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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 18 of 18 Research Studies DisplayedKilaru AS, Illenberger N, Meisel ZF
Incidence of timely outpatient follow-up care after emergency department encounters for acute heart failure.
The purpose of this retrospective cohort study was to explore the incidence of outpatient follow-up care after presentation for acute heart failure at the emergency department (ED), and to present patient characteristics associated with receiving timely follow-up care. Using an administrative claims database from a United States commercial insurer, the researchers reviewed 52,732 adult patients with a mean age of 73.9 years discharged from the ED with the principal diagnosis of acute heart failure. The study found that within 30 days of the ED encounter, 23.2% of patients attended an outpatient clinic visit for heart failure, with 15.9% patients hospitalized before they could obtain an outpatient clinic visit. Patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. The study concluded that almost 20% of patients require hospitalization within 30 days of an ED for visit for heart failure, and few obtain timely outpatient follow-up after the initial visit.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Illenberger N, Meisel ZF .
Incidence of timely outpatient follow-up care after emergency department encounters for acute heart failure.
Circ Cardiovasc Qual Outcomes 2022 Sep;15(9):e009001. doi: 10.1161/circoutcomes.122.009001..
Keywords: Ambulatory Care and Surgery, Emergency Department, Heart Disease and Health, Cardiovascular Conditions
Prabhakaran S, Khorzad R, Parnianpour Z
Door-in-door-out process times at primary stroke centers in Chicago.
This study sought to identify modifiable predictors of door-in-door-out times for transfer of acute stroke patients from primary stroke centers to comprehensive stroke centers using 3 Chicago-region primary stroke centers as a model. A retrospective analysis of consecutive patients with acute stroke from February 2018 to January 2020 who required transfer from 1 of 3 primary stroke centers to 1 of 3 affiliated comprehensive stroke centers was conducted. Of 191 total patients, 67.9% arrived by emergency medical services and 57.4% during off-hours. Telestroke was performed in 84.2% of patients, 30.5% received alteplase, and 48.4% underwent a computed tomography (CT) at the primary stroke center. The median door-in-door-out time was 148.5 minutes. The largest contributors to longer door-in-door-out times were CT to CT angiography time, transfer center contact to ambulance request time, ambulance request to arrive time, and transfer ambulance at primary stroke center. Other factors included CT angiography performed at the primary stroke center, walk-in arrival mode, administration of intravenous alteplase request by primary stroke center, and ambulance request by the primary stroke center.
AHRQ-funded; HS025359.
Citation: Prabhakaran S, Khorzad R, Parnianpour Z .
Door-in-door-out process times at primary stroke centers in Chicago.
Ann Emerg Med 2021 Nov;78(5):674-81. doi: 10.1016/j.annemergmed.2021.06.018..
Keywords: Stroke, Cardiovascular Conditions, Healthcare Delivery, Emergency Department
Vaghani V, Wei L, U
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
Diagnostic errors are major contributors to preventable patient harm. In this study, the investigators validated the use of an electronic health record (EHR)-based trigger (e-trigger) to measure missed opportunities in stroke diagnosis in emergency departments (EDs). The investigators concluded that a symptom-disease pair-based e-trigger identified missed diagnoses of stroke with a modest positive predictive value, underscoring the need for chart review validation procedures to identify diagnostic errors in large data sets.
AHRQ-funded; HS017820; HS024459.
Citation: Vaghani V, Wei L, U .
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
J Am Med Inform Assoc 2021 Sep 18;28(10):2202-11. doi: 10.1093/jamia/ocab121..
Keywords: Stroke, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Adverse Events
Soares WE, Knee A, Gemme SR
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
The HEART score is a risk stratification aid that may safely reduce chest pain admissions for emergency department patients. However, differences in interpretation of subjective components potentially alters the performance of the score. In this study, the investigators compared agreement between HEART scores determined during clinical practice with research-generated scores and estimated their accuracy in predicting 30-day major adverse cardiac events.
AHRQ-funded; HS024815.
Citation: Soares WE, Knee A, Gemme SR .
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
Ann Emerg Med 2021 Aug;78(2):231-41. doi: 10.1016/j.annemergmed.2021.03.024..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Health Information Technology (HIT)
Swanson MB, Miller AC, Ward MM MM
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (1) identify the impact of telemedicine on ED stroke care, (2) identify if telemedicine impact varied by network, and (3) describe the variation in process outcomes by telemedicine across EDs.
AHRQ-funded; HS025753.
Citation: Swanson MB, Miller AC, Ward MM MM .
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
J Telemed Telecare 2021 Jul;27(6):343-52. doi: 10.1177/1357633x19877746..
