Academic Journal
Pediatric Emergency Care Variation: Might Normothetic Data Undermine Adaptive Expertise?
| Τίτλος: | Pediatric Emergency Care Variation: Might Normothetic Data Undermine Adaptive Expertise? |
|---|---|
| Συγγραφείς: | Sartori LF; Division of Emergency Medicine, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, US., Watsjold BK; Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, US., Wu K; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, US., Quzack L; Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, US., Ilgen JS; Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, US., Zorc JJ; Division of Emergency Medicine, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, US., Varpio L; Division of Emergency Medicine, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, US. |
| Πηγή: | Perspectives on medical education [Perspect Med Educ] 2026 Sep 30; Vol. 15 (1), pp. 1028-1038. Date of Electronic Publication: 2026 Sep 30 (Print Publication: 2026). |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Ubiquity Press Country of Publication: Netherlands NLM ID: 101590643 Publication Model: eCollection Cited Medium: Internet ISSN: 2212-277X (Electronic) Linking ISSN: 22122761 NLM ISO Abbreviation: Perspect Med Educ Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2023- : [London] : Ubiquity Press Original Publication: [Houten] : Bohn Stafleu van Loghum |
| Ιατρικοί όροι (MeSH): | Asthma*/diagnosis , Asthma*/therapy , Pediatric Emergency Medicine*/standards , Pediatric Emergency Medicine*/statistics & numerical data , Practice Patterns, Physicians'*/standards , Practice Patterns, Physicians'*/statistics & numerical data , Symptom Assessment*/methods , Symptom Assessment*/statistics & numerical data , Clinical Competence*/standards , Clinical Competence*/statistics & numerical data, Qualitative Research ; Interviews as Topic ; Humans ; Male ; Female ; Child ; Adult ; Middle Aged |
| Περίληψη: | Purpose: Practice variation across physicians is commonly attributed to idiosyncratic tendencies. What factors contribute to physicians' practice variation in the disposition of children with asthma exacerbation? How do metrics demonstrating variation impact physicians and learners? Methods: In this social constructivist qualitative study, we interviewed 11 Pediatric Emergency Medicine attendings, purposively sampling across a spectrum of acute asthma exacerbation admission rates. Participants reflected on their recent care of patients with asthma, how they assess patients, and how they determine disposition. They were shown a de-identified funnel plot demonstrating disposition rates across the physician group and reflected on the 1) quality of the metric and 2) impact on practice. We used reflexive thematic analysis to describe patterns across the data that addressed the study's research questions. Results: Participants cited factors at the patient, caregiver, clinical care team, clinical environment, and personal practice levels that might result in variation. Participants framed the ability to weigh these sometimes competing factors as a reflection of patient-centered care. But when presented with a group-level data display, participants were surprised by the variation, valued seeing how they practiced compared to peers, and sometimes expressed a willingness to alter their practices to be "nearer the mean." Conclusions: Some variation in care may be driven by physician adaptive expertise, which is not fully captured through metric-driven nomothetic data. Though metrics are fundamental to understanding practice patterns, decontextualized aggregations of data may risk minimizing, or even framing as deviant, the expertise exercised by physicians when they weigh multiple factors in decision-making. (Copyright: © 2026 The Author(s).) |
| Competing Interests: | Lara Varpio was an associate editor for PoME from 2015–2023. All other authors have no competing interests. |
| References: | Hosp Pediatr. 2018 Jun;8(6):305-313. (PMID: 29764909) Fam Med. 2021 Jun 8;53(7):559-566. (PMID: 34101818) Acad Emerg Med. 2016 Feb;23(2):166-70. (PMID: 26766222) Pediatrics. 2002 Oct;110(4):e49. (PMID: 12359822) Acad Emerg Med. 2025 Aug;32(8):874-902. (PMID: 40095423) Thromb Res. 2017 Nov;159:52-57. (PMID: 28982030) Pediatrics. 2015 Sep;136(3):e670-9. (PMID: 26260722) Ann Emerg Med. 2021 Oct;78(4):474-483. (PMID: 34148659) Pediatr Blood Cancer. 2018 Jan;65(1):. (PMID: 28766843) Contemp Clin Trials. 2010 Sep;31(5):429-37. (PMID: 20478406) Pediatr Emerg Care. 2010 Dec;26(12):902-8. (PMID: 21088636) Pediatrics. 2013 Aug;132(2):245-52. (PMID: 23878045) Pediatrics. 2014 Sep;134(3):539-45. (PMID: 25113291) Ann Emerg Med. 2013 Jun;61(6):638-43. (PMID: 23415741) Pain Physician. 2022 Sep;25(6):E857-E862. (PMID: 36122269) Worldviews Evid Based Nurs. 2021 Jun;18(3):170-179. (PMID: 33512082) Can Fam Physician. 2021 May;67(5):321-322. (PMID: 33980620) Acad Med. 2020 Jul;95(7):989-994. (PMID: 31725464) J Neurooncol. 2025 Sep;174(3):765-777. (PMID: 40512280) West J Emerg Med. 2016 Sep;17(5):561-6. (PMID: 27625720) Hosp Pediatr. 2025 Nov 1;15(11):901-910. (PMID: 41062095) J Eval Clin Pract. 2018 Jun;24(3):674-677. (PMID: 29516651) Med Teach. 2021 Aug;43(8):865-867. (PMID: 34078230) JAMA Netw Open. 2021 Sep 1;4(9):e2125193. (PMID: 34546373) JAMA Intern Med. 2025 Feb 01;185(2):153-160. (PMID: 39714798) Pediatr Blood Cancer. 2020 Jun;67(6):e28140. (PMID: 32275120) Health Aff (Millwood). 2021 Feb;40(2):251-257. (PMID: 33523749) Pediatrics. 2013 Aug;132(2):237-44. (PMID: 23878049) J Public Health Manag Pract. 2022 Mar-Apr 01;28(2):E518-E524. (PMID: 34016911) Qual Health Res. 2016 Nov;26(13):1753-1760. (PMID: 26613970) |
| Entry Date(s): | Date Created: 20261002 Date Completed: 20261005 Latest Revision: 20261005 |
| Update Code: | 20261005 |
| PubMed Central ID: | PMC13629558 |
| DOI: | 10.5334/pme.2887 |
| PMID: | 42824811 |
| Βάση Δεδομένων: | MEDLINE |
καταχωρήστε σχόλιο πρώτοι!