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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 DisplayedUrdaneta A, Fisk C, Tandel MD
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
This study examined patterns of air transport for acute ischemic stroke patients over a period of 8 years (2007-2014). The authors abstracted a 20% national sample of Medicare data from patients ≥ 66 years of age hospitalized with a primary diagnosis of acute ischemic stroke who presented to the emergency department by ambulance (air or ground). They analyzed data from 149,751 hospitalized stroke patients who had a mean age of 81.6 years (standard deviation = 8.0 years), 62.1% female (n = 93,007), and 86.3% White (n = 129,268). Of these, 3.7% used any form of air ambulance. Air ambulance use (2007: 2.5%, 2014: 4.9%) and arrival at certified stroke centers (2007: 40.3%, 2014: 63.2%) increased over time. Air ambulance use was less likely among older patients (76-85 years and >85 years vs. 66-75 years; odds ratio [OR] = 0.68 and OR = 0.34, respectively) and all racial minorities except American Natives (OR = 2.07) and more likely among sicker patients (Charlson Comorbidity Index ≥ 2 vs. 1, OR = 1.23) and rural residents (OR = 1.34). After adjustment for covariates, air ambulance use was associated with higher odds of thrombolysis (adjusted OR = 2.57).
AHRQ-funded; HS026207.
Citation: Urdaneta A, Fisk C, Tandel MD .
Air medical transport for acute ischemic stroke patients: a retrospective cohort study of national trends over an 8-year period.
Air Med J 2023 Nov-Dec; 42(6):423-28. doi: 10.1016/j.amj.2023.06.007..
Keywords: Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Mihandoust S, Joseph A, Madathil KC
Comparing sources of disruptions to telemedicine-enabled stroke care in an ambulance.
This study investigated the nature and source of disruptions in an ambulance during the telemedicine-based caregiving process for stroke patients to enhance the ambulance design for supporting telemedicine-based care. Thirteen simulated telemedicine-based stroke consults were video recorded and then coded and analyzed using an existing systems-based flow disruption (FD) taxonomy. Factors that impacted disruptions included seat size, arrangement of assessment equipment, location of telemedicine equipment, and design of the telemedicine camera. The left ambulance seat zone and head of the patient bed had more environmental hazard-related disruptions, while the right zone was more prone to interruptions and communication-related disruptions.
AHRQ-funded; HS026809.
Citation: Mihandoust S, Joseph A, Madathil KC .
Comparing sources of disruptions to telemedicine-enabled stroke care in an ambulance.
HERD 2022 Apr;15(2):96-115. doi: 10.1177/19375867211054759..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Glober N, Supples M, Persaud S
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
This paper describes the outcomes of a pilot study that used novel emergency medical services (EMS) protocol to expedite transfer of patients with large vessel occlusions (LVOs) to a comprehensive stroke center (CSC). The pilot study took place from Oct. 1, 2020 to Feb. 22, 2021 with Indianapolis EMS providers. In patients with possible LVO, the providers remained at the bedside until the clinical assessment and CT angiography were complete. This 5-month mixed methods study measured case-control assessment of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergency transfers via conventional interfacility transfer agencies. The protocol was used 42 times during the study period, with four patients found to have LVOs and transferred to a CSC. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes compared to 314.5 minutes for acute non-stroke transfers during the same period.
AHRQ-funded; HS026390.
Citation: Glober N, Supples M, Persaud S .
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
PLoS One 2022 Feb;17(2):e0264539. doi: 10.1371/journal.pone.0264539..
Keywords: Emergency Medical Services (EMS), Stroke, Cardiovascular Conditions, Critical Care
Rogers H, Madathil KC, Joseph A
An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care.
This study investigates the impact of telemedicine on workload, teamwork, workflow, and communication of geographically distributed caregivers delivering stroke care in ambulance-based telemedicine. Simulated stroke sessions were conducted with selected caregivers, then followed with a survey and interviews. Findings showed that barriers included frustration with equipment, the loss of personal connection of the neurologists with the patients, and physical constraints in the ambulance. Facilitators included live visual communication increasing teamwork and efficiency, the ease of access to neurologist, increased flexibility, and high overall satisfaction and usability.
