National Healthcare Quality and Disparities Report
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- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Back Health and Pain (1)
- Behavioral Health (2)
- Children/Adolescents (4)
- Clinician-Patient Communication (1)
- Communication (1)
- Comparative Effectiveness (2)
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- Injuries and Wounds (3)
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- Medication (15)
- (-) Opioids (20)
- Outcomes (1)
- Pain (9)
- Patient-Centered Outcomes Research (2)
- Patient and Family Engagement (1)
- Patient Safety (1)
- Policy (1)
- Practice Patterns (9)
- Provider (1)
- Provider: Clinician (1)
- Provider: Pharmacist (1)
- Provider: Physician (1)
- Quality Improvement (1)
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- Racial and Ethnic Minorities (2)
- Sickle Cell Disease (1)
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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 DisplayedDecker S, Dworsky M, Gibson TB
AHRQ Author: Decker S
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
The authors leveraged ACA coverage expansions, including Medicaid expansion and Marketplaces, to study the impact of health insurance on opioid-related emergency department (ED) visits. They used ZIP-code–level ED utilization data from HCUP’s State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states. They found evidence of a dose-response relationship between pre-ACA uninsured and changes in ED visit rates in both expansion and non-expansion states: areas with higher uninsured rates prior to ACA saw larger reductions in opioid-related ED visits after the ACA took effect. The authors concluded that these findings suggest that increased insurance coverage may to help mitigate the opioid crisis.
AHRQ-authored.
Citation: Decker S, Dworsky M, Gibson TB .
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
American Journal of Health Economics 2023 Sum; 9(3):405–34..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Policy, Health Insurance, Emergency Department, Access to Care, Medicaid, Healthcare Utilization
Thakrar AP, Faude S, Perrone J
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
This study’s aim was to determine whether urine fentanyl concentration is associated with severity of opioid withdrawal. The study was conducted in 3 emergency departments in an urban, academic health system from January 1, 2020, to December 31, 2021. It included patients with opioid use disorder, detectable urine fentanyl or norfentanyl, and Clinical Opiate Withdrawal Scale (COWS) recorded within 6 hours of urine drug testing. Primary exposure measured was urine fentanyl concentration stratified as high (>400 ng/mL), medium (40-399 ng/mL), or low (<40 ng/mL). COWS was used to measure opioid withdrawal severity within 6 hours before or after urine specimen collection. A total of 1127 patients were included in the sample, with a mean age (SD) of 40.0 (10.7), 384 (34.1%) identified as female, 332 (29.5%) reported their race/ethnicity as non-Hispanic Black, and 658 (58.4%) reported their race/ethnicity as non-Hispanic White. For patients with high urine fentanyl concentrations, the adjusted mean COWS was 4.4 (3.9-4.8) compared with 5.5 (5.1-6.0) among those with medium and 7.7 (6.8-8.7) among those with low fentanyl concentrations.
AHRQ-funded; HS026372.
Citation: Thakrar AP, Faude S, Perrone J .
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
J Addict Med 2023 Jul-Aug; 17(4):447-53. doi: 10.1097/adm.0000000000001155..
Keywords: Opioids, Medication, Emergency Department, Substance Abuse
Meisel ZF, Shofer F, Dolan A
AHRQ Author: Rhodes KV
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
The purpose of this trial was to compare the effectiveness of three approaches for communicating opioid risk during an emergency department visit for a common painful condition. Participants were adult patients with kidney stone or musculoskeletal back pain, randomly assigned to one of three risk communication strategies: a personalized probabilistic risk visual aid, a visual aid and video narrative, or general risk information. Findings showed that an emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall.
AHRQ-authored.
Citation: Meisel ZF, Shofer F, Dolan A .
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
Am J Public Health 2022 Feb;112(S1):S45-s55. doi: 10.2105/ajph.2021.306511..
Keywords: Pain, Emergency Department, Education: Patient and Caregiver, Opioids, Comparative Effectiveness, Clinician-Patient Communication, Communication
Schoenfeld EM, Soares WE, Schaeffer EM
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Despite evidence demonstrating the safety and efficacy of buprenorphine for the treatment of emergency department (ED) patients with opioid use disorder (OUD), incorporation into clinical practice has been highly variable. In this study, the investigators explored barriers and facilitators to the prescription of buprenorphine, as perceived by practicing ED clinicians. The investigators concluded that while some participants were hesitant to adopt a "new" role in treating patients with medications for OUD, many already had.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Soares WE, Schaeffer EM .
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Acad Emerg Med 2022 Jan;29(1):28-40. doi: 10.1111/acem.14369..
