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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedAchola EM, Griffith KN, Wrenn JO
Injuries from legal interventions involving conducted energy devices.
This cross-sectional study evaluated emergency department (ED) visits for physical injuries from use of conducted energy devices (CEDs) such as TASERs by police departments. The authors evaluated sociodemographic and clinical characteristics of patients presenting with law enforcement-related CED injuries. They sampled US ED visits from the Nationwide Emergency Department Sample, which provided a 20% stratified sample of all EDs and weights to allow calculation of national representative estimates for all ED visits. They identified 1276 visits with the ICD-10 Y35.83X codes for CED injuries. Patients included 1186 males and 91 females with a mean age of 32.9 years residing in zip codes below the 50th percentile for median household income (67.5%). Most presented to teaching hospitals (70.8%) in metropolitan areas (86.1%) and were Asian or Pacific Islander (1.4%), Black (35.7%), Hispanic (17.6%), Native American (1.8%), White (39.2%), or other (4.3%) race and ethnicity. Among patients with serious injuries (70.8%), most (61.1%) were minor, 25.4% were moderate, 2.9% were severe, and 1.6% were critical injuries. The most common area of injury was extremities (36.9%), followed by chest (27.4%), head and neck (25.6%), abdomen (24.2%), and face (8.7%). Patients with lower income were more likely to receive serious, severe, or critical injuries, but these differences were not statistically significant.
AHRQ-funded; HS026395.
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Citation: Achola EM, Griffith KN, Wrenn JO .
Injuries from legal interventions involving conducted energy devices.
JAMA Intern Med 2024 Apr; 184(4):440-43. doi: 10.1001/jamainternmed.2023.8012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Injuries and Wounds, Emergency Department
Aghaei P, Bayramzadeh S
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
This study’s objective was to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space. The authors conducted a total of 21 focus group sessions with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA. Findings were analyzed and categorized into three parent themes: imaging equipment, assistive devices, and room features. The results suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. CT-scanners were not usually optimized for easy access to the TR. Other suggestions included the implementation of cameras and screens to accommodate situation awareness, and the rapid sharing of data such as imaging results. This study will inform health-care designers with the knowledge they need to make informed decisions when designing TRs. It covers key considerations such as room layout, equipment selection, lighting and controls.
AHRQ-funded; HS027261.
Citation: Aghaei P, Bayramzadeh S .
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
Facilities 2024 Mar 12. 2024/02/14..
Keywords: Workflow, Teams, Emergency Department, Trauma
Iantorno SE, Scaife JH, Bryce JR
Emergency department utilization for pediatric gastrostomy tubes across the United States.
This study investigated the number and nature of emergency department (ED) visits to community hospitals for pediatric gastrostomy tube complication. The authors used the 2019 Nationwide Emergency Department Sample to perform a retrospective cross-sectional analysis of pediatric patients (<18 y) with a primary diagnosis of gastrostomy tube complication. Their primary outcome was a potentially preventable ED visit, defined as an encounter that did not result in any imaging, procedures, or an inpatient admission. They observed 32,036 ED visits at 535 hospitals and 15,165 (47.3%) were potentially preventable. Median age was 2 years, and 17,707 (55%) were male. Compared to White patients, patients with higher odds of potentially preventable visits were Black and Hispanic. Patients with residential zip codes in the first, second, and third median household income quartiles had higher odds of potentially preventable visits compared to the highest.
AHRQ-funded; HS025776.
Citation: Iantorno SE, Scaife JH, Bryce JR .
Emergency department utilization for pediatric gastrostomy tubes across the United States.
J Surg Res 2024 Mar; 295:820-26. doi: 10.1016/j.jss.2023.11.028.
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Healthcare Utilization, Surgery, Adverse Events
Bui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Wust KL, Carayon P, Werner NE
Older adult patients and care partners as knowledge brokers in fragmented health care.
This study explores the knowledge broker roles of older adult patients and their care partners during emergency department (ED) visits. The research concludes that patients and care partners serve as information liaisons between fragmented care systems, providing details on diagnostic testing, medications, health history, and care accommodations. They engage in proactive and reactive knowledge brokering within and across ED work systems, aiding in communication and care coordination to mitigate healthcare fragmentation.
AHRQ-funded; HS026624.
Citation: Wust KL, Carayon P, Werner NE .
Older adult patients and care partners as knowledge brokers in fragmented health care.
Hum Factors 2024 Mar; 66(3):701-13. doi: 10.1177/00187208221092847.