Keywords: Emergency Department, Telehealth, Health Information Technology (HIT), Imaging, Stroke, Cardiovascular Conditions
Zachrison KS, Natsui S, Luan Erfe BM
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
The objective of this study was to determine whether acute ischemic stroke (AIS) patients' language preference was associated with differences in time from symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DTI), and door-to-needle (DTN) time. The investigators concluded that consistent with prior reports examining disparities in care, a systems-based approach to acute stroke prevents differences in hospital-based metrics.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Natsui S, Luan Erfe BM .
Language preference does not influence stroke patients' symptom recognition or emergency care time metrics.
Am J Emerg Med 2021 Feb;40:177-80. doi: 10.1016/j.ajem.2020.10.064..
Keywords: Stroke, Cardiovascular Conditions, Emergency Department, Cultural Competence, Diagnostic Safety and Quality
Miller AC, Ward MM, Ullrich F
Emergency department telemedicine consults are associated with faster time-to-electrocardiogram and time-to-fibrinolysis for myocardial infarction patients.
The objective of this study was to evaluate the impact of telemedicine on the timeliness of emergency acute myocardial infarction (AMI) care for patients presenting to rural emergency departments (EDs) with chest pain. Findings showed that, in telemedicine networks, telemedicine consultation during the ED visit was associated with improved timeliness of electrocardiogram evaluation and increased use of fibrinolytic reperfusion therapy for rural AMI patients.
AHRQ-funded; HS025753.
Citation: Miller AC, Ward MM, Ullrich F .
Emergency department telemedicine consults are associated with faster time-to-electrocardiogram and time-to-fibrinolysis for myocardial infarction patients.
Telemed J E Health 2020 Dec;26(12):1440-48. doi: 10.1089/tmj.2019.0273..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Rural Health, Heart Disease and Health, Cardiovascular Conditions
Jaffe TA, Goldstein JN, Yun BJ
Impact of emergency department crowding on delays in acute stroke care.
This study examined the relationship between emergency department (ED) crowding and timely delivery of emergency stroke care. The authors prospectively collected data from their own institution’s Get with the Guidelines-Stroke registry to identify consecutive acute ischemic stroke patients who came to their urban academic ED from July 2016-August 2018. ED conditions were categorized as normal capacity, high ED crowding, and severe crowding. Of the 1379 patients presenting with ischemic stroke during the study period, 78% presented at normal, 15% during high ED crowding, and 7% during severe crowding times. Outcomes of interest were door-to-imaging (DIT) time. There were no significant delays in stroke care delivery associated with ED crowding.
AHRQ-funded; HS024561.
Citation: Jaffe TA, Goldstein JN, Yun BJ .
Impact of emergency department crowding on delays in acute stroke care.
West J Emerg Med 2020 Jul 8;21(4):892-99. doi: 10.5811/westjem.2020.5.45873..
Keywords: Emergency Department, Stroke, Cardiovascular Conditions, Healthcare Delivery, Quality of Care
Martsolf GR, Nuckols TK, Fingar KR
AHRQ Author: Stocks C, Owens PL
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
The purpose of this study was to compare the rate at which patients with nonspecific chest pain return to the hospital within 7 days after index observation visits versus after index emergency department and inpatient visits. Findings showed that up to 1 in 10 patients discharged with nonspecific chest pain returned to the hospital within 1week. Compared with emergency department and inpatient care, observation visits were associated with lower revisit rates. Recommendations include further research to refine clinical standards of care for nonspecific chest pain as well as to investigate the healthcare delivery and patient factors that influence 7-day revisit rates.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Martsolf GR, Nuckols TK, Fingar KR .
Nonspecific chest pain and hospital revisits within 7 days of care: variation across emergency department, observation and inpatient visits.
BMC Health Serv Res 2020 Jun 8;20(1):516. doi: 10.1186/s12913-020-05200-x..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Pain, Healthcare Utilization, Hospitals, Heart Disease and Health, Cardiovascular Conditions
Chen J, Sadasivam R, Blok AC
The association between patient-reported clinical factors and 30-day acute care utilization in chronic heart failure.
The purpose of this study was to identify post-discharge patient-reported clinical factors associated with repeat acute care use. Through phone surveys with patients with chronic heart failure, findings indicated that patient-reported poor health status, pain, and poor appetite were positively associated with 30-day acute care utilization. Recommendations included further study before incorporation into risk prediction to drive quality improvement efforts.
AHRQ-funded; HS017786.
Citation: Chen J, Sadasivam R, Blok AC .
The association between patient-reported clinical factors and 30-day acute care utilization in chronic heart failure.
Med Care 2020 Apr;58(4):336-43. doi: 10.1097/mlr.0000000000001258..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Emergency Department, Chronic Conditions
Pang PS, Fermann GJ, Hunter BR
TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial).
This study examined the use of high-sensitivity troponin assays to determine whether a patient presenting in the emergency department with chest pains is safe for discharge. An observational study called High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) explored whether serial high-sensitivity troponin (hsTnT) might aid in making diagnosis of acute heart failure faster. The presence of hsTnT above the 99th percentile usually indicates acute heart failure. Patients in the cohort with hsTnT at or above the 99th percentile were older, more often male, less often black, and more likely to have chronic kidney disease. The study found no difference in risk for 90-day death or rehospitalization or return ED visits in the group with hsTnT above the 99th percentile than those with levels below the 99th percentile so hsTnT would not be considered useful.