AHRQ-funded; HS026809.
Citation: Rogers H, Madathil KC, Joseph A .
An exploratory study investigating the barriers, facilitators, and demands affecting caregivers in a telemedicine integrated ambulance-based setting for stroke care.
Appl Ergon 2021 Nov;97:103537. doi: 10.1016/j.apergo.2021.103537..
Keywords: Telehealth, Health Information Technology (HIT), Caregiving, Stroke, Cardiovascular Conditions, Emergency Medical Services (EMS)
Kass-Hout T, Lee J, Tataris K
Prehospital comprehensive stroke center vs primary stroke center triage in patients with suspected large vessel occlusion stroke.
This study’s objective was to evaluate the association of a regional prehospital transport policy that directly triages patients with suspected large vascular occlusion (LVO) stroke to the nearest comprehensive stroke center with rates of endovascular therapy (EVT). This retrospective, multicenter preimplementation-postimplementation study used an interrupted time series analysis to compare treatment rates before and after implementation in patients with acute ischemic stroke (AIS) arriving at 15 primary stroke centers and 8 comprehensive stroke centers in Chicago, Illinois, via emergency medical services (EMS) transport from December 1, 2017, to May 31, 2019. Among 7709 individuals with stroke, 663 with AIS arrived within 6 hours of stroke onset by EMS transport. The EVT rate increased overall among patients with AIS postimplementation and among EMS-transported patients with AIS within 6 hours of onset. There were no differences in EVT rates in patients not arriving by EMS within the 6- to 24-hour window or by interhospital transfer or walk-in.
AHRQ-funded; HS025359.
Citation: Kass-Hout T, Lee J, Tataris K .
Prehospital comprehensive stroke center vs primary stroke center triage in patients with suspected large vessel occlusion stroke.
JAMA Neurol 2021 Oct;78(10):1220-27. doi: 10.1001/jamaneurol.2021.2485..
Keywords: Stroke, Cardiovascular Conditions, Critical Care, Emergency Medical Services (EMS)
Mayampurath A, Parnianpour Z, Richards CT
Improving prehospital stroke diagnosis using natural language processing of paramedic reports.
Accurate prehospital diagnosis of stroke by emergency medical services (EMS) can increase treatments rates, mitigate disability, and reduce stroke deaths. IN this study, the investigators aimed to develop a model that utilized natural language processing of EMS reports and machine learning to improve prehospital stroke identification. The investigators conducted a retrospective study of patients transported by the Chicago EMS to 17 regional primary and comprehensive stroke centers.
AHRQ-funded; HS025359; HS027264.
Citation: Mayampurath A, Parnianpour Z, Richards CT .
Improving prehospital stroke diagnosis using natural language processing of paramedic reports.
Stroke 2021 Aug;52(8):2676-79. doi: 10.1161/strokeaha.120.033580..
Keywords: Stroke, Cardiovascular Conditions, Diagnostic Safety and Quality, Health Information Technology (HIT), Emergency Medical Services (EMS)
Govindarajan P, Shiboski S, Grimes B
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Investigators sought to determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Studying two urban counties in the western region of US that regionalized acute stroke care, they found that in Santa Clara County, intravenous alteplase was administered to 1.7% of patients in the pre-regionalization period and 2.1% in the post-regionalization period, while in San Mateo County, the numbers were 1.3% and 3.2%, respectively. In the post-regionalization phase, San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers, and more frequent use of intravenous alteplase at stroke centers. They concluded that greater post-regionalization improvements in San Mateo County contributed to significantly improved county-level thrombolysis use than Santa Clara County.
AHRQ-funded; HS026207; HS017965.
Citation: Govindarajan P, Shiboski S, Grimes B .
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Prehosp Emerg Care 2020 Jul-Aug;24(4):505-14. doi: 10.1080/10903127.2019.1679303..
