Emergency Care Research: Solutions for the U.S. Heath Care System (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Robert W. Neumar, MD, Ph.D., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (680 KB; Plugin Software Help).

Slide 1

Emergency Care Research: Solutions for the U.S. Heath Care System

Robert W. Neumar, MD, PhD
Chair, Research Committee
American College of Emergency Physicians (ACEP)
September 8, 2008

Slide 2

Future of Emergency Care Series. Hospital-Based Emergency Care: At the Breaking Point

Committee on the Future of Emergency Care in the United States Health System
Institute of Medicine of the National Academies 2006
Advising the Nation. Improving Health.

Slide 3

Emergency Care Research AHRQ Mission

http://www.ahrq.gov/about/highlt07.htm

"The Agency for Healthcare Research and Quality (AHRQ) has a mission to improve the quality, safety, efficiency, effectiveness, and cost-effectiveness of health care for all Americans."

Slide 4

Emergency Care Research AHRQ Portfolio
http://www.ahrq.gov/about/highlt07.htm

• Comparative effectiveness.
• Patient safety/medical errors.
• Health care quality.
• Health information technology.
• Evidence-based medicine.
• Clinical practice.
• Outcomes of care and effectiveness.
• Primary care and care for priority populations.
• Organization and delivery of care and use of health care resources.
• Health care costs and financing.
• Health care system and public health preparedness

Slide 5

Emergency Care Research Problem or Solution?

An image of the ACEP Logo—a large square comprised of smaller blue squares minus one which is located in the upper right quadrant.

Slide 6

Emergency Care Research Problem or Solution?

A chart made up of 3 rows of 5 blue rectangles, with the exception of the middle rectangle which is white with "Emergency Department, 115,000,000". Both the 3 vertical, middle rectangles and the 5 horizontal, middle,rectangles are connected with a black line. The upper left hand rectangle and the lower left hand rectangle are joined by a black line running to the right of the rectangles. The middle rectangle in the last row on the right has a line coming out from both the top and bottom and running along the length of the middle, horizontal row until it connects to the line joining the upper and lower left hand rectangles.

Slide 7

Emergency Care Research Problem or Solution?

The previous slide's chart with a portion of the rectangles filled in.

• The first set of 3 vertical rectangles on the left read from top to bottom:
  • Residence or Public Setting
  • Ambulatory Care 1,000,000,000
  • Managed Care Facility
• The middle set of 3 vertical rectangles read from top to bottom:
  • Hospital Transfer 2,000,000
  • Emergency Department 115,000,000
  • Observation Unit 1,000,000
• The middle set of 5 horizontal rectangles read from left to right:
  • Ambulatory Care 1,000,000,000
  • Emergency Medical Services (EMS) System
  • Emergency Department 115,000,000
  • Hospital 14,000,000 (43% of total)
  • Rehab Facility

Notes:

• Centers for Disease Control and Prevention (CDC) Advanced Data No 386, 2007
• http://hcupnet.ahrq.gov/HCUPnet.jsp

Slide 8

Emergency Care Research Fundamental Questions

• In patients with [symptom] does EMS care compared to [alternative management] improve outcomes?
• In patients with [symptom] does emergency department care compared to [alternative management] improve outcomes?
• In emergency department patients with [symptom/diagnosis], does hospital admission compared to [alternative management] improve outcomes?

Slide 9

Emergency Care Research Hypothesis

"Rapid diagnosis and early intervention in acute illness or acutely decompensated chronic illness improves patient outcomes."

Notes:

• A large, red oval circles "Rapid diagnosis."

Slide 10

The document image shows an article entitled "National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary" from the CDC's Advance Data: From Vital and Health Statistics, Number 386, June 29, 2007.

Slide 11

The document image shows "Table 9. Emergency department visits principal reasons for visit: United States, 2005" from the CDC Advanced Data No 386, 2007. The page shows the results for "Number of Visits in Thousands" and "Percent Distribution" for the "Principal Reasons for Visit". "Stomach and abdominal pain, cramps, and spasms—7,833" and "Chest pain and related symptoms—5,812" are highlighted.

• 13,600,000 Emergency Department (ED) visits for abdominal or chest pain.

Slide 12

The document image shows "Table 11. ED Visits by Primary ED Diagnosis Groups: United States, 2005" from the CDC Advanced Data No 386, 2007.  The page shows the results for "Number of Visits in Thousands" and "Percent Distribution" for the "Primary Diagnosis Group". "Abdominal pain—4,628" and "Chest pain—4,438" are highlighted.

• 13,600,000 ED visits for abdominal or chest pain.
• 9,000,000 ED diagnosis abdominal or chest pain (66%).

Slide 13

The document image shows "Table 11. ED Visits by Hospital Discharge Diagnosis: United States, 2005" from the CDC Advanced Data No 386, 2007. The page shows the results for "Number of Visits in Thousands" and "Percent Distribution" for the "Principal Diagnosis Group and ICD-9-CM code(s)⊃1;". "Chest pain...786.5:  786" and "Abdominal pain...789.0:  186" are highlighted.

• 13,600,000 ED visits for abdominal or chest pain.
• 9,000,000 ED diagnosis abdominal or chest pain.
• 972,000 hospital discharge diagnosis abdominal or chest pain.

Slide 14

Emergency Care Research ACEP/SAEM Joint Research Task Force

"Clinical research that improves the accuracy, speed, safety, and cost-effectiveness of diagnosis in the emergency care setting has the potential to both improve outcomes and reduce resource utilization."

Slide 15

Emergency Care Research Undifferentiated Presentations

• Chest pain
• Dyspnea
• Abdominal pain
• Altered mental status
• Fever
• Headache
• Hypotension
• Shock
• Cardiac arrest

Slide 16

Emergency Care Research Challenges

• Undifferentiated presentations
• Unscheduled
• Multiple locations and providers
• Time sensitive diagnosis and treatment
• Consent
• Standardized data elements
• Interoperable data sets
• Investigator training infrastructure

Slide 17

Emergency Care Research Strengths

• 24/7/365 operation
• High acuity
• High volume
• Concentrated resources
• Patient access
• Integral part of health care system

Slide 18

Emergency Care Research AHRQ Portfolio

• Emergency Care Investigator Training:
  • Comparative effectiveness.
  • Patient safety/medical errors.
  • Health care quality.
  • Health information technology.
  • Evidence-based medicine.
  • Clinical practice.
  • Outcomes of care and effectiveness.
  • Primary care and care for priority populations.
  • Organization and delivery of care and use of health care resources.
  • Health care costs and financing.
  • Health care system and public health preparedness
  • http://www.ahrq.gov/about/highlt07.htm