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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 17 of 17 Research Studies DisplayedHoffmann JA, Carter CP, Olsen CS
Pediatric firearm injury emergency department visits from 2017 to 2022: a multicenter study.
This retrospective study aimed to assess how pediatric firearm injury emergency department (ED) visits during the pandemic differed from expected prepandemic trends. The authors looked at firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. They calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. They identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic. Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61), females (RR 2.46), males (RR 2.00), Hispanic children (RR 2.30), and Black non-Hispanic children (RR 1.88).
AHRQ-funded; R01HS020270.
Citation: Hoffmann JA, Carter CP, Olsen CS .
Pediatric firearm injury emergency department visits from 2017 to 2022: a multicenter study.
Pediatrics 2023 Dec; 152(6). doi: 10.1542/peds.2023-063129..
Keywords: Children/Adolescents, Emergency Department, Healthcare Utilization, Injuries and Wounds
Decker 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
Soltani Batt, RJ Bavafa, H
Does what happens in the ED stay in the ED? The effects of emergency department physician workload on post-ed care use.
The purpose of this study was to evaluate the effects of Emergency Department (ED) crowding on the performance of systems outside of the ED: specifically, on the use of post-ED care. The researchers also examined the mediating effects of care intensity in the ED on post-ED use of care. The study utilized microdata from a large U.S. hospital dataset gathered from over four years of exhaustive billing data in an integrated health system. The study found that when ED provider workload increased from the 5th percentile to the median, the number of medical services for patients who were discharged home from the ED increased by 5% and was stable after. The researchers also discovered that when a physician is busier, they order a greater number of tests for patients who are less severe. The study concluded that "extra" testing by providers results in "extra" post-ED care use for those patients, and that earlier studies estimating the cost of ED crowding underestimate the actual effect, because they do not take into account the "extra" post-ED care use.
AHRQ-funded; HS024558.
Citation: Soltani Batt, RJ Bavafa, H .
Does what happens in the ED stay in the ED? The effects of emergency department physician workload on post-ed care use.
Manuf Serv Oper Manag 2022 Nov-Dec;24(6):3079-98. doi: 10.1287/msom.2022.1110..
Keywords: Emergency Department, Healthcare Utilization
Shah W, Villaflores CW, Chuong LH
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
This study investigated whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person versus telehealth encounters for post-ED follow-up care. This retrospective cohort study included adult patients who came to either of 2 in-system EDs of a single urban integrated academic system from April 2020 to September 2021, were discharged home, and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit. Overall, the study recorded 12,848 patients with 16,987 ED encounters (mean age 53 years; 57% women, 12% Black or African American; 22% Hispanic or Latinx; and 58% White) included. Overall, 17% of initial ED encounters led to returns to the ED, and 4% subsequent hospitalizations. Telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 more ED returns per 1000 encounters) and hospitalizations (10.6 more hospitalizations per 1000 encounters).
AHRQ-funded; HS026372.
Citation: Shah W, Villaflores CW, Chuong LH .
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
JAMA Netw Open 2022 Oct;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Hospitals
Encinosa W, Lane K, Cornelio N
AHRQ Author: Encinosa W
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
This article discusses the 2022 No Surprises Act whose goal was to prevent patients from receiving unexpected emergency department (ED) out-of-network physician bills and restrict out-of-network co-payments to in-network co-payment levels. Similar state bans were examined to determine whether the large reduction in out-of-pocket payments under bans will have an unintended consequence of an increase in ED visits and spending. The authors examined 16 million nonelderly, fully funded, privately insured health maintenance organization (HMO) enrollees between 2007 and 2018 from 15 states with balance billing bans for HMO ED visits and 16 states without bans as the control group. They found that the bans reduced spending per visit by 14% but spurred a demand response with an increase of 3 percentage points in ED visits which wiped away the cost savings. The authors predict that the federal ban will result in $5.1 billion in savings but 3.5 million more ED visits at $4.2 billion in extra spending per year, largely negating expected savings.
AHRQ-authored; AHRQ-funded; HS027698.
Citation: Encinosa W, Lane K, Cornelio N .
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
Am J Manag Care 2022 Sep;28(9):e333-e38. doi: 10.37765/ajmc.2022.89226..
Keywords: Healthcare Costs, Emergency Department, Policy, Healthcare Utilization
Shankar LG, Habich M, Rosenman M
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Investigators described pediatric mental health emergency department (ED) visit rates and visit characteristics before and during the COVID-19 pandemic. They found that mental health ED visit rates by children increased during the COVID-19 pandemic.
AHRQ-funded; HS026385.
Citation: Shankar LG, Habich M, Rosenman M .
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Acad Pediatr 2022 Sep-Oct;22(7):1127-32. doi: 10.1016/j.acap.2022.05.022..
