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Topics
- Access to Care (1)
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Asthma (6)
- Blood Clots (4)
- Cardiovascular Conditions (2)
- Care Management (1)
- Children/Adolescents (7)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (3)
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- Critical Care (1)
- Diagnostic Safety and Quality (5)
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- (-) Emergency Department (22)
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- Imaging (4)
- Influenza (1)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (1)
- Medication (1)
- Outcomes (2)
- Patient-Centered Outcomes Research (3)
- Pneumonia (1)
- Practice Patterns (1)
- Primary Care (1)
- Provider (1)
- Provider: Pharmacist (1)
- Provider: Physician (1)
- Quality of Life (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 22 of 22 Research Studies DisplayedGyftopoulos 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
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
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Weekes AJ, Davison J, Lupez K
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
The objective of this prospective multicenter registry study was to determine whether any clinical or pathophysiologic features of pulmonary embolism were associated with worse Pulmonary Embolism Quality-of-Life (PEmb-QoL) scores after one month. Pulmonary embolism patients participated in QoL assessments and received PEmb-QoL questionnaires conducted by the researchers. Results indicated that acute clinical deterioration, right ventricular dysfunction, and pulmonary embolism PE severity were not predictors of QoL at 1 month post-embolism. Independent predictors of worsened QoL were COPD, rehospitalization, and hospital length of stay.
AHRQ-funded; HS025979.
Citation: Weekes AJ, Davison J, Lupez K .
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
Acad Emerg Med 2023 Aug; 30(8):819-31. doi: 10.1111/acem.14692..
Keywords: Quality of Life, Respiratory Conditions, Emergency Department
Mahony T, Harder VS, Ang N
Weekend versus weekday asthma-related emergency department utilization.
The objective of this study was to assess variation in pediatric asthma-related emergency department (ED) visits between weekends and weekdays. Data was taken from California 2016 Medicaid data and Vermont 2016 and Massachusetts 2015 all-payer claims sources for children and adolescents in stratified groups aged 3 to 21. The asthma-related ED visit rate was slightly lower on weekends. The authors concluded that their findings suggest the increase of access options during the weekend may not necessarily decrease asthma-related ED visits.
AHRQ-funded; HS025297; HS020518; 233201600221A; 233201550088A
Citation: Mahony T, Harder VS, Ang N .
Weekend versus weekday asthma-related emergency department utilization.
Acad Pediatr 2022 May-Jun;22(4):640-46. doi: 10.1016/j.acap.2021.09.005..
Keywords: Asthma, Respiratory Conditions, Emergency Department, Healthcare Utilization
Bardach NS, Harder VS, McCulloch CE
Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization.
Researchers sought to assess the association between follow-up after an asthma-related emergency department (ED) visit and the likelihood of subsequent asthma-related ED utilization. Using data from California Medicaid, Vermont, and Massachusetts all-payer claims databases, they found a protective association between outpatient 14-day follow-up and asthma-related ED revisits. They suggested that this may reflect improved asthma control as providers follow the NHLBI guideline stepwise approach.
AHRQ-funded; HS025297; HS020518.
Citation: Bardach NS, Harder VS, McCulloch CE .
Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization.
Acad Pediatr 2022 Apr;22(3S):S125-S32. doi: 10.1016/j.acap.2021.10.015..
Keywords: Children/Adolescents, Asthma, Emergency Department, Respiratory Conditions, Healthcare Utilization
Zhang NJ, Rameau P, Julemis M
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
The authors sought to create an automated process to calculate the Wells score for pulmonary embolism for emergency department patients, which might reduce unnecessary computed tomography pulmonary angiography (CTPA) testing. They designed the process using electronic health records data elements, including free-text fields, and calculated Wells scores for a sample of adult emergency department visits that resulted in a CTPA study for pulmonary embolism at two tertiary care hospitals in New York. After validation, the authors concluded that the development of the automated process to classify risk for pulmonary embolism in emergency department visits was successful.
AHRQ-funded; HS026196.
Citation: Zhang NJ, Rameau P, Julemis M .
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
JMIR Form Res 2022 Feb 28;6(2):e32230. doi: 10.2196/32230.
Keywords: Blood Clots, Respiratory Conditions, Risk, Emergency Department
Anesi GL, Chelluri J, Qasim ZA
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
The purpose of this study was to evaluate the potential impact of an emergency department-embedded critical care unit (CCU) at the Hospital of the University of Pennsylvania among patients with sepsis and acute respiratory failure (ARF) admitted from the emergency department to a medical ward or ICU from January 2016 to December 2017. Findings showed that the emergency department-embedded CCU was not associated with clinical outcomes among patients admitted with sepsis or ARF. Among less sick patients with sepsis, the emergency department-embedded CCU was initially associated with reduced rates of direct ICU admission from the emergency department. Further research was recommended to further evaluate the impact and utility of the emergency department-embedded CCU model.
AHRQ-funded; HS026372.
Citation: Anesi GL, Chelluri J, Qasim ZA .
Association of an emergency department-embedded critical care unit with hospital outcomes and intensive care unit use.
Ann Am Thorac Soc 2020 Dec;17(12):1599-609. doi: 10.1513/AnnalsATS.201912-912OC..
Keywords: Emergency Department, Critical Care, Intensive Care Unit (ICU), Hospitals, Sepsis, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Healthcare Delivery
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Joshi RP, Pejaver V, Hammarlund NE
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
This retrospective case-control study investigated whether the use of a prediction tool based on complete blood count results and patient sex can better allocate testing for SARS-CoV-2 PCR testing in hospital emergency departments. Participants were emergency department patients who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California, Seattle, Washington, Chicago Illinois, and South Korea. A hypothetical scenario of 1000 patients requiring testing was developed, but in this scenario testing resources are limited to 60% of patients. This tool would allow a 33% increase in properly allocated resources.
AHRQ-funded; HS026385.
Citation: Joshi RP, Pejaver V, Hammarlund NE .
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
J Clin Virol 2020 Aug;129:104502. doi: 10.1016/j.jcv.2020.104502..
Keywords: Emergency Department, COVID-19, Pneumonia, Respiratory Conditions, Diagnostic Safety and Quality, Clinical Decision Support (CDS)
Cushing AM, Bucholz E, Michelson KA
Trends in regionalization of emergency care for common pediatric conditions.
This study examined trends in regionalization of emergency care for common pediatric conditions. The authors sought to determine how the likelihood of definitive care has changed for 3 common conditions: asthma, croup, and gastroenteritis. They used the National Emergency Department Sample Database to study children from 2008 to 2016 who presented to emergency departments with those primary diagnoses, excluding critically ill patients. Researchers conducted analyses by stratification of annual emergency department pediatric volume categorized by quartiles. Referral rates increased for all conditions in all volume quartiles, with referral rates greatest in the lowest pediatric volume quartile.
AHRQ-funded; HS026503.
Citation: Cushing AM, Bucholz E, Michelson KA .
Trends in regionalization of emergency care for common pediatric conditions.
Pediatrics 2020 Apr;145(4). doi: 10.1542/peds.2019-2989..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Asthma, Respiratory Conditions, Digestive Disease and Health, Healthcare Delivery
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
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
Simon E, Miake-Lye IM, Smith SW
An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department.
The aim of this study was to determine rates of and possible reasons for guideline-discordant ordering of CT pulmonary angiography for the evaluation of suspected pulmonary embolism (PE) in the emergency department. The investigators concluded that many of the guideline-discordant orders were placed for patients who presented with evidence-based risk factors for PE that are not included in the risk stratification scores. They suggest that guideline-discordant ordering may indicate that in the presence of these factors, the assessment of risk made by current scoring systems may not align with clinical suspicion.
AHRQ-funded; HS024376.
Citation: Simon E, Miake-Lye IM, Smith SW .
An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department.
J Am Coll Radiol 2019 Aug;16(8):1064-72. doi: 10.1016/j.jacr.2018.12.015..
Keywords: Respiratory Conditions, Emergency Department, Guidelines, Evidence-Based Practice, Blood Clots
Toy D, Braga MS, Greenhawt M
An update on allergic emergencies.
The purpose of this review was to provide an updated framework of management for allergic emergencies. The authors suggest that although fatalities resulting from anaphylaxis and asthma are rare, patient education serves an important role in preparing for unexpected emergencies, instituting prompt and appropriate treatment, and incorporating effective strategies into the lives of children and families.
AHRQ-funded; HS024599.
Citation: Toy D, Braga MS, Greenhawt M .
An update on allergic emergencies.
Curr Opin Pediatr 2019 Jun;31(3):426-32. doi: 10.1097/mop.0000000000000769..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Emergency Department, Patient-Centered Outcomes Research, Evidence-Based Practice
Russell FM, Ehman RR, Ferre R
Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial.
Medical treatment for acute heart failure (AHF) has not changed substantially over the last four decades. Emergency department (ED)-based evidence for treatment is limited. The investigators discuss BLUSHED-AHF, a multicenter, randomized, pilot trial designed to test whether a strategy of care that utilizes a LUS-driven treatment protocol outperforms usual care for reducing pulmonary congestion in the ED.
AHRQ-funded; HS025411.
Citation: Russell FM, Ehman RR, Ferre R .
Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial.
Heart Lung 2019 May - Jun;48(3):186-92. doi: 10.1016/j.hrtlng.2018.10.027..
Keywords: Emergency Department, Heart Disease and Health, Cardiovascular Conditions, Imaging, Respiratory Conditions
Kenyon CC, Gruschow SM, Haaland WL
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
The authors’ goal was to assess the relationship between perceived access to timely office-based care and subsequent 30-day pediatric revisits following hospital discharge for asthma, bronchiolitis, croup, and pneumonia. They found that perceived access to timely office-based care was associated with significantly greater odds of subsequent emergency department revisit. They concluded that focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.
AHRQ-funded; HS024299.
Citation: Kenyon CC, Gruschow SM, Haaland WL .
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
Acad Pediatr 2019 May - Jun;19(4):370-77. doi: 10.1016/j.acap.2018.07.001..
Keywords: Children/Adolescents, Respiratory Conditions, Ambulatory Care and Surgery, Emergency Department, Access to Care, Hospitals
Hirayama A, Goto T, Shimada YJ
Acute exacerbation of chronic obstructive pulmonary disease and subsequent risk of emergency department visits and hospitalizations for atrial fibrillation.
Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. The investigators found that among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Shimada YJ .
Acute exacerbation of chronic obstructive pulmonary disease and subsequent risk of emergency department visits and hospitalizations for atrial fibrillation.
Circ Arrhythm Electrophysiol 2018 Sep;11(9):e006322. doi: 10.1161/circep.118.006322..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Respiratory Conditions, Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Hospitalization, Risk, Healthcare Utilization
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
Chaaban MR, Zhang D, Resto V
Factors influencing recurrent emergency department visits for epistaxis in the elderly.
The objective of the study was to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly. The investigators concluded that additional ED visits for epistaxis were more common in the elderly and in males. Congestive heart failure, diabetes mellitus and obstructive sleep apnea were found to be independent risk factors.
AHRQ-funded; HS022134.
Citation: Chaaban MR, Zhang D, Resto V .
Factors influencing recurrent emergency department visits for epistaxis in the elderly.
Auris Nasus Larynx 2018 Aug;45(4):760-64. doi: 10.1016/j.anl.2017.11.010..
Keywords: Elderly, Emergency Department, Risk, Respiratory Conditions, Healthcare Utilization
Gullett J, Donnelly JP, Sinert R
Interobserver agreement in the evaluation of B-lines using bedside ultrasound.
The researchers evaluated agreement among trained emergency physicians assessing the degree of B-line presence on bedside ultrasound in patients presenting to the emergency department (ED) with acute undifferentiated dyspnea. They concluded that interrater agreement was best in the anterior/superior thoracic zones followed by the lateral/superior zones for both expert/expert and expert/novice pairs.
AHRQ-funded; HS013852.
Citation: Gullett J, Donnelly JP, Sinert R .
Interobserver agreement in the evaluation of B-lines using bedside ultrasound.
J Crit Care 2015 Dec;30(6):1395-9. doi: 10.1016/j.jcrc.2015.08.021.
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Keywords: Emergency Department, Imaging, Respiratory Conditions
Mehrotra A, Gidengil CA, Setodji CM
Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments.
The authors compared antibiotic prescribing among retail clinics, primary care practices, and emergency departments (EDs) for acute respiratory infections (ARIs): antibiotics-may-be-appropriate ARIs and antibiotics-never-appropriate ARIs. They found that, compared with primary care practices and EDs, there was no difference at retail clinics in overall ARI antibiotic prescribing, which was more diagnosis-appropriate.
AHRQ-funded; HS018419.
Citation: Mehrotra A, Gidengil CA, Setodji CM .
Antibiotic prescribing for respiratory infections at retail clinics, physician practices, and emergency departments.
Am J Manag Care 2015 Apr;21(4):294-302.
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Keywords: Antibiotics, Emergency Department, Provider: Pharmacist, Primary Care, Respiratory Conditions