Keywords: Stroke, Cardiovascular Conditions, Urban Health, Access to Care, Emergency Medical Services (EMS), Critical Care
Stangenes SR, Painter IS, Rea TD
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
The objective of this study was to test if caller descriptions of chief complaint delays emergency medical dispatchers' (EMDs) recognition of the need for telephone-assisted CPR (T-CPR). The investigators conducted an analysis of N = 433 cardiac arrest calls from six large call centers in the United States. They concluded that caller chief complaint description affected the time to recognition of the need for T-CPR.
AHRQ-funded; HS021658.
Citation: Stangenes SR, Painter IS, Rea TD .
Delays in recognition of the need for telephone-assisted CPR due to caller descriptions of chief complaint.
Resuscitation 2020 Apr;149:82-86. doi: 10.1016/j.resuscitation.2020.02.013..
Keywords: Emergency Medical Services (EMS), Cardiovascular Conditions, Patient Safety, Quality of Care, Telehealth, Health Information Technology (HIT), Communication
Bahr N, Meckler G, Hansen M
Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.
This study used simulation to evaluate Pediatric Advanced Life Support (PALS) guideline performance in pediatric emergency medical service (EMS) care and to introduce this easy-to-use tool to score guideline compliance and patient safety. Standard pediatric resuscitation simulations with a child manikin were created. The manikin was presented as a choking 6-year-old with a complex medical history who is unconscious and apneic, with bradycardic pulse. Teams were expected to monitor vitals, initiate airway management and CPR, and establish vascular access and administer epinephrine based on PALS guidelines. The authors observed 34 EMS teams providing care in P-OHCA simulations. Teams were found to be proficient in assessing vitals, using correct-sized equipment, intubation, and confirmation of tube placement. The teams were delayed in initiating positive pressure ventilation (PPV) and chest compressions, with many teams (53%) deviating from guidelines in chest compression. Half the teams performed continuous compressions before establishing an advanced airway and one team did not perform compressions. Twenty teams also deviated from medication guidelines with 12 teams failing to administer epinephrine, six teams underdosing, and two teams overdosing by more than 20%.
AHRQ-funded; HS025590.
Citation: Bahr N, Meckler G, Hansen M .
Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.
Am J Emerg Med 2021 Oct;48:301-06. doi: 10.1016/j.ajem.2021.06.061.
AHRQ-funded; HS025590..
AHRQ-funded; HS025590..
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Critical Care, Cardiovascular Conditions
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)
Geri G, Fahrenbruch C, Meischke H
Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival.
In this paper, the investigators evaluated bystander cardiopulmonary resuscitation (CPR), hospital-based costs, and long-term survival following out-of-hospital cardiac arrest (OHCA) in order to assess the potential cost-effectiveness of bystander CPR.
AHRQ-funded; HS021658.
Citation: Geri G, Fahrenbruch C, Meischke H .
Effects of bystander CPR following out-of-hospital cardiac arrest on hospital costs and long-term survival.
Resuscitation 2017 Jun;115:129-34. doi: 10.1016/j.resuscitation.2017.04.016..
Keywords: Cardiovascular Conditions, Emergency Medical Services (EMS), Healthcare Costs, Outcomes
Musey PI, Jr., Kline JA
Do gender and race make a difference in acute coronary syndrome pretest probabilities in the emergency department?
The objective was to test for significant differences in subjective and objective pretest probabilities for acute coronary syndrome (ACS) in chest pain patients. Despite consistently estimating the risk for ACS to be lower for both females and minorities concordantly with calculated objective pretest assessments, there does not appear to have been any significant decrease in subsequent evaluation of these perceived lower-risk groups when radiation exposure and costs are taken into account.
AHRQ-funded; HS018519.
Citation: Musey PI, Jr., Kline JA .
Do gender and race make a difference in acute coronary syndrome pretest probabilities in the emergency department?
Acad Emerg Med 2017 Feb;24(2):142-51. doi: 10.1111/acem.13131.