Keywords: COVID-19, Children/Adolescents, Emergency Department, Behavioral Health, Healthcare Utilization, Public Health
Newgard CD, Lin A, Caughey AB
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
The purpose of this study was to assess the prognoses, healthcare use, transitions to skilled nursing or hospice, and mortality of older, community-living adults after a fall. The researchers conducted a secondary analysis of all adults in 7 Northwest U.S. counties greater than or equal to 65 years of age who had been transported to one of 51 hospitals after a fall. The study analyzed Medicare claims, state trauma registry data, state inpatient data, and death records for outcomes which included healthcare use, new claims for skilled nursing and hospice for one year, and mortality. The researchers found that in 3,159 older adults there were 147 deaths within 30 days and 665 deaths within one year, and the following predictors of mortality: respiratory diagnosis, serious brain injury, having a baseline disability, or a score of greater than or equal to 2 on the Charlson Comorbidity Index. The study concluded that in the year after experiencing a fall, community-living older adults who require ambulance transport to the hospital have increases in institutionalized living, the utilization of health care, and mortality.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Caughey AB .
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
West J Emerg Med 2022 May 14;23(3):375-85. doi: 10.5811/westjem.2021.11.54327..
Keywords: Elderly, Falls, Emergency Department, Mortality, Healthcare Utilization
Green RK, Shah MN, Clark LR
Comparing emergency department use among individuals with varying levels of cognitive impairment.
This study compared the frequency of emergency department (ED) use among a cohort of individuals with mild to well-defined cognitive impairment. This retrospective cohort study of English-speaking, community-dwelling individuals was conducted at four health system-based multidisciplinary clinics from 2014 to 2016. The authors obtained demographic and clinical data, including neuropsychological testing results, through chart review and linkage to electronic health record data. They characterized the frequency and quantity of ED use within one year (6 months before and after) of cognitive evaluation and compared ED use between the three groups using bivariate and multivariate approaches. Of the 779 eligible patients, 89 were diagnosed as cognitively intact, 372 as having mild cognitive impairment (MCI), and 318 as having Alzheimer’s Disease and related dementias (ADRD). The proportion of subjects with any annual ED use did not significantly increase with greater cognitive impairment. The average number of ED visits also did not increase significantly with patients with MCI or ADRD having an elevated but non-significant risk of an ED visit compared to cognitively intact individuals.
AHRQ-funded; HS024558.
Citation: Green RK, Shah MN, Clark LR .
Comparing emergency department use among individuals with varying levels of cognitive impairment.
BMC Geriatr 2022 May 2;22(1):382. doi: 10.1186/s12877-022-03093-5..
Keywords: Emergency Department, Neurological Disorders, Healthcare Utilization
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
Michelson KA, Cushing AM, Bucholz EM
Association of county-level availability of pediatricians with emergency department visits.
This study examined whether children in counties with more pediatricians had fewer emergency department (ED) visits. The authors conducted a cross-sectional study of all ED visits among children younger than 18 years from 6 states. Each additional pediatrician per 1000 children was associated with a 13.7% decrease in ED visits in the state-adjusted model. In the full model however, there was no association. Other factors such as presence of an urgent care facility, high socioeconomic status, urban status and higher proportions of White race and nonpublic insurance were also associated with decreased ED visit rates.
AHRQ-funded; HS026503.
Citation: Michelson KA, Cushing AM, Bucholz EM .
Association of county-level availability of pediatricians with emergency department visits.
Pediatr Emerg Care 2022 Feb;38(2):e953-e57. doi: 10.1097/pec.0000000000002502..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Workforce, Provider: Physician, Rural Health
Holland JE, Varni SE, Pulcini CD
Assessing the relationship between well-care visit and emergency department utilization among adolescents and young adults.
This study investigated the association between adolescent and young adult (AYA) well-care visits and emergency department (ED) utilization. Vermont’s all-payer claims data for 2018 was used to evaluate visits for 49,089 AYAs (aged 12-21 years) with a health-care claim. Nearly half (49%) of AYAs who engaged with the health-care system did not have a well-care visit in 2018. Those AYAs had 24% greater odds of going to the ED at least once in 2018, controlling for age, sex, insurance type, and medical complexity. Late adolescents and young adults (aged 18-21) who did not attend a well-care visit had 47% greater odds of ED visits, middle adolescents (15-17 years) had 9% greater odds, and early adolescents (12-14 years) had 16% greater odds.
AHRQ-funded; HS024575.
Citation: Holland JE, Varni SE, Pulcini CD .
Assessing the relationship between well-care visit and emergency department utilization among adolescents and young adults.
J Adolesc Health 2022 Jan;70(1):64-69. doi: 10.1016/j.jadohealth.2021.08.011..
Keywords: Children/Adolescents, Young Adults, Emergency Department, Healthcare Utilization, Medicaid, Prevention
James TG, Varnes JR, Sullivan MK
Conceptual model of emergency department utilization among deaf and hard-of-hearing patients: a critical review.
