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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 25 of 25 Research Studies DisplayedMcGeorge N, Hedge S, Berg RL
Assessment of innovative emergency department information displays in a clinical simulation center.
The authors assessed the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. They found that participants using the new displays showed improved situation awareness, demonstrating that cognitive systems engineering methods can be used to create innovative displays that better support emergency medicine tasks, without increasing workload, compared to more standard displays.
AHRQ-funded; HS020433.
Citation: McGeorge N, Hedge S, Berg RL .
Assessment of innovative emergency department information displays in a clinical simulation center.
J Cogn Eng Decis Mak 2015 Dec;9(4):329-46. doi: 10.1177/1555343415613723.
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Keywords: Healthcare Delivery, Emergency Department, Emergency Medical Services (EMS), Health Information Technology (HIT)
Lewiss RE, Chan W, Sheng AY
Research priorities in the utilization and interpretation of diagnostic imaging: Education, assessment, and competency.
A group of radiologists, physicists, and emergency physicians convened at the 2015 Academic Emergency Medicine consensus conference to discuss and prioritize a research agenda related to education, assessment, and competency in ordering and interpreting diagnostic imaging. In this article, the authors review the supporting reliability and validity evidence and make specific recommendations for future research on the education, competency, and assessment of learning diagnostic imaging.
AHRQ-funded; HS023498.
Citation: Lewiss RE, Chan W, Sheng AY .
Research priorities in the utilization and interpretation of diagnostic imaging: Education, assessment, and competency.
Acad Emerg Med 2015 Dec;22(12):1447-54. doi: 10.1111/acem.12833.
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Keywords: Imaging, Education: Continuing Medical Education, Emergency Department, Emergency Medical Services (EMS), Healthcare Utilization, Health Services Research (HSR)
Lee DC, Carr BG, Smith TE
The impact of hospital closures and hospital and population characteristics on increasing emergency department volume: a geographic analysis.
The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. Emergency volume increased nearly twice as fast at tertiary referral centers (4.8 percent) and nonurban hospitals (3.7 percent versus urban at 2.1 percent) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth.
AHRQ-funded; HS018362; HS010914.
Citation: Lee DC, Carr BG, Smith TE .
The impact of hospital closures and hospital and population characteristics on increasing emergency department volume: a geographic analysis.
Popul Health Manag 2015 Dec;18(6):459-66. doi: 10.1089/pop.2014.0123.
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Keywords: Emergency Medical Services (EMS), Emergency Department, Hospitals, Access to Care
Wexler R, Hefner JL, Sieck C
Connecting emergency department patients to primary care.
The researchers developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients. The intervention did not decrease ED visits nor increase primary care use over the 12 months of the study period. The qualitative results provide insight into nonurgent ED utilization by patients with Medicaid, suggesting potential future interventions.
AHRQ-funded; HS020693.
Citation: Wexler R, Hefner JL, Sieck C .
Connecting emergency department patients to primary care.
J Am Board Fam Med 2015 Nov-Dec;28(6):722-32. doi: 10.3122/jabfm.2015.06.150044.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Primary Care, Health Information Technology (HIT), Healthcare Utilization
Gabayan GZ, Derose SF, Chiu VY
Emergency department crowding and outcomes after emergency department discharge.
The researchers assess whether a panel of emergency department (ED) crowding measures, including 2 reported by the Centers for Medicare & Medicaid Services (CMS), is associated with inpatient admission and death within 7 days of ED discharge. Their findings suggest that ED length of stay is a proxy for unmeasured differences in case mix and challenge the validity of the CMS metric as a safety measure for discharged patients.
AHRQ-funded; HS018098.
Citation: Gabayan GZ, Derose SF, Chiu VY .
Emergency department crowding and outcomes after emergency department discharge.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospital Discharge, Outcomes, Hospitalization
Werner NE, Holden RJ
Interruptions in the wild: development of a sociotechnical systems model of interruptions in the emergency department through a systematic review.
After a systematic review and synthesis of the literature and drawing on ergonomic concepts, the authors present a sociotechnical model of interruptions in complex settings that motivates new directions in research and design. The model conceptualizes interruptions as a process, not a single event, that occurs within and is shaped by an interacting socio-technical system and that results in a variety of interrelated outcomes.
AHRQ-funded; HS022916.
Citation: Werner NE, Holden RJ .
Interruptions in the wild: development of a sociotechnical systems model of interruptions in the emergency department through a systematic review.
Appl Ergon 2015 Nov;51:244-54. doi: 10.1016/j.apergo.2015.05.010..
Keywords: Emergency Department, Emergency Medical Services (EMS)
Vogel JA, Seleno N, Hopkins E
Denver ED Trauma Organ Failure Score outperforms traditional methods of risk stratification in trauma.
The objective of this study was to compare prognostic accuracies of the Denver Emergency Department (ED) Trauma Organ Failure (TOF) Score, ED Sequential Organ Failure Assessment (SOFA) score, and ED base deficit and ED lactate for inhospital mortality in adult trauma patients. It concluded that The Denver ED TOF Score more accurately predicts inhospital mortality in adult trauma patients compared to the other three.
AHRQ-funded; HS017526.
Citation: Vogel JA, Seleno N, Hopkins E .
Denver ED Trauma Organ Failure Score outperforms traditional methods of risk stratification in trauma.
Am J Emerg Med 2015 Oct;33(10):1440-4. doi: 10.1016/j.ajem.2015.07.006..
Keywords: Emergency Medical Services (EMS), Risk, Mortality, Comparative Effectiveness, Emergency Department
Le Grand Rogers R, Narvaez Y, Venkatesh AK
Improving emergency physician performance using audit and feedback: a systematic review.
The objective of the review was to assess the effect of audit and feedback on emergency physician performance and identify features critical to success. It concluded that the literature on audit and feedback in the ED reports positive results for interventions across numerous clinical conditions but without the standardized reporting sufficient for meta-analysis.
AHRQ-funded; HS021271.
Citation: Le Grand Rogers R, Narvaez Y, Venkatesh AK .
Improving emergency physician performance using audit and feedback: a systematic review.
Am J Emerg Med 2015 Oct;33(10):1505-14. doi: 10.1016/j.ajem.2015.07.039..
Keywords: Provider Performance, Emergency Medical Services (EMS), Emergency Department
Yanagizawa-Drott L, Kurland L, Schuur JD
Infection prevention practices in Swedish emergency departments: results from a cross-sectional survey.
This study aimed to estimate the extent to which Swedish EDs have adopted evidence-based measures to prevent healthcare-associated infections (HAIs). It found that thirty-nine percent of EDs participate in a project to improve hand hygiene compliance. Staff hand hygiene compliance rates were audited at least monthly in 45 percent of EDs. Forty-three percent reported a compliance rate of 80 percent or more.
AHRQ-funded; HS021616; HS020013.
Citation: Yanagizawa-Drott L, Kurland L, Schuur JD .
Infection prevention practices in Swedish emergency departments: results from a cross-sectional survey.
Eur J Emerg Med 2015 Oct;22(5):338-42. doi: 10.1097/mej.0000000000000159..
Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare-Associated Infections (HAIs), Prevention, Risk
Marin JR, Wang L, Winger DG
Variation in computed tomography imaging for pediatric injury-related emergency visits.
This study assessed variation in the use of computed tomography (CT) for pediatric injury-related emergency department (ED) visits. It found wide variation in CT imaging for pediatric injury-related visits not attributable solely to case mix. In multivariable analysis of nonpediatric EDs, trauma centers and nonacademic EDs were associated with CT use. Higher pediatric volume was associated with any CT use.
AHRQ-funded; HS023498.
Citation: Marin JR, Wang L, Winger DG .
Variation in computed tomography imaging for pediatric injury-related emergency visits.
J Pediatr 2015 Oct;167(4):897-904.e3. doi: 10.1016/j.jpeds.2015.06.052..
Keywords: Emergency Medical Services (EMS), Children/Adolescents, Children/Adolescents, Emergency Department, Imaging
Smith-Bindman R, Moghadassi M, Griffey RT
Computed tomography radiation dose in patients with suspected urolithiasis.
The researchers determined the radiation doses of CT scans for suspected urolithiasis in the emergency department setting. They found that less than 8 percent of patients received appropriately low-dose CT for suspected urolithiasis. Furthermore, they found a 200-fold variation in dose between patients and a 5-fold variation in median dose across hospitals.
AHRQ-funded; HS019312.
Citation: Smith-Bindman R, Moghadassi M, Griffey RT .
Computed tomography radiation dose in patients with suspected urolithiasis.
JAMA Intern Med 2015 Aug;175(8):1413-6. doi: 10.1001/jamainternmed.2015.2697..
Keywords: Emergency Department, Guidelines, Imaging, Emergency Medical Services (EMS)
Peng J, Wheeler K, Shi J
Trauma with Injury Severity Score of 75: are these unsurvivable injuries?
This study aimed to assess the true mortality among patients with an ISS=75, and to examine the characteristics and primary diagnoses of these patients. Its results revealed that at least half of patients with an ISS=75 survived, demonstrating that the rationale for excluding patients with an ISS=75 from analysis is not always justified.
AHRQ-funded; HS022277.
Citation: Peng J, Wheeler K, Shi J .
Trauma with Injury Severity Score of 75: are these unsurvivable injuries?
PLoS One 2015 Jul 31;10(7):e0134821. doi: 10.1371/journal.pone.0134821..
Keywords: Mortality, Healthcare Cost and Utilization Project (HCUP), Trauma, Emergency Medical Services (EMS), Emergency Department
Akosa Antwi Y, Moriya AS, Simon K
AHRQ Author: Moriya AS
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
The researchers evaluated the effect of the Patient Protection and Affordable Care Act insurance expansion on ED use among young adults. They found a modest decrease in ED use of young adults aged 19 to 25 years compared with those aged 27 to 29 years, particularly for less urgent conditions.
AHRQ-authored.
Citation: Akosa Antwi Y, Moriya AS, Simon K .
Changes in emergency department use among young adults after the Patient Protection and Affordable Care Act's dependent coverage provision.
Ann Emerg Med 2015 Jun;65(6):664-72.e2. doi: 10.1016/j.annemergmed.2015.01.010..
Keywords: Emergency Department, Emergency Medical Services (EMS), Health Insurance
Troyer JL, Jones AE, Shapiro NI
Cost-effectiveness of quantitative pretest probability intended to reduce unnecessary medical radiation exposure in emergency department patients with chest pain and dyspnea.
The purpose of this study was to consider the long-term (beyond 30-day) costs and beyond 90-day outcomes of the pretest probability intervention. It found that a single use of a quantitative pretest probability instrument with associated clinical advice resulted in lifetime medical cost savings of approximately $500, with a small increase in quality-of-life years, for a 40-year-old patient.
AHRQ-funded; HS018519.
Citation: Troyer JL, Jones AE, Shapiro NI .
Cost-effectiveness of quantitative pretest probability intended to reduce unnecessary medical radiation exposure in emergency department patients with chest pain and dyspnea.
Acad Emerg Med 2015 May;22(5):525-35. doi: 10.1111/acem.12648..
Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare Costs, Healthcare Costs
Del Fiol G, Crouch BI, Cummins MR
Data standards to support health information exchange between poison control centers and emergency departments.
The researchers identified and assessed a set of data standards to enable a standards-based health information exchange process between emergency departments (EDs) and poison control centers (PCCs). They determined that four Consolidated Clinical Document Architecture document types were necessary to support the PCC–ED information exchange process: History & Physical Note, Consultation Note, Progress Note, and Discharge Summary.
AHRQ-funded; HS021472.
Citation: Del Fiol G, Crouch BI, Cummins MR .
Data standards to support health information exchange between poison control centers and emergency departments.
J Am Med Inform Assoc 2015 May;22(3):519-28. doi: 10.1136/amiajnl-2014-003127..
Keywords: Data, Emergency Department, Emergency Medical Services (EMS), Health Information Exchange (HIE), Health Information Technology (HIT)
Marin JR, Lewiss RE
Point-of-care ultrasonography by pediatric emergency medicine physicians.
This article announces that the American Academy of Pediatrics (AAP) has recently published in the journal Pediatrics the first guideline for point-of-care ultrasonography (US) use by pediatric emergency medicine (PEM) physicians. The AAP policy statement and accompanying technical report provide background and a framework for PEM physicians, who currently use or are planning to incorporate point-of-care US into their practice.
AHRQ-funded; HS023498.
Citation: Marin JR, Lewiss RE .
Point-of-care ultrasonography by pediatric emergency medicine physicians.
Acad Emerg Med 2015 May;22(5):623-4. doi: 10.1111/acem.12659..
Keywords: Children/Adolescents, Children/Adolescents, Emergency Medical Services (EMS), Emergency Department, Children/Adolescents
Courtney DM, Mills AM, Marin JR
To test or not to test ... decision analysis of decision support.
In this article, the authors comment on a study by Troyer and colleagues in the same issue that presents a provocative decision analysis study exploring the cost and benefits associated with a web-based quantitative pretest probability calculator. Their discussion centers around the decision to test or not test in the emergency department setting for a condition. Such decisions are among the most consequential that physicians make and often hinge on advanced imaging.
AHRQ-funded; HS023498.
Citation: Courtney DM, Mills AM, Marin JR .
To test or not to test ... decision analysis of decision support.
Acad Emerg Med 2015 May;22(5):594-6. doi: 10.1111/acem.12663..
Keywords: Shared Decision Making, Emergency Department, Emergency Medical Services (EMS)
Desai AD, Popalisky J, Simon TD
The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature.
The objective of this study was to conduct a targeted literature review of studies examining the effectiveness of family-centered transition processes from hospital-and emergency department (ED)-to-home for improving patient health outcomes and health care utilization. It determined that patient-tailored discharge education is associated with improved patient health outcomes in pediatric ED patients.
AHRQ-funded; HS020506.
Citation: Desai AD, Popalisky J, Simon TD .
The effectiveness of family-centered transition processes from hospital settings to home: a review of the literature.
Hosp Pediatr 2015 Apr;5(4):219-31. doi: 10.1542/hpeds.2014-0097..
Keywords: Patient-Centered Outcomes Research, Hospital Discharge, Emergency Department, Emergency Medical Services (EMS), Transitions of Care
Hilligoss B, Mansfield JA, Patterson ES
Collaborating-or "selling" patients? A conceptual framework for emergency department-to-inpatient handoff negotiations.
The authors propose an empirically grounded conceptual framework of emergency department admission handoff negotiations that represents handoffs as situated within ongoing flows of action, variable negotiation contexts, stable organizational structures, and macro environments. The purpose of this framework is to raise awareness of potential opportunities to intervene and improve the contexts in which handoffs occur in order to foster greater collaboration and improve resilience.
AHRQ-funded; HS018758
Citation: Hilligoss B, Mansfield JA, Patterson ES .
Collaborating-or "selling" patients? A conceptual framework for emergency department-to-inpatient handoff negotiations.
Jt Comm J Qual Patient Saf. 2015 Mar;41(3):134-43..
Keywords: Emergency Department, Emergency Medical Services (EMS), Quality of Care, Patient Safety
Fertel BS, Hart KW, Lindsell CJ
Patients who use multiple EDs: quantifying the degree of overlap between ED populations.
The researchers estimated the proportion of emergency department (ED) patients who seek care from more than one ED by using a sample of three EDs in a region with a total of 18 EDs and one dedicated pediatric ED. They found that most repeat encounters occur within a single ED rather than among multiple EDs. Nonetheless, nearly one of every four ED encounters were by patients who also visited another ED during the study period.
AHRQ-funded; HS021749.
Citation: Fertel BS, Hart KW, Lindsell CJ .
Patients who use multiple EDs: quantifying the degree of overlap between ED populations.
West J Emerg Med 2015 Mar;16(2):229-33. doi: 10.5811/westjem.2015.1.22838..
Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare Utilization
Galbraith JW, Franco RA, Donnelly JP
Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department.
The researchers described early experience with integrated opt-out HCV antibody (Ab) screening of medically stable baby boomers presenting to an urban academic ED. They observed high prevalence of unrecognized chronic HCV infection in this series of baby boomers presenting to the ED, highlighting the ED as an important venue for high-impact HCV screening and linkage to care.
AHRQ-funded; HS013852.
Citation: Galbraith JW, Franco RA, Donnelly JP .
Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department.
Hepatology 2015 Mar;61(3):776-82. doi: 10.1002/hep.27410.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Hepatitis, Screening, Emergency Medical Services (EMS), Emergency Department
Moore CL, Daniels B, Ghita M
Accuracy of reduced-dose computed tomography for ureteral stones in emergency department patients.
The researchers compared the sensitivity and specificity of reduced-dose computed tomography (CT) for diagnosis of clinically important urologic causes of kidney stones likely to require intervention within a 90-day follow-up period. In 201 patients with a range of body mass indexes who received both regular and reduced dose scans contemporaneously, reduced-dose CT were 96% sensitive for stones requiring intervention.
AHRQ-funded; HS018322.
Citation: Moore CL, Daniels B, Ghita M .
Accuracy of reduced-dose computed tomography for ureteral stones in emergency department patients.
Ann Emerg Med 2015 Feb;65(2):189-98.e2. doi: 10.1016/j.annemergmed.2014.09.008..
Keywords: Emergency Medical Services (EMS), Emergency Department, Kidney Disease and Health, Imaging
Moy E, Barrett M, Coffey R
AHRQ Author: Moy E
Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics.
The purpose of this study is to estimate the frequency of missed heart attacks or their precursors (e.g., unstable angina) in the emergency department (ED) by examining use of EDs in the week prior to hospitalization for heart attack. This study of 111,973 patients found an overall rate of 0.9 percent for missed diagnoses of heart attacks.
AHRQ-authored; AHRQ-funded; 290201300002C
Citation: Moy E, Barrett M, Coffey R .
Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics.
Diagn. 2015 Feb;2(1):29-40..
Keywords: Diagnostic Safety and Quality, Heart Disease and Health, Emergency Department, Emergency Medical Services (EMS), Healthcare Cost and Utilization Project (HCUP)
Kindermann DR, Mutter RL, Houchens RL
AHRQ Author: Mutter RL
The transfer instability index: a novel metric of emergency department transfer relationships.
The researchers developed the “transfer instability index” to describe sending hospitals’ relationships with receiving hospitals. They found that emergency departments with a greater share of publicly insured patients had a greater transfer instability index, which may indicate less stable, protocolized, and regionalized transfer relationships.
AHRQ-funded; 290201300002C.
Citation: Kindermann DR, Mutter RL, Houchens RL .
The transfer instability index: a novel metric of emergency department transfer relationships.
Acad Emerg Med 2015 Feb;22(2):166-71. doi: 10.1111/acem.12589..
Keywords: Emergency Medical Services (EMS), Emergency Department, Transitions of Care, Medicaid, Medicare
Samim M, Goss S, Luty S
Incidental findings on CT for suspected renal colic in emergency department patients: prevalence and types in 5,383 consecutive examinations.
This study aimed to determine the prevalence, importance, and types of incidental findings (IF) in non-enhanced CT scans performed for suspected renal colic, based on ACR white papers and other accepted radiographic recommendations. It found that important IF occurred in 12.7% of non-enhanced CT scans performed for suspected renal colic in the emergency department and are more common in older individuals.
AHRQ-funded; HS018322.
Citation: Samim M, Goss S, Luty S .
Incidental findings on CT for suspected renal colic in emergency department patients: prevalence and types in 5,383 consecutive examinations.
J Am Coll Radiol 2015 Jan;12(1):63-9. doi: 10.1016/j.jacr.2014.07.026..
Keywords: Emergency Department, Emergency Medical Services (EMS), Imaging, Elderly