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Keywords: Sex Factors, Racial and Ethnic Minorities, Cardiovascular Conditions, Emergency Medical Services (EMS)
Meischke H, Painter I, Turner AM
Protocol: simulation training to improve 9-1-1 dispatcher identification of cardiac arrest.
The researchers aim to evaluate the use of phone-based standardized patient simulation training to improve identification of the need for Telephone-CPR (T-CPR) and shorten time to start of T-CPR instructions. They specify that the STAT-911 study will evaluate if over-the-phone simulation training with standardized patients can improve 9-1-1 dispatchers' ability identify the need for, and promptly begin T-CPR.
AHRQ-funded; HS021658.
Citation: Meischke H, Painter I, Turner AM .
Protocol: simulation training to improve 9-1-1 dispatcher identification of cardiac arrest.
BMC Emerg Med 2016 Feb 1;16:9. doi: 10.1186/s12873-016-0073-6.
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Keywords: Cardiovascular Conditions, Emergency Medical Services (EMS), Patient Safety, Training
DeLia D, Wang HE, Kutzin J
Prehospital transportation to therapeutic hypothermia centers and survival from out-of-hospital cardiac arrest.
This study provides a real world evaluation of the effectiveness of post-arrest care in therapeutic hypothermia (TH) centers during a time of growing TH dissemination in the state of New Jersey. It concluded that post-arrest outcomes are more favorable at TH centers but these improved outcomes are not apparent until after hospital discharge.
AHRQ-funded; HS020097.
Citation: DeLia D, Wang HE, Kutzin J .
Prehospital transportation to therapeutic hypothermia centers and survival from out-of-hospital cardiac arrest.
BMC Health Serv Res 2015 Dec 2;15:533. doi: 10.1186/s12913-015-1199-z.
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Keywords: Cardiovascular Conditions, Comparative Effectiveness, Emergency Medical Services (EMS), Outcomes
Tataris KL, Mercer MP, Govindarajan P
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
The researchers sought to determine (1) the proportion of patients with suspected cardiac ischaemia who received aspirin and (2) patient and prehospital characteristics that independently predicted administration of aspirin. Patients living in the Southern region of the USA and patients with governmental (federally administered such as Veteran's Health Care, but not Medicare or Medicaid) insurance had the lowest odds of receiving aspirin.
AHRQ-funded; HS017965.
Citation: Tataris KL, Mercer MP, Govindarajan P .
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
Emerg Med J 2015 Nov;32(11):876-81. doi: 10.1136/emermed-2014-204299.
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Keywords: Cardiovascular Conditions, Care Management, Emergency Medical Services (EMS), Heart Disease and Health, Healthcare Delivery, Medication
Sanghavi P, Jena AB, Newhouse JP
Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.
Patients with out-of-hospital cardiac arrest who received basic life support had a higher survival rate and had better neurological functioning at hospital discharge and at 90 days after discharge than those patients who received advanced life support.
AHRQ-funded; HS022798
Citation: Sanghavi P, Jena AB, Newhouse JP .
Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.
JAMA Intern Med. 2015 Feb;175(2):196-204. doi: 10.1001/jamainternmed.2014.5420..
Keywords: Emergency Medical Services (EMS), Cardiovascular Conditions, Critical Care
Johnson MA, Grahan BJ, Haukoos JS
Demographics, bystander CPR, and AED use in out-of-hospital pediatric arrests.
The researchers sought to determine if the 2005 American Heart Association guidelines for routine use of automated external defibrillators during pediatric out-of-hospital arrest are used during resuscitations. They found that young children suffering from presumed out-of-hospital cardiac arrests are less likely to have a shockable rhythm when compared to adults, and are less likely to have an AED used during resuscitation.
AHRQ-funded; HS017526.
Citation: Johnson MA, Grahan BJ, Haukoos JS .
Demographics, bystander CPR, and AED use in out-of-hospital pediatric arrests.
Resuscitation 2014 Jul;85(7):920-6. doi: 10.1016/j.resuscitation.2014.03.044.
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Keywords: Cardiovascular Conditions, Children/Adolescents, Emergency Medