improve Care

The National Quality Forum, the organization that approves health care quality measures, recently approved pregnancy testing in female patients with abdominal pain as a new quality measure for EDs.  Researchers at Brigham and Women’s Hospital (BWH) found conflicting results regarding adherence to the pregnancy testing protocol when looking at a national database of ED records compared to individual chart reviews. The research demonstrates the difficulties and potential disadvantages of using national databases to develop and measure quality indicators. This research is published online and in an upcoming issue of Annals of Emergency Medicine.

With the National Quality Forum’s approval of the pregnancy testing quality measure, government programs such as Medicare and private insurers may now call for adherence to this testing standard as a quality indicator for EDs.  Therefore, researchers identified a need to determine the testing standard’s current success in EDs. “There is little to no data to demonstrate how well EDs are adhering to this protocol,” says lead study author Jeremiah Schuur, MD, MHS, of the Department of Emergency Medicine at BWH. “Determining this and whether administrative data surveys would provide an accurate measurement are crucial steps before successfully instituting this as a quality indicator.”

Using data from the Center for Disease Control’s National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2002 to 2006, researchers looked at women 14 to 50 years of age who reported abdominal pain as their reason for visiting the ED. The data came from over 180,000 patient records at more than 400 hospital EDs, weighed to represent the 568 million ED visits in the US during this time. Researchers also conducted chart reviews at four hospital EDs in the US. In each hospital, fifty charts were randomly selected from all women aged 14 to 50 years who visited the ED with abdominal pain as their chief complaint in 2006.

According to the data from NHAMCS, only about one third of the women who should have best tested were. However, in an explicit chart review at four hospitals, more than 90 percent of eligible women received a pregnancy test. “The major discrepancy in results creates a concern for using administrative data to determine the success an ED has with this protocol,” says Dr. Schuur. If the database results are accurate, then there is a serious quality gap in U.S. emergency care for women, but if the chart review data from these four hospitals is representative of nationwide performance, then there is little benefit to be gained from this new quality measure. “Before more than 4,500 U.S. emergency departments are required to collect data on pregnancy testing as a quality measure, an accurate estimate of current practice is needed,” says Dr. Schuur.

Other study authors included Jesse M. Pines, MD, MBA, MSCE of the Department of Emergency Medicine and the Leonard Davis Institute of Health Economics of the University of Pennsylvania, and Sarah A. Tibbetts, MD of North Shore Medical Center.


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