National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (3)
- Blood Clots (2)
- Blood Pressure (3)
- Cancer (1)
- Cardiovascular Conditions (3)
- Children/Adolescents (10)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (4)
- Clinician-Patient Communication (2)
- Communication (1)
- COVID-19 (2)
- Cultural Competence (1)
- Diabetes (1)
- (-) Diagnostic Safety and Quality (46)
- Disparities (1)
- Domestic Violence (1)
- Electronic Health Records (EHRs) (1)
- (-) Emergency Department (46)
- Emergency Medical Services (EMS) (3)
- Evidence-Based Practice (2)
- Guidelines (3)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Health Information Technology (HIT) (3)
- Heart Disease and Health (2)
- Hospitalization (1)
- Hospital Readmissions (1)
- Hospitals (2)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (11)
- Influenza (1)
- Injuries and Wounds (1)
- Kidney Disease and Health (1)
- Medical Errors (7)
- Newborns/Infants (1)
- Outcomes (1)
- Pain (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (5)
- Pneumonia (1)
- Practice Patterns (1)
- Prevention (1)
- Provider (1)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Provider: Physician (2)
- Provider Performance (1)
- Quality Improvement (2)
- Quality Indicators (QIs) (2)
- Quality Measures (2)
- Quality of Care (3)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (5)
- Risk (4)
- Screening (2)
- Sepsis (2)
- Shared Decision Making (7)
- Stroke (5)
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
26 to 46 of 46 Research Studies DisplayedKocher KE, Arora R, Bassin BS
Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC).
The Michigan Emergency Department Improvement Collaborative (MEDIC) has baseline performance data to identify practice variation across 15 diverse emergency departments on key emergency care quality indicators. The authors assessed MEDIC quality measures and found that performance varied greatly, with demonstrated opportunity for improvement. They conclude that MEDIC provides a robust platform for emergency physician engagement across emergency department practice settings to improve care and is a model for other states.
AHRQ-funded; HS024160.
Citation: Kocher KE, Arora R, Bassin BS .
Baseline performance of real-world clinical practice within a statewide emergency medicine quality network: the Michigan Emergency Department Improvement Collaborative (MEDIC).
Ann Emerg Med 2020 Feb;75(2):192-205. doi: 10.1016/j.annemergmed.2019.04.033..
Keywords: Emergency Department, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Imaging, Diagnostic Safety and Quality
Colton K, Richards CT, Pruitt PB
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
This study compared time for early stroke recognition for intracerebral hemorrhage for hospitals with and without stroke teams. An observational cohort study was conducted at an urban comprehensive stroke center from 2009 to 2017 with 204 cases included. Stroke team activation resulted in faster emergency care compared to no activation. This process resulted in shorter onset-to-arrival times, higher NIH Stroke Scale scores, and higher Glasgow Coma Scale scores.
AHRQ-funded; HS023437.
Citation: Colton K, Richards CT, Pruitt PB .
Early stroke recognition and time-based emergency care performance metrics for intracerebral hemorrhage.
J Stroke Cerebrovasc Dis 2020 Feb;29(2):104552. doi: 10.1016/j.jstrokecerebrovasdis.2019.104552..
Keywords: Stroke, Emergency Department, Provider Performance, Diagnostic Safety and Quality, Quality Improvement, Quality Indicators (QIs), Patient-Centered Outcomes Research, Outcomes, Quality of Care, Evidence-Based Practice, Hospitals
Dugas AF, Hsieh YH, LoVecchio F
Derivation and validation of a clinical decision guideline for influenza testing in 4 US emergency departments.
This study looked at which patients should be tested for influenza among adult emergency department (ED) patients with fever or respiratory symptoms who met criteria for antiviral treatment per 2013 CDC guidelines. A prospective cohort study was conducted at 4 US EDs from November 2013 to April 2014. All 1941 enrolled participants were tested for influenza using polymerase chain reaction (PCR), and 183 patients (9.4%) had influenza. The CDC clinical decision guidelines (CDGs) for influenza testing includes new or increased cough (2 points), headache (1 point), subjective fever (1 point), and triage temperature >100.4F degrees. The CDG had a sensitivity and specificity of 94.1% and 36.6% respectively in the derivation set and the validation set.
AHRQ-funded; HS009699.
Citation: Dugas AF, Hsieh YH, LoVecchio F .
Derivation and validation of a clinical decision guideline for influenza testing in 4 US emergency departments.
Clin Infect Dis 2020 Jan;70(1):49-58. doi: 10.1093/cid/ciz171..
Keywords: Guidelines, Shared Decision Making, Influenza, Respiratory Conditions, Emergency Department, Evidence-Based Practice, Diagnostic Safety and Quality
Zins ZP, Wheeler KK, Brink F
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
The purpose of this study was to determine if US child physical abuse and neglect injury rates changed from 2006 to 2014, whether definitive diagnoses of physical abuse and neglect were used more often over time, and what patient factors influenced definitive physical maltreatment diagnoses. The investigators found that definitive diagnoses of physical abuse and neglect increased over the study period and were associated with hospital volume and patient characteristics which may reflect provider experience and possible bias.
AHRQ-funded; HS024263.
Citation: Zins ZP, Wheeler KK, Brink F .
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
Child Abuse Negl 2019 Dec;98:104179. doi: 10.1016/j.chiabu.2019.104179..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Diagnostic Safety and Quality, Domestic Violence, Injuries and Wounds, Emergency Department, Hospitalization
Moore CL, Carpenter CR, Heilbrun ME
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
This study conducted a Delphi process consensus on 29 specific clinical scenarios when kidney stones are suspected due to renal colic. The authors wanted to create an evidence-based, multispecialty consensus on optimal imaging for suspected renal colic in the acute setting. A 9-member panel was conducted with 3 physician representatives from the American College of Emergency Physicians (ACEP), 3 from the American College of Radiology, and 3 from the American Urology Association. First a systematic literature review was conducted. Out of 6,337 records, there were 232 relevant articles. Out of the 29 clinical scenarios examined, 15 were rated as perfect, 8 were excellent, and 3 good and 3 moderate.
AHRQ-funded; HS023778.
Citation: Moore CL, Carpenter CR, Heilbrun ME .
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
Ann Emerg Med 2019 Sep;74(3):391-99. doi: 10.1016/j.annemergmed.2019.04.021..
Keywords: Imaging, Diagnostic Safety and Quality, Emergency Department
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Shared Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Cohen E, Rodean J, Dong C
Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada.
This study compared rates of diagnostic imaging for pediatric emergency department (ED) patients in the United States and Canada. Rates were compared for 4 pediatric EDs in Ontario and 26 in the United States from 2006 through 2016. Overall, Canada had lower rates of diagnostic imaging of all types than the United Sates. Adverse outcomes were compared as well and lower use in Canada was not associated with highr rates of adverse outcomes.
AHRQ-funded; HS026006.
Citation: Cohen E, Rodean J, Dong C .
Low-value diagnostic imaging use in the pediatric emergency department in the United States and Canada.
JAMA Pediatr 2019 Aug;173(8):e191439. doi: 10.1001/jamapediatrics.2019.1439..
Keywords: Children/Adolescents, Emergency Department, Diagnostic Safety and Quality
Aronson PL, Schaeffer P, Fraenkel L
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
This paper discusses the reasons for wide variation in the decision to perform lumbar punctures (LPs) in febrile infants 8 weeks or less. Semi-structured interviews were conducted with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Five themes emerged from the interviews that included: age of the infant, the physician’s clinical experience, physician’s use of research findings, the physician’s values, and the role of the primary care pediatrician.
AHRQ-funded; HS026006.
Citation: Aronson PL, Schaeffer P, Fraenkel L .
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
Hosp Pediatr 2019 Jun;9(6):405-14. doi: 10.1542/hpeds.2019-0002..
Keywords: Newborns/Infants, Shared Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
Goldberg EM, Wilson T, Jambhekar B
Emergency department-provided home blood pressure devices can help detect undiagnosed hypertension.
This study researched the value of giving home blood pressure devices to patients in emergency departments (EDs) with a triage blood pressure (BP) of >= 120/80 mmHg and no history of hypertension. About 68% of the participants used the device at least 4 times. Those participants with elevated BP had follow-up with their primary care doctor 46% of the time.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Wilson T, Jambhekar B .
Emergency department-provided home blood pressure devices can help detect undiagnosed hypertension.
High Blood Press Cardiovasc Prev 2019 Feb;26(1):45-53. doi: 10.1007/s40292-019-00300-0..
Keywords: Blood Pressure, Emergency Department, Diagnostic Safety and Quality
Medford-Davis LN, Singh H, Mahajan P
Diagnostic decision-making in the emergency department.
Emergency providers must often diagnose from undifferentiated symptoms, without previous knowledge of the patient. Failure to provide an accurate assessment of the problem or to communicate the problem to the patient is diagnostic error. This article considers methods to monitor diagnostic error in emergency departments.
AHRQ-funded; HS024953.
Citation: Medford-Davis LN, Singh H, Mahajan P .
Diagnostic decision-making in the emergency department.
Pediatr Clin North Am 2018 Dec;65(6):1097-105. doi: 10.1016/j.pcl.2018.07.003..
Keywords: Emergency Department, Diagnostic Safety and Quality, Shared Decision Making, Medical Errors, Patient Safety
Koziatek CA, Simon E, Horwitz LI
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
The objective of this study was to measure the performance of automated, structured data-only versions of the Wells and revised Geneva risk scores in emergency department encounters during which a computed tomography pulmonary angiography was ordered. The hypothesis was that such an automated method would classify a patient's pulmonary embolism risk with high accuracy compared to manual chart review.
AHRQ-funded; HS024376.
Citation: Koziatek CA, Simon E, Horwitz LI .
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
Acad Emerg Med 2018 Sep;25(9):1053-61. doi: 10.1111/acem.13442..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality, Emergency Department, Imaging, Guidelines
Gyftopoulos S, Smith SW, Simon E
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
The purpose of the study was to better understand, using semi-structured interviews, the decision making behind the ordering of CT pulmonary angiography (CTPA) for the diagnosis of pulmonary embolism (PE) in the emergency department. The authors found that EM providers were the main drivers of CTPA ordering, and there was a marginalized role for the radiologist. Experience- and gestalt-based heuristics were the main influencers of CTPA ordering.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Smith SW, Simon E .
Qualitative study to understand ordering of CT angiography to diagnose pulmonary embolism in the emergency room setting.
J Am Coll Radiol 2018 Sep;15(9):1276-84. doi: 10.1016/j.jacr.2017.08.022..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Imaging
Haukoos JS, Lyons MS, Rothman RE
The evolving landscape of HIV screening in the emergency department.
This article is a summary of two studies that appear in the same edition of the journal. The two studies describe the value of using targeted vs. non-targeted screening for HIV in emergency departments (EDs). New diagnosis rates were relatively small, which suggested that the use of targeted screening may be need to be refined more in terms of selection criteria.
AHRQ-funded; HS021749.
Citation: Haukoos JS, Lyons MS, Rothman RE .
The evolving landscape of HIV screening in the emergency department.
Ann Emerg Med 2018 Jul;72(1):54-56. doi: 10.1016/j.annemergmed.2018.01.041..
Keywords: Diagnostic Safety and Quality, Emergency Department, Human Immunodeficiency Virus (HIV), Prevention, Screening
Richards CT, Huebinger R, Tataris KL
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
This study explores the hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), an assessment tool currently used by emergency medical services (EMS) providers, can be used to identify large vessel occlusion (LVO). Patients with acute ischemic stroke arriving via EMS at a high-volume stroke center in a large city were identified in a prospective, single-center registry. LVO was confirmed via head and neck vessel imaging and CPSS scores were abstracted from pre-hospital EMS records. The researchers conclude that a CPSS score of 3 identifies LVO in AIS patients reliably, and that EMS providers may be able to use the CPSS with a cut-off score to screen for patients with suspected LVO.
AHRQ-funded; HS000078.
Citation: Richards CT, Huebinger R, Tataris KL .
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
Prehosp Emerg Care 2018 May-Jun;22(3):312-18. doi: 10.1080/10903127.2017.1387629..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Stroke
Goldberg EM, Wilson T, Saucier C
Achieving the BpTRUth: emergency department hypertension screening and the Centers for Medicare & Medicaid Services quality measure.
The aims of this study were to (1) assess the reliability of ED triage blood pressure (BP) as a metric to establish when the CMS threshold (>/=120/80 mm Hg), and other clinically relevant BP thresholds (>/=140/90 and >/=160/100 mm Hg) have been met; and (2) determine whether correct identification varies by gender, race, or triage acuity. At the three suggested BP thresholds, 66.1 percent, 74.0 percent, and 88.8 percent of patients were confirmed to meet the CMS threshold, respectively. There were no differences by gender, race, or triage acuity.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Wilson T, Saucier C .
Achieving the BpTRUth: emergency department hypertension screening and the Centers for Medicare & Medicaid Services quality measure.
J Am Soc Hypertens 2017 May;11(5):290-94. doi: 10.1016/j.jash.2017.03.003.
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Keywords: Blood Pressure, Emergency Department, Quality Measures, Screening, Diagnostic Safety and Quality, Quality of Care
Brody AM, Sharma VK, Singh A
Barriers to emergency physician diagnosis and treatment of uncontrolled chronic hypertension.
This study surveyed a national sample of emergency physicians on their perceived barriers in establishing an ED diagnosis of asymptomatic hypertension (HTN) and ED treatment of such patients. It found that the most common barriers to diagnosis of HTN were uncertainty regarding the validity of ED blood pressure measurements (92 percent)and reluctance to diagnose a condition which cannot be comprehensively managed in the ED setting (29 percent).
AHRQ-funded; HS000011.
Citation: Brody AM, Sharma VK, Singh A .
Barriers to emergency physician diagnosis and treatment of uncontrolled chronic hypertension.
Am J Emerg Med 2016 Nov;34(11):2241-42. doi: 10.1016/j.ajem.2016.08.050.
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Keywords: Blood Pressure, Emergency Department, Diagnostic Safety and Quality, Chronic Conditions
Medford-Davis L, Park E, Shlamovitz G
Diagnostic errors related to acute abdominal pain in the emergency department.
This study reviewed a selected high-risk cohort of patients presenting to the ED with abdominal pain to evaluate for possible diagnostic errors and associated process breakdowns. Diagnostic errors occurred in 35 of 100 high-risk cases. Over two-thirds had breakdowns involving the patient-provider encounter (most commonly history-taking or ordering additional tests) and/or follow-up and tracking of diagnostic information (most commonly follow-up of abnormal test results).
AHRQ-funded; HS022087.
Citation: Medford-Davis L, Park E, Shlamovitz G .
Diagnostic errors related to acute abdominal pain in the emergency department.
Emerg Med J 2016 Apr;33(4):253-9. doi: 10.1136/emermed-2015-204754.
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Keywords: Pain, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Clinician-Patient Communication
Wang RC
Managing urolithiasis.
More than 1 million patients with suspected urolithiasis present to an emergency department (ED) each year in the United States. This review describes ED evaluation, therapies and the identification of patients who require urgent urologic intervention, with recommendations based on clinical trials; on guidelines from the American College of Emergency Physicians (ACEP), American College of Radiology, and American Urologic Association; and on anecdotal experience.
AHRQ-funded; HS021281.
Citation: Wang RC .
Managing urolithiasis.
Ann Emerg Med 2016 Apr;67(4):449-54. doi: 10.1016/j.annemergmed.2015.10.021.
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Keywords: Diagnostic Safety and Quality, Emergency Department, Guidelines
Okafor N, Payne VL, Chathampally Y
Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine.
The researchers analysed incidents reported by ED physicians to determine disease conditions, contributory factors and patient harm associated with ED-related diagnostic errors. Among the 209 incidents, they identified 214 diagnostic errors associated with 65 unique diseases/conditions. Most diagnostic errors in ED appeared to relate to common disease conditions.
AHRQ-funded; HS017586; HS022087.
Citation: Okafor N, Payne VL, Chathampally Y .
Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine.
Emerg Med J 2016 Apr;33(4):245-52. doi: 10.1136/emermed-2014-204604.
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Keywords: Diagnostic Safety and Quality, Emergency Department, Medical Errors, Risk, Patient Safety
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)
Newman-Toker DE, Moy E, Valente E
AHRQ Author: Moy E
Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample.
The authors sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics. They estimated 15,000-165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. They recommended that physicians evaluating these symptoms be particularly attuned to the possibility of stroke in younger, female, and non-White patients.
AHRQ-authored; AHRQ-funded; HS019252.
Citation: Newman-Toker DE, Moy E, Valente E .
Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample.
Diagnosis 2014 Jun;1(2):155-66. doi: 10.1515/dx-2013-0038.
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Keywords: Diagnostic Safety and Quality, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Patient Safety, Stroke