Keywords: Elderly, Emergency Department, Caregiving, Clinician-Patient Communication, Communication
Salwei ME, Hoonakker P, Carayon P
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
A human-centered design process was followed to assess the usability and adoption of human factors (HF)-based clinical decision support (CDS) in the emergency department (ED). A CDS was developed to aid in pulmonary embolism (PE) diagnosis, showing high usability in testing. However, despite positive perceptions, actual CDS usage remained low due to integration issues with clinician workflow. The findings highlight the need for ongoing refinement of CDS design to align with clinical workflows and enhance usability.
AHRQ-funded; HS026395; HS024558; HS022086. NIH 142099
Citation: Salwei ME, Hoonakker P, Carayon P .
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
Hum Factors 2024 Mar; 66(3):647-57. doi: 10.1177/00187208221078625.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Emergency Department, Implementation
Patel MD, Lin P, Cheng Q
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
The purpose of this multi-site retrospective study was to assess differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, factoring in age, clinical factors, and ED operating conditions. The study assessed differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. For the study outcome, ESI levels were grouped into three categories: 1-2 (highest acuity), 3, and 4-5 (lowest acuity). The researchers analyzed patient-level data from three EDs affiliated with a large Southeastern United States health system. The study found 186,840 eligible ED visits with 56,417 from an academic ED, 69,698 from a metropolitan community ED, and 60,725 from a rural community ED. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females had a lower likelihood of being assigned ESI 1-2 compared to White males although both groups were roughly comparable in the assignment of ESI 4-5. Non-White and Hispanic females were generally least likely to be assigned ESI 1-2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant.
AHRQ-funded; HS029078.
Citation: Patel MD, Lin P, Cheng Q .
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
Am J Emerg Med 2024 Feb; 76:29-35. doi: 10.1016/j.ajem.2023.11.008..
Keywords: Emergency Department, Disparities, Racial and Ethnic Minorities
Gyftopoulos S, Simon E, Swartz JL
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
The objective of this study was to evaluate the efficacy of a multimodal intervention to reduce overutilization of computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism in the emergency department. Results indicated that guideline concordance increased significantly after intervention. The authors concluded that their success in increasing guideline concordance demonstrated the efficacy of a mixed-methods, human-centered approach to behavior change; however, given that neither of the secondary outcomes improved, the results may demonstrate potential limitations to the guidelines directing the ordering of CTPA studies.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Simon E, Swartz JL .
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
J Am Coll Radiol 2024 Feb; 21(2):309-18. doi: 10.1016/j.jacr.2023.02.033.
Keywords: Emergency Department, Respiratory Conditions, Imaging, Diagnostic Safety and Quality, Blood Clots
Khalaf N, Ali B, Liu Y
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
This study evaluated the association between pancreatic emergency presentation (EP) and cancer stage, treatment, and survival. The authors conducted a retrospective cohort study among patients with pancreatic adenocarcinoma diagnosed from 2007 to 2019 at a tertiary-care Veterans Affairs medical center. They used electronic health records to identify EP cases, defined as a new pancreatic cancer diagnosis made within 30 days of an ED visit where cancer was suspected. Of 243 identified pancreatic cancer patients, 66.7% had EPs. Although there was no difference in stage by EP status, patients diagnosed through EPs were 72% less likely to receive cancer treatment compared to non-emergency presenters. Patients with EPs also had a 73% higher mortality risk. This difference in mortality remained statistically significant after adjusting for cancer stage and receipt of cancer treatment.
AHRQ-funded; HS029347; HS028595.
Citation: Khalaf N, Ali B, Liu Y .
Emergency presentations predict worse outcomes among patients with pancreatic cancer.
Dig Dis Sci 2024 Feb; 69(2):603-14. doi: 10.1007/s10620-023-08207-6.
Keywords: Cancer, Emergency Department, Outcomes
Haimovich AD, Shah MN, Southerland LT
Automating risk stratification for geriatric syndromes in the emergency department.
This study discussed using automated risk stratification to implement screening programs for geriatric syndromes in the emergency department (ED). This method would reduce significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. The authors defined the concept of automated risk stratification and screening using existing electronic health record (EHR) data. They discussed progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care; emphasizing the importance of linking automated screening with systems of healthcare delivery. They found that research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care, but should still be considered a potential solution.
AHRQ-funded; HS027735.
Citation: Haimovich AD, Shah MN, Southerland LT .
Automating risk stratification for geriatric syndromes in the emergency department.
