Pregnancy testing in women of reproductive age in US emergency departments, 2002 to 2006: assessment of a national quality measure
Document Type
Response or Comment
Publication Date
5-2010
Journal
Annals of Emergency Medicine
Volume
Volume 55, Issue 5
Inclusive Pages
449-457
Keywords
Emergency Medical Services--statistics & numerical data; Pregnancy Tests--statistics & numerical data; Emergent Care; Women's Health; Quality improvement
Abstract
STUDY OBJECTIVE:
We assess performance and explore definitions for a new emergency department (ED) quality measure: the proportion of women aged 14 to 50 years who have abdominal pain and receive pregnancy testing (aimed at detecting ectopic pregnancy).
METHODS:
We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) (2002 to 2006) to test trends and predictors of the new measure, using both restrictive and broad definitions from the International Classification of Diseases, Ninth Revision (ICD-9) and reason-for-visit codes, and determine the proportion of women with ectopic pregnancy who had undergone pregnancy testing. For comparison, we conducted a detailed chart review in 4 US hospitals among patients who visited the ED in 2006.
RESULTS:
Using a broad ICD-9 definition for inclusion in NHAMCS, 2.13 million women aged 14 to 50 years with abdominal pain visited an ED annually between 2002 and 2006. Of those, 33.0% (95% confidence interval [CI] 30.5% to 35.5%) received pregnancy testing. Testing rates were materially stable, regardless of the definition used (broad or restrictive ICD-9 or reason-for-visit code). Among women with an ICD-9 diagnosis of ectopic pregnancy, 55.6% (95% CI 43.7% to 67.6%) had a documented pregnancy test. In the chart review, among 200 women aged 14 to 50 years and with abdominal pain, 89.4% (95% CI 85.0% to 94.0%) were eligible for the measure; of those, 93.9% (95% CI 90.3% to 97.4%) received testing.
CONCLUSION:
Analysis of national ED survey data demonstrated a large performance gap for a new pregnancy testing quality measure, whereas focused chart review at 4 sites showed a smaller gap. Given these discrepancies, additional study is recommended before the widespread implementation of the pregnancy testing measure as an assessment of ED performance.
APA Citation
Schuur, D., Tibbetts, S.A., Pines, J.M. (2010). Pregnancy testing in women of reproductive age in US emergency departments, 2002 to 2006: assessment of a national quality measure. Annals of Emergency Medicine, 55(5), 449-457.
Peer Reviewed
1
Comments
Comment in
Annals of Emergency Medicine Journal Club. The NHAMCS database, chart review methods, and more on regression modeling answers to the May 2010 journal club questions. [Ann Emerg Med. 2010]
Journal Club: The NHAMCS database, chart review methods, and more on regression modeling. [Ann Emerg Med. 2010]