AHRQ-funded; HS025411.
Citation: Pang PS, Fermann GJ, Hunter BR .
TACIT (High Sensitivity Troponin T Rules Out Acute Cardiac Insufficiency Trial).
Circ Heart Fail 2019 Jul;12(7):e005931. doi: 10.1161/circheartfailure.119.005931..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Emergency Department, Risk, Decision Making
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
Trent SA, Morse EA, Ginde AA
Barriers to prompt presentation to emergency departments in Colorado after onset of stroke symptoms.
Despite significant morbidity and mortality from stroke, patient delays to emergency department (ED) presentation following the onset of stroke symptoms are one of the main contraindications to treatment for acute ischemic stroke (AIS). The objective of this study was to identify patient and environmental factors associated with delayed presentations to the ED after onset of stroke symptoms.
AHRQ-funded; HS022400.
Citation: Trent SA, Morse EA, Ginde AA .
Barriers to prompt presentation to emergency departments in Colorado after onset of stroke symptoms.
West J Emerg Med 2019 Mar;20(2):237-43. doi: 10.5811/westjem.2018.10.38731..
Keywords: Emergency Department, Stroke, Cardiovascular Conditions, Healthcare Delivery
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
Fong A, Kim TC, Ratwani RM
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
This paper presents Task2Heart, a system developed to integrate near real-time heart rate with in-situ time motion observations. The authors describe and validate the system and discuss its use in the exploration of emergency physician heart rate in-situ.
AHRQ-funded; HS024801.
Citation: Fong A, Kim TC, Ratwani RM .
Task2Heart: exploring heart rate differences with time-motion workflow observations of emergency medicine physicians.
J Med Syst 2018 Aug 7;42(9):170. doi: 10.1007/s10916-018-1024-4..
Keywords: Cardiovascular Conditions, Emergency Department, Workflow, Emergency Medical Services (EMS)
Trent SA, Johnson MA, Morse EA
Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the ED.
The primary objectives of this study were to estimate differences in emergency department (ED) adherence across coronary-related clinical practice guidelines (CPGs) and identify patient, provider, and environmental factors associated with adherence. The investigators found that adherence to ED CPGs for acute coronary syndrome, ST-elevation myocardial infarction, or acute ischemic stroke, differs significantly between cardiovascular and cerebrovascular diseases and is more likely to occur when the diagnosis is highly suggested by the patient's complaint and acknowledged as the primary diagnosis by the treating ED physician.
AHRQ-funded; HS022400.
Citation: Trent SA, Johnson MA, Morse EA .
Patient, provider, and environmental factors associated with adherence to cardiovascular and cerebrovascular clinical practice guidelines in the ED.
Am J Emerg Med 2018 Aug;36(8):1397-404. doi: 10.1016/j.ajem.2017.12.062..
Keywords: Cardiovascular Conditions, Emergency Department, Guidelines, Practice Patterns
Michelson KA, Hudgins JD, Monuteaux MC
Cardiac arrest survival in pediatric and general emergency departments.
Understanding whether pediatric emergency departments (EDs) have higher survival than general EDs may help identify ways to improve care for all patients with out-of-hospital cardiac arrest (OHCA). Researchers sought to determine if OHCA survival differs between pediatric and general EDs. In their nationally representative sample, survival from nontraumatic OHCA was higher in pediatric EDs than general EDs. Survival did not differ in traumatic OHCA.
AHRQ-funded; HS000063.
Citation: Michelson KA, Hudgins JD, Monuteaux MC .
Cardiac arrest survival in pediatric and general emergency departments.
Pediatrics 2018 Feb;141(2). doi: 10.1542/peds.2017-2741.
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Keywords: Cardiovascular Conditions, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Patient-Centered Outcomes Research, Children/Adolescents
Blecker S, Ladapo JA, Doran KM
Emergency department visits for heart failure and subsequent hospitalization or observation unit admission.
The purpose of this study was to examine trends in ED visits for heart failure and disposition following such visits. The investigators found that the number of ED visits for heart failure and the high proportion of ED visits with subsequent inpatient hospitalization have not changed in the last decade. They suggest that opportunities may exist to reduce hospitalizations by increasing short-term management of heart failure in the ED or observation unit.
AHRQ-funded; HS023683.
Citation: Blecker S, Ladapo JA, Doran KM .
Emergency department visits for heart failure and subsequent hospitalization or observation unit admission.
Am Heart J 2014 Dec;168(6):901-8.e1. doi: 10.1016/j.ahj.2014.08.002..
Keywords: Cardiovascular Conditions, Emergency Department, Heart Disease and Health, Hospitalization