J Am Geriatr Soc 2024 Jan; 72(1):258-67. doi: 10.1111/jgs.18594..
Keywords: Elderly, Emergency Department, Risk, Health Information Technology (HIT)
Jurlina A, Maul T, Hunsaker P
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
The purpose of this retrospective, cross-sectional study was to describe changes in bronchiolitis characteristics in pediatric emergency department patients in a community hospital during the COVID-19 pandemic. The researchers conducted the study with children with bronchiolitis aged 1 to 24 months during an ED visit between 2019 and 2021. The study found that bronchiolitis cases decreased by 75% from 2019 to 2020 and rose back to prepandemic levels by 2021. Radiographs, steroids, and bronchodilators decreased during the study period. Laboratory studies, viral testing, antibiotic use, and respiratory support were unchanged. The decrease in steroids and bronchodilators was related to a clinical pathway that discouraged their use. Respiratory support remained unchanged.
AHRQ-funded; HS026393.
Citation: Jurlina A, Maul T, Hunsaker P .
Changes in bronchiolitis characteristics during the COVID-19 pandemic: a description of pediatric emergency department visits in a community hospital, 2019-2021.
Clin Pediatr 2024 Jan; 63(1):73-79. doi: 10.1177/00099228231208941..
Keywords: COVID-19, Respiratory Conditions, Children/Adolescents, Emergency Department
Scaife JH, Bryce JR, Iantorno SE
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
The term “Undertriage” refers to the treatment of patients at facilities lacking in the equipment needed to treat the patient's injuries appropriately. The purpose of this retrospective cohort study was to assess the relationship between patient and hospital characteristics and secondary undertriage in children after major trauma. The researchers utilized the 2019 Nationwide Emergency Department Sample and included patients aged less than 18 years of age if they presented to a Level 3 or non-trauma center (NTC) and were diagnosed with a traumatic injury with an injury severity score of greater than 15 based on International Classification of Diseases 10 codes. The study found that of 6,572 weighted patients, 15% were undertriaged. Undertriage was significantly associated with older age, metropolitan location, and major abdominal injuries. After multivariable adjustment, secondary undertriage was significantly associated with patients aged 6-10 years of age compared to patients aged 15-17 years, penetrating injury, major chest injury, and presentation at a teaching hospital.
AHRQ-funded; HS025776.
Citation: Scaife JH, Bryce JR, Iantorno SE .
Secondary undertriage of pediatric trauma patients across the United States emergency departments.
J Surg Res 2024 Jan; 293:37-45. doi: 10.1016/j.jss.2023.07.054..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Injuries and Wounds
Hwang SW, Chambers C, Chiu S
A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance.
The researchers comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. They found that homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.
AHRQ-funded; HS014129.
Citation: Hwang SW, Chambers C, Chiu S .
A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance.
Am J Public Health 2013 Dec;103 Suppl 2:S294-301. doi: 10.2105/ajph.2013.301369..
Keywords: Healthcare Utilization, Social Determinants of Health, Emergency Department, Emergency Medical Services (EMS)
Shapiro JS, Johnson SA, Angiollilo J
Health information exchange improves identification of frequent emergency department users.
The goal of the project was to measure the incremental increase in the number of frequent ED users who were identified when data
from all EDs participating in an health information exchange were compared with site-specific data. When the researchers analyzed HIE-wide data instead of site-specific data, they identified 20.3 percent more frequent ED users and 16.0 percent more visits by them to the ED.
from all EDs participating in an health information exchange were compared with site-specific data. When the researchers analyzed HIE-wide data instead of site-specific data, they identified 20.3 percent more frequent ED users and 16.0 percent more visits by them to the ED.
AHRQ-funded; HS021261.
Citation: Shapiro JS, Johnson SA, Angiollilo J .
Health information exchange improves identification of frequent emergency department users.
Health Aff 2013 Dec;32(12):2193-8. doi: 10.1377/hlthaff.2013.0167..
Keywords: Data, Emergency Department, Healthcare Utilization, Health Information Exchange (HIE), Health Information Technology (HIT)
Chambers C, Chiu S, Katic M
High utilizers of emergency health services in a population-based cohort of homeless adults.
This study identified predictors of frequent emergency department (ED) use among a population-based sample of homeless adults in Toronto, Ontario. It found that among homeless adults with universal health insurance, a small subgroup accounted for the majority of visits to emergency services. Frequent use was driven by multiple predisposing, enabling, and need factors.
AHRQ-funded; HS014129.
Citation: Chambers C, Chiu S, Katic M .
High utilizers of emergency health services in a population-based cohort of homeless adults.
Am J Public Health 2013 Dec;103 Suppl 2:S302-10. doi: 10.2105/ajph.2013.301397..
Keywords: Emergency Department, Social Determinants of Health, Health Insurance, Healthcare Utilization
Gabayan GZ, Asch SM, Hsia RY
Factors associated with short-term bounce-back admissions after emergency department discharge.
The researchers describe the prevalence, characteristics, and predictors of 7-day bounce-back admissions after ED discharge in a cohort of California hospitals. They found that older white men and patients with a disposition of eloped or having left against medical advice especially at risk for a bounce-back admission. They also found that use of Medicaid or Medicare was associated with higher rates of bounce-back admission.
AHRQ-funded; HS018098.
Citation: Gabayan GZ, Asch SM, Hsia RY .
Factors associated with short-term bounce-back admissions after emergency department discharge.
Ann Emerg Med 2013 Aug;62(2):136-44.e1. doi: 10.1016/j.annemergmed.2013.01.017..
Keywords: Emergency Department, Hospital Discharge, Hospital Readmissions
Easter JS, Haukoos JS, Claud J
Traumatic intracranial injury in intoxicated patients with minor head trauma.
This study to estimate the prevalence of intracranial injury following minor head injury found that 8% of 225 intoxicated patients with minor head injury had clinically important injuries requiring either hospital admission or neurosurgical followup. Neither the Canadian CT Head Rule nor NEXUS criteria had adequate sensitivity to be used with these patients.
AHRQ-funded; HS019464; HS017526
Citation: Easter JS, Haukoos JS, Claud J .
Traumatic intracranial injury in intoxicated patients with minor head trauma.
Acad Emerg Med. 2013 Aug;20(8):753-60. doi: 10.1111/acem.12184..
Keywords: Emergency Department, Trauma, Brain Injury, Shared Decision Making
Shah MN, Morris D, Jones CM
A qualitative evaluation of a telemedicine-enhanced emergency care program for older adults.
The purpose of this study was to document the experiences of patients, their caregivers, healthcare personnel, and staff members with a program that provides telemedicine-enhanced emergency care to older adults residing in senior living communities (SLCs) and to delineate perceived barriers and facilitators. The authors concluded that telemedicine-enhanced emergency care is an acceptable method of providing emergency care to older adults in SLCs.
AHRQ-funded; HS018047.
Citation: Shah MN, Morris D, Jones CM .
A qualitative evaluation of a telemedicine-enhanced emergency care program for older adults.
J Am Geriatr Soc 2013 Apr;61(4):571-6. doi: 10.1111/jgs.12157..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Delivery, Long-Term Care
Pines JM, Mutter RL, Zocchi MS
AHRQ Author: Mutter RL
Variation in emergency department admission rates across the United States.
The authors investigated factors related to variation in hospital-level emergency department (ED) admission rates. Using HCUP data, they found that higher proportions of Medicare and uninsured patients, more inpatient beds, lower ED volumes, for-profit ownership, trauma center status, and higher hospital occupancy rates were associated with higher ED admission rates.
AHRQ-authored.
Citation: Pines JM, Mutter RL, Zocchi MS .
Variation in emergency department admission rates across the United States.
Med Care Res Rev 2013 Apr;70(2):218-31. doi: 10.1177/1077558712470565.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Health Insurance, Healthcare Cost and Utilization Project (HCUP), Hospitalization
Rubinson L, Mutter R, Viboud C
AHRQ Author: Mutter R
Impact of the fall 2009 influenza A(H1N1)pdm09 pandemic on US hospitals.
The authors investigated the impact of the 2009 influenza A(H1N1)pdm09 pandemic on US hospitals. They found that the fall 2009 pandemic period substantially impacted US hospitals, mostly through increased emergency department visits. Furhter, for a small proportion of hospitals that experienced a high surge in inpatient admissions, increased mortality from selected clinical conditions was associated with both prepandemic outcomes and surge, highlighting the linkage between daily hospital operations and disaster preparedness.
AHRQ-authored.
Citation: Rubinson L, Mutter R, Viboud C .
Impact of the fall 2009 influenza A(H1N1)pdm09 pandemic on US hospitals.
Med Care 2013 Mar;51(3):259-65. doi: 10.1097/MLR.0b013e31827da8ea.
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Keywords: Emergency Department, Emergency Preparedness, Healthcare Cost and Utilization Project (HCUP), Hospitals, Influenza