Peer review and feedback can modify pain treatment patterns for emergency department patients with fractures

Consecutive fracture patients presenting to an adult (AED) or pediatric trauma center (PED) or a community teaching hospital (CED) were reviewed for treatment. Physicians received individual and group feedback. Data were dichotomized by age, gender, race and insurance status. Logistic regression analysis modeled variables approaching statistical significance. A total of 1454 patients participated in the study. The aggregate initial treatment rate was 54%, with no subgroup differences. Significant improvements were seen in all sites/subgroups; the final aggregate treatment rate was 84% (P <.001). PED and CED patients were less likely to receive treatment than AED patients (odds ratios = 0.49,0.68). After feedback, whites were treated more often than were non-whites (84% vs 71%, P <.0001); CED alone did not show this pattern (odds ratios = AED 4.14, PED 2.67, CED 1.28). Patients at all sites received improved pain treatment in association with directed feedback. Race and treatment site were significant factors.