National Healthcare Quality and Disparities Report
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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
476 to 500 of 559 Research Studies DisplayedKanzaria HK, Hall MK, Moore CL
Emergency department diagnostic imaging: the journey to quality.
The authors examine the current state of quality measurement as it pertains to ED imaging. They also review relevant policies and discuss both the associated challenges and the facilitators of using quality measures to help optimize ED imaging. Understanding such factors will help ensure the delivery of diagnostic imaging that is appropriate, high-quality, and patient-centered.
AHRQ-funded; HS023498.
Citation: Kanzaria HK, Hall MK, Moore CL .
Emergency department diagnostic imaging: the journey to quality.
Acad Emerg Med 2015 Dec;22(12):1380-4. doi: 10.1111/acem.12817.
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Keywords: Emergency Department, Imaging, Quality Indicators (QIs), Quality of Care
Cherney AR, Marin JR, Brown J
AHRQ Author: Henriksen K
Funding research in emergency diagnostic imaging: summary of a panel discussion at the 2015 Academic Emergency Medicine Consensus Conference.
As part of the 2015 Academic Emergency Medicine consensus conference "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization," a panel of representatives from several Federal agencies and organizations including AHRQ was assembled to discuss future opportunities for funding research in this particular area of interest. Representatives from these agencies and organizations discussed their missions and priorities and how they distribute funding.
AHRQ-authored.
Citation: Cherney AR, Marin JR, Brown J .
Funding research in emergency diagnostic imaging: summary of a panel discussion at the 2015 Academic Emergency Medicine Consensus Conference.
Acad Emerg Med 2015 Dec;22(12):1400-5. doi: 10.1111/acem.12825.
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Keywords: Imaging, Emergency Department, Health Services Research (HSR), Healthcare Utilization
Blackmore CC, Castro A
Improving the quality of imaging in the emergency department.
The six-tier efficacy hierarchy of Fryback and Thornbury enables understanding of the value of imaging on multiple levels, ranging from technical efficacy to medical decision-making and higher-level patient and societal outcomes. In this article, the authors elucidate the Fryback and Thornbury framework to define the value of imaging in the ED and to relate emergency imaging to the IOM quality domains.
AHRQ-funded; HS023498.
Citation: Blackmore CC, Castro A .
Improving the quality of imaging in the emergency department.
Acad Emerg Med 2015 Dec;22(12):1385-92. doi: 10.1111/acem.12816.
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Keywords: Decision Making, Emergency Department, Imaging, Quality Improvement
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
Probst MA, Dayan PS, Raja AS
Knowledge translation and barriers to imaging optimization in the emergency department: a research agenda.
This article outlines a research agenda to promote the dissemination and implementation (also known as knowledge translation) of evidence-based interventions for emergency department (ED) imaging, i.e., clinical pathways, clinical decision instruments, and clinical practice guidelines. A multidisciplinary group of stakeholders held online and telephone discussions over a 6-month period culminating at the 2015 Academic Emergency Medicine consensus conference. They were able to identify four overarching research questions.
AHRQ-funded; HS023498.
Citation: Probst MA, Dayan PS, Raja AS .
Knowledge translation and barriers to imaging optimization in the emergency department: a research agenda.
Acad Emerg Med 2015 Dec;22(12):1455-64. doi: 10.1111/acem.12830.
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Keywords: Emergency Department, Evidence-Based Practice, Health Services Research (HSR), Guidelines, Imaging, Implementation
Berdahl C, Schuur JD, Fisher NL
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
In May 2015, Academic Emergency Medicine convened a consensus conference titled "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." As part of the conference, a panel of health care policy leaders and emergency physicians discussed the effect of the Affordable Casre Act and other quality programs on ED diagnostic imaging. This article discusses the content of the panel's presentations.
AHRQ-funded; HS023498.
Citation: Berdahl C, Schuur JD, Fisher NL .
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
Acad Emerg Med 2015 Dec;22(12):1393-9. doi: 10.1111/acem.12829.
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Keywords: Emergency Department, Healthcare Costs, Payment, Policy, Imaging, Policy, Quality Improvement
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
Okafor NG, Doshi PB, Miller SK
Voluntary medical incident reporting tool to improve physician reporting of medical errors in an emergency department.
A web-based, password-protected tool was developed by members of a quality assurance committee for ED providers to report incidents that they believe could impact patient safety. The researchers found that the utilization of this system in one residency program with two academic sites resulted in an increase from 81 reported incidents in 2009, the first year of use, to 561 reported incidents in 2012.
AHRQ-funded; HS017586.
Citation: Okafor NG, Doshi PB, Miller SK .
Voluntary medical incident reporting tool to improve physician reporting of medical errors in an emergency department.
West J Emerg Med 2015 Dec;16(7):1073-8. doi: 10.5811/westjem.2015.8.27390.
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Keywords: Emergency Department, Adverse Events, Medical Errors, Patient Safety, Public Reporting, Quality of 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
Mitchell SE, Martin JM, Krizman K
Design and rationale for a randomized controlled trial to reduce readmissions among patients with depressive symptoms.
This study aims to examine the effectiveness of RED-D, a modified brief Cognitive behavioral therapy (CBT) protocol delivered as a post-discharge extension of the Re-Engineered Discharge (RED), in reducing 30-day readmissions rates and emergency department use as well as depressive symptoms for medical patients with comorbid depressive symptoms.
AHRQ-funded; HS019700.
Citation: Mitchell SE, Martin JM, Krizman K .
Design and rationale for a randomized controlled trial to reduce readmissions among patients with depressive symptoms.
Contemp Clin Trials 2015 Nov;45(Pt B):151-6. doi: 10.1016/j.cct.2015.08.016.
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Keywords: Depression, Emergency Department, Hospital Discharge, Hospital Readmissions, Behavioral Health
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)
Singh S, Lin YL, Nattinger AB
Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge.
This study of Texas acute-care hospitals and ED facilities has found that the risk of readmission varies by ED provider caring for patients after discharge. A large part of this variation is explained by the ED facility in which the ED providers practice. Thus, ED provider practices patterns and ED facility systems of care may be a target for interventions to reduce readmissions.
AHRQ-funded; HS022134.
Citation: Singh S, Lin YL, Nattinger AB .
Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge.
J Hosp Med 2015 Nov;10(11):705-10. doi: 10.1002/jhm.2407.
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Keywords: Emergency Department, Elderly, Hospital Discharge, Hospital Readmissions, Medicare
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
Vickers BP, Shi J, Lu B
Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers.
The researchers used National Emergency Department Sample (NEDS) data to explore the hypothesis that severely injured trauma victims properly triaged to a level I or level II trauma center have significantly lower odds of death than those undertriaged to a non-trauma center. They found that trauma patients with Injury Severity Score of greater than 25 received most benefit from proper triage. Efforts to reduce undertriage should focus on this population.
AHRQ-funded; HS022277.
Citation: Vickers BP, Shi J, Lu B .
Comparative study of ED mortality risk of US trauma patients treated at level I and level II vs nontrauma centers.
Am J Emerg Med 2015 Sep;33(9):1158-65. doi: 10.1016/j.ajem.2015.05.010..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Trauma, Comparative Effectiveness, Mortality
Theodoro D, Olsen MA, Warren DK
Emergency department central line-associated bloodstream infections (CLABSI) incidence in the era of prevention practices.
The incidence of central line–associated bloodstream infections (CLABSI) attributed to central venous catheters (CVCs) inserted in the emergency department (ED) is not widely reported. The goal of this study was to report the incidence of ED CLABSI. It concluded that the CLABSI rates in this academic medical center ED were in the range of those reported by the ICU.
AHRQ-funded; HS018092; HS019455.
Citation: Theodoro D, Olsen MA, Warren DK .
Emergency department central line-associated bloodstream infections (CLABSI) incidence in the era of prevention practices.
Acad Emerg Med 2015 Sep;22(9):1048-55. doi: 10.1111/acem.12744..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Emergency Department, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Prevention
Meisel ZF, Smith RJ
Engaging patients around the risks of opioid misuse in the emergency.
The authors of this editorial considered a number of different types of strategies to increase patient awareness of risks and benefits associated with alternative pain management strategies in the ED. These include traditional education, communicating risks, shared decisionmaking, community interventions and “sticky” narratives. They conclude that patients, families and communities must be included in order to navigate the tight¬rope walk between providing adequate pain control and mitigating misuse and dependency.
AHRQ-funded; HS021956.
Citation: Meisel ZF, Smith RJ .
Engaging patients around the risks of opioid misuse in the emergency.
Pain Manag 2015 Sep;5(5):323-6. doi: 10.2217/pmt.15.31..
Keywords: Emergency Department, Opioids, Pain, Patient and Family Engagement
Toth M, Holmes M, Van Houtven C
Rural Medicare beneficiaries have fewer follow-up visits and greater emergency department use postdischarge.
This study tested whether rural Medicare beneficiaries have a lower likelihood of follow-up care and greater likelihood of a readmission and ED visit within 30 days postdischarge, compared with urban beneficiaries. The results provide evidence of lower quality postdischarge care for Medicare beneficiaries in rural settings.
AHRQ-funded; HS000032.
Citation: Toth M, Holmes M, Van Houtven C .
Rural Medicare beneficiaries have fewer follow-up visits and greater emergency department use postdischarge.
Med Care 2015 Sep;53(9):800-8. doi: 10.1097/mlr.0000000000000401..
Keywords: Rural Health, Elderly, Medicare, Hospital Readmissions, Emergency Department, Hospital Discharge
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)
McElroy LM, Schmidt KA, Richards CT
Early postoperative emergency department care of abdominal transplant recipients.
The goal of this study was to describe early postoperative ED care of transplant recipients. It found that transplant recipients have a high frequency of ED visits in the first post transplantation year and high rates of subsequent hospital admission.
AHRQ-funded; HS000078.
Citation: McElroy LM, Schmidt KA, Richards CT .
Early postoperative emergency department care of abdominal transplant recipients.
Transplantation 2015 Aug;99(8):1652-7. doi: 10.1097/tp.0000000000000781..
Keywords: Emergency Department, Transplantation, Hospital Readmissions, Hospitals
Yang NH, Dharmar M, Yoo BK
Economic evaluation of pediatric telemedicine consultations to rural emergency departments.
The researchers conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. They found that treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. They concluded that telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving or cost-effective compared with telephone consultations.
AHRQ-funded; HS013179.
Citation: Yang NH, Dharmar M, Yoo BK .
Economic evaluation of pediatric telemedicine consultations to rural emergency departments.
Med Decis Making 2015 Aug;35(6):773-83. doi: 10.1177/0272989x15584916.
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Keywords: Healthcare Costs, Emergency Department, Children/Adolescents, Rural Health, Telehealth