期刊
PEDIATRICS
卷 139, 期 5, 页码 -出版社
AMER ACAD PEDIATRICS
DOI: 10.1542/peds.2016-3011
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资金
- US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation [R18AE000029]
- Oregon Comparative Effectiveness Research K12 Program from the Agency for Healthcare Research and Quality [1K12HS019456]
- Medical Research Foundation of Oregon
- Physician Services Incorporated Foundation (of Ontario, Canada)
OBJECTIVES: To define hospital factors associated with proportion of time spent by pediatric residents in direct patient care. METHODS: We assessed 6222 hours of time-motion observations from a representative sample of 483 pediatric-resident physicians delivering inpatient care across 9 pediatric institutions. The primary outcome was percentage of direct patient care time (DPCT) during a single observation session (710 sessions). We used one-way analysis of variance to assess a significant difference in the mean percentage of DPCT between hospitals. We used the intraclass correlation coefficient analysis to determine within- versus between-hospital variations. We compared hospital characteristics of observation sessions with >= 12% DPCT to characteristics of sessions with <12% DPCT (12% is the DPCT in recent resident trainee time-motion studies). We conducted mixed-effects regression analysis to allow for clustering of sessions within hospitals and accounted for correlation of responses across hospital. RESULTS: Mean proportion of physician DPCT was 13.2% (SD = 8.6; range, 0.2%-49.5%). DPCT was significantly different between hospitals (P <.001). The intraclass correlation coefficient was 0.25, indicating more within-hospital than between-hospital variation. Observation sessions with >= 12% DPCT were more likely to occur at hospitals with Magnet designation (odds ratio [OR] = 3.45, P =.006), lower medical complexity (OR = 2.57, P =.04), and higher patient-to-trainee ratios (OR = 2.48, P =.05). CONCLUSIONS: On average, trainees spend <8 minutes per hour in DPCT. Variation exists in DPCT between hospitals. A less complex case mix, increased patient volume, and Magnet designation were independently associated with increased DPCT.
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