10.3390/ijerph182412901.
This study’s purpose was to develop a conceptual model describing patient and non-patient factors influencing emergency department (ED) utilization and care processes among deaf and hard-of-hearing (DHH) populations. This critical review used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The conceptual model developed provides predisposing, enabling, and reinforcing factors influencing DHH patient care, ED care seeking, and ED care processes.
This study’s purpose was to develop a conceptual model describing patient and non-patient factors influencing emergency department (ED) utilization and care processes among deaf and hard-of-hearing (DHH) populations. This critical review used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The conceptual model developed provides predisposing, enabling, and reinforcing factors influencing DHH patient care, ED care seeking, and ED care processes.
AHRQ-funded; HS027537.
Citation: James TG, Varnes JR, Sullivan MK .
Conceptual model of emergency department utilization among deaf and hard-of-hearing patients: a critical review.
Int J Environ Res Public Health 2021 Dec 7;18(24). doi: 10.3390/ijerph182412901..
Keywords: Emergency Department, Disabilities, Healthcare Utilization
Heslin KC, Barrett ML, Hensche M
AHRQ Author: Heslin KC, Karaca Z, Owens PL
Effects of hurricanes on emergency department utilization: an analysis across 7 US storms.
This study examines changes in emergency department (ED) utilization for residents of 344 counties after the occurrence of 7 US hurricanes between 2005 and 2016. Using HCUP data, findings showed that the overall population rate of weekly ED visits changed little post-hurricane, but rates by disease categories and age demonstrated varying results. ED utilization rates for respiratory disorders exhibited the largest post-hurricane increase, especially 2-3 weeks following the hurricane. The change in population rates by disease categories and age tended to be higher for people residing in counties closer to the hurricane path.
Citation: Heslin KC, Barrett ML, Hensche M .
Effects of hurricanes on emergency department utilization: an analysis across 7 US storms.
Disaster Med Public Health Prep 2021 Dec;15(6):762-69. doi: 10.1017/dmp.2020.281..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Emergency Preparedness
Carrel M, Clore GS, Kim S
Health care utilization among Texas Veterans Health Administration enrollees before and after Hurricane Harvey, 2016-2018.
The purpose of this study was to determine how the differential exposure to Hurricane Harvey in August 2017 was associated with changes in utilization of Veterans Health Administration health care. Findings suggested that flood disasters such as Hurricane Harvey may be associated with declines in health care utilization that differ according to flood status, race, and income strata. The patients most exposed to the disaster had the greatest delay or nonreceipt of care.
AHRQ-funded; HS027472.
Citation: Carrel M, Clore GS, Kim S .
Health care utilization among Texas Veterans Health Administration enrollees before and after Hurricane Harvey, 2016-2018.
JAMA Netw Open 2021 Dec;4(12):e2138535. doi: 10.1001/jamanetworkopen.2021.38535..
Keywords: Healthcare Utilization, Emergency Department
Hoffmann JA, Hall M, Lorenz D
Emergency department visits for suicidal ideation and self-harm in rural and urban youths.
The authors sought to compare emergency department (ED) visit rates for suicidal ideation and/or self-harm among youth by urban-rural location of residence. Data was taken from the Nationwide Emergency Department Sample. They found that, compared with youths living in urban areas, youths living in rural areas had higher ED visit rates for self-harm, including self-inflicted firearm injuries. The researchers recommended preventive approaches for self-harm based in community and ED settings in order to help address these differences.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Hall M, Lorenz D .
Emergency department visits for suicidal ideation and self-harm in rural and urban youths.
J Pediatr 2021 Nov;238:282-89.e1. doi: 10.1016/j.jpeds.2021.07.013..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Behavioral Health, Rural Health, Urban Health, Healthcare Utilization
Allen L, Cummings JR, Hockenberry JM
The impact of urgent care centers on nonemergent emergency department visits.
This study looked at the impact of urgent care centers on nonemergency emergency department (ED) use. Secondary data from a novel urgent care center database, linked to the HCUP State Emergency Department Databases (SEDD) from six states was used. Data from ZIP codes with no urgent care centers served as a control group compared to areas with local urgent care centers. Having an open urgent care center in a ZIP code reduced the total number of ED visits by residents by 17.2% largely due to visits for less urgent conditions. The effect was concentrated in areas with hospitals with the longest ED wait times. The total number of uninsured visits to the ED were reduced by 21% and for Medicaid visits by 29.1%.
AHRQ-funded; HS2484501.
Citation: Allen L, Cummings JR, Hockenberry JM .
The impact of urgent care centers on nonemergent emergency department visits.
Health Serv Res 2021 Aug;56(4):721-30. doi: 10.1111/1475-6773.13631..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Access to Care