Keywords: Emergency Department, Opioids, Medication, Substance Abuse, Behavioral Health
Serina PT, Lank PM, Kim HS
Perceptions of signs of addiction among opioid naive patients prescribed opioids in the emergency department.
Patient knowledge deficits related to opioid risks, including lack of knowledge regarding addiction, are well documented. The objective of this study was to characterize patients' perceptions of signs of addiction. The investigators concluded that signs of addiction identified by opioid naive patients were similar to concepts identified in medical definitions. However, participants' understanding also included misconceptions, omissions, and conflated misuse behaviors with signs of addiction.
AHRQ-funded; HS023459.
Citation: Serina PT, Lank PM, Kim HS .
Perceptions of signs of addiction among opioid naive patients prescribed opioids in the emergency department.
J Addict Med 2021 Nov-Dec;15(6):491-97. doi: 10.1097/adm.0000000000000806..
Keywords: Opioids, Substance Abuse, Emergency Department
Goyal MK, Drendel AL, Chamberlain JM
Racial/ethnic differences in ED opioid prescriptions for long bone fractures: trends over time.
The purpose of this study was to investigate whether racial and/or ethnic differences in provision of outpatient opioid prescriptions for children discharged from the ED with long bone fractures have decreased over time. Findings showed that, as provision of opioid prescriptions declined over time, previously marked racial and/or ethnic disparities in opioid
prescription rates at ED discharge decreased.
prescription rates at ED discharge decreased.
AHRQ-funded; HS020270.
Citation: Goyal MK, Drendel AL, Chamberlain JM .
Racial/ethnic differences in ED opioid prescriptions for long bone fractures: trends over time.
Pediatrics 2021 Nov;148(5):e2021052481. doi: 10.1542/peds.2021-052481..
Keywords: Children/Adolescents, Opioids, Emergency Department, Racial and Ethnic Minorities, Injuries and Wounds, Pain, Medication
Worsham CM, Woo J, Jena AB
Adverse events and emergency department opioid prescriptions in adolescents.
Understanding the risks associated with opioid prescription in adolescents is critical for informing opioid policy, but the risks are challenging to quantify given the lack of randomized trial data. Using a regression discontinuity design, the investigators exploited a discontinuous increase in opioid prescribing in the emergency department (ED) when adolescents transitioned from "child" to "adult" at age eighteen to estimate the effect of an ED opioid prescription on subsequent opioid-related adverse events.
AHRQ-funded; HS026753.
Citation: Worsham CM, Woo J, Jena AB .
Adverse events and emergency department opioid prescriptions in adolescents.
Health Aff 2021 Jun;40(6):970-78. doi: 10.1377/hlthaff.2020.01762..
Keywords: Children/Adolescents, Emergency Department, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Practice Patterns
McCarthy DM, Kim HS, Hur SI
Patient-reported opioid pill consumption after an ed visit: how many pills are people using?
This study examined opioid use patterns after an emergency department (ED) visit. The study was conducted at an urban academic emergency department and included patients 18 years or older, not chemically using opioids, and had been newly prescribed hydrocodone-acetaminophen. They were asked to complete and return a 10-day medication diary. Two-hundred sixty patients returned completed medication diaries that included treatment for different conditions. The mean age was 45 years and 59% of the sample was female. The median number of pills prescribed was 12. Patients with renal colic used the least number of pills and patients with back pain used the most. Almost all (92.5%) of patients had leftover pills by the end of the 10 days.
AHRQ-funded; HS023459.
Citation: McCarthy DM, Kim HS, Hur SI .
Patient-reported opioid pill consumption after an ed visit: how many pills are people using?
Pain Med 2021 Feb 23;22(2):292-302. doi: 10.1093/pm/pnaa048..
Keywords: Opioids, Medication, Emergency Department, Practice Patterns, Pain
Wentz AE, Wang RRC, Marshall BDL
Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis.
Previous research has suggested caution about opioid analgesic usage in the emergency department (ED) setting and raised concerns about variations in prescription opioid analgesic usage, both across institutions and for whom they are prescribed. In this study, the investigators examined opioid analgesic usage in ED patients with suspected urolithiasis across fifteen participating hospitals. They found marked hospital-level differences in opioid analgesic administration and prescribing, as well as associations with education, healthcare insurance, and race/ethnicity groups.
AHRQ-funded; HS019312.
Citation: Wentz AE, Wang RRC, Marshall BDL .
Variation in opioid analgesia administration and discharge prescribing for emergency department patients with suspected urolithiasis.
Am J Emerg Med 2020 Oct;38(10):2119-24. doi: 10.1016/j.ajem.2020.07.016..
Keywords: Opioids, Medication, Emergency Department, Practice Patterns, Hospital Discharge
Drendel AL, Brousseau DC, Casper TC
Opioid prescription patterns at emergency department discharge for children with fractures.
The authors sought to measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture. They found that, for children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain.
AHRQ-funded; HS020270.
Citation: Drendel AL, Brousseau DC, Casper TC .
Opioid prescription patterns at emergency department discharge for children with fractures.
Pain Med 2020 Sep;21(9):1947-54. doi: 10.1093/pm/pnz348..
Keywords: Children/Adolescents, Opioids, Medication, Emergency Department, Injuries and Wounds, Practice Patterns
Goyal MK, Johnson TJ, Chamberlain JM
Racial and ethnic differences in emergency department pain management of children with fractures.
Researchers tested the hypotheses that minority children with long-bone fractures are less likely to receive analgesics, to receive opioid analgesics, and to achieve pain reduction. Using data from the Pediatric Emergency Care Applied Research Network Registry, they found that there are differences in process and outcome measures by race and ethnicity in the emergency department management of pain among children with long-bone fractures. Although minority children are more likely to receive analgesics and achieve reduction in pain, they are less likely to receive opioids and achieve optimal pain reduction.
AHRQ-funded; HS020270.
Citation: Goyal MK, Johnson TJ, Chamberlain JM .
Racial and ethnic differences in emergency department pain management of children with fractures.
Pediatrics 2020 May;145(5):e20193370. doi: 10.1542/peds.2019-3370..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Emergency Department, Pain, Injuries and Wounds, Medication, Opioids, Disparities
Andereck JW, Reuter QR, Allen KC
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
This study compared opioid prescribing rates in emergency departments before and after a quality improvement initiative featuring peer-comparison feedback. All 117 ED prescribers at an urban academic medical center were provided regular feedback on their opioid prescribing rate compared to their de-identified peers. Pre-intervention rates were 8.6% compared to post-intervention at 4.8%.
AHRQ-funded; HS023011.
Citation: Andereck JW, Reuter QR, Allen KC .
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):669-79. doi: 10.1016/j.jcjq.2019.07.008..
Keywords: Emergency Department, Opioids, Medication, Practice Patterns, Quality Improvement, Quality of Care
Kim HS, Kaplan SH, McCarthy DM
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Researchers used a retrospective cohort study to examine whether physical therapy (PT) is associated with lower analgesic prescribing in the emergency department (ED) setting. They found that, in this single center study, ED back and neck pain visits receiving PT were no less likely to receive an opioid prescription and were more likely to receive a benzodiazepine than visits receiving usual care. They conclude that, although prior studies demonstrated that PT may reduce opioid utilization in the subsequent year, these results indicated that analgesic prescribing is not reduced at the initial ED encounter.
AHRQ-funded; HS023011.
Citation: Kim HS, Kaplan SH, McCarthy DM .
A comparison of analgesic prescribing among ED back and neck pain visits receiving physical therapy versus usual care.
Am J Emerg Med 2019 Jul;37(7):1322-26. doi: 10.1016/j.ajem.2018.10.009..
Keywords: Opioids, Medication, Practice Patterns, Emergency Department, Patient-Centered Outcomes Research, Pain, Back Health and Pain, Outcomes, Evidence-Based Practice
Vijay A, Rhee TG, Ross JS
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
This retrospective study tracked US prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department (ED) visits from 2006 to 2015. Data from the 2006-2015 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys was used. During that time period, 17.4% of office-based outpatient visits and 45% of ED visits listed a pain medication prescription. There was an increase of about 5% from 2006-2007 to 2014-2015 for outpatient visits in which any pain medication was prescribed. Fentanyl prescription rates remained stable but doubled at EDs. There was also an increase in non-opioid pain medications in both settings.
AHRQ-funded; HS022882; HS025164.
Citation: Vijay A, Rhee TG, Ross JS .
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
Prev Med 2019 Jun;123:123-29. doi: 10.1016/j.ypmed.2019.03.022..
Keywords: Ambulatory Care and Surgery, Emergency Department, Hospitals, Medication, Opioids, Pain, Practice Patterns
Knight LMJ, Onsomu EO, Bosworth HB
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
This study compared perceptions of nurses and physicians on protocols to treat sickle cell disease vaso-occlusive episodes (VOEs) in emergency rooms (ERs). Two different protocols were used for VOEs: weight –based and individualized vaso-occlusive. Nurses were less satisfied with clarity of the protocols than physicians. Pain management protocol perceptions differed widely between physicians, residents, physician assistants, nurse practitioners and nurses.
AHRQ-funded; HS024501.
Citation: Knight LMJ, Onsomu EO, Bosworth HB .
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
Adv Emerg Nurs J 2019 Jan/Mar;41(1):86-97. doi: 10.1097/tme.0000000000000232..
Keywords: Emergency Department, Medication, Opioids, Pain, Provider, Sickle Cell Disease
Axeen S, Seabury SA, Menchine M
Emergency department contribution to the prescription opioid epidemic.
The investigators used MEPS data to characterize the relative contribution of emergency departments (EDs) to national opioid prescribing, to estimate trends in opioid prescribing by site of care, and to examine whether higher-risk opioid users receive a disproportionate quantity of their opioids from ED settings. During the study period, they found that the relative contribution of EDs to the prescription opioid problem was modest and declining. They therefore recommended that further efforts to reduce the quantity of opioids prescribed focus on office-based settings.
AHRQ-funded; HS024251.
Citation: Axeen S, Seabury SA, Menchine M .
Emergency department contribution to the prescription opioid epidemic.
Ann Emerg Med 2018 Jun;71(6):659-67.e3. doi: 10.1016/j.annemergmed.2017.12.007..
Keywords: Behavioral Health, Emergency Department, Medical Expenditure Panel Survey (MEPS), Medication, Opioids, Practice Patterns, Substance Abuse
Kim HS, McCarthy DM, Hoppe JA
Emergency department provider perspectives on benzodiazepine-opioid coprescribing: a qualitative study.
This study examined attitudes of emergency department residents, attending physicians, and pharmacists from three hospitals on coprescribing benzodiazepines and opioids. There is mounting evidence that this increases overdose risk. Focus groups were conducted using semistructured interviews which were audio-recorded and transcribed. Participants were reluctant to admit coprescribing and said when they did that specific discharge instructions were provided. The decision was also influenced by a provider’s belief in the efficacy of combination therapy as well as self-imposed pressure to escalate care or avoid hospital admission. They did not like the idea of using computerized alerts, but were support of pharmacist-assisted interventions.
AHRQ-funded; HS023011; HS000078.
Citation: Kim HS, McCarthy DM, Hoppe JA .
Emergency department provider perspectives on benzodiazepine-opioid coprescribing: a qualitative study.
Acad Emerg Med 2018 Jan;25(1):15-24. doi: 10.1111/acem.13273..
Keywords: Emergency Department, Guidelines, Medication, Opioids, Practice Patterns, Provider: Clinician, Provider: Pharmacist, Provider: Physician
Tedesco D, Asch SM, Curtin C
Opioid abuse and poisoning: trends in inpatient and emergency department discharges.
This study analyzed national trends in inpatient and emergency department (ED) discharges for opioid abuse, dependence, and poisoning using Healthcare Cost and Utilization Project data.
AHRQ-funded; HS024096.
Citation: Tedesco D, Asch SM, Curtin C .
Opioid abuse and poisoning: trends in inpatient and emergency department discharges.
Health Aff 2017 Oct;36(10):1748-53. doi: 10.1377/hlthaff.2017.0260..
Keywords: Emergency Department, Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Opioids, Substance Abuse
Beaudoin FL, Gutman R, Merchant RC
Persistent pain after motor vehicle collision: comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis.
This study evaluated the effect of opioid analgesics vs NSAIDs initiated from the ED on the presence of moderate to severe musculoskeletal pain and ongoing opioid use at 6 weeks in a large cohort of adult ED patients presenting to the ED after motor vehicle collision. No difference in risk for moderate to severe musculoskeletal pain at 6 weeks was observed between those discharged with opioid analgesics vs NSAIDs.
AHRQ-funded; HS022998.
Citation: Beaudoin FL, Gutman R, Merchant RC .
Persistent pain after motor vehicle collision: comparative effectiveness of opioids vs nonsteroidal antiinflammatory drugs prescribed from the emergency department-a propensity matched analysis.
Pain 2017 Feb;158(2):289-95. doi: 10.1097/j.pain.0000000000000756.
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Keywords: Comparative Effectiveness, Emergency Department, Medication, Opioids, Pain, Patient-Centered Outcomes Research
Meisel ZF, Smith RJ
Engaging patients around the risks of opioid misuse in the emergency.
The authors of this editorial considered a number of different types of strategies to increase patient awareness of risks and benefits associated with alternative pain management strategies in the ED. These include traditional education, communicating risks, shared decisionmaking, community interventions and “sticky” narratives. They conclude that patients, families and communities must be included in order to navigate the tight¬rope walk between providing adequate pain control and mitigating misuse and dependency.
AHRQ-funded; HS021956.
Citation: Meisel ZF, Smith RJ .
Engaging patients around the risks of opioid misuse in the emergency.
Pain Manag 2015 Sep;5(5):323-6. doi: 10.2217/pmt.15.31..
Keywords: Emergency Department, Opioids, Pain, Patient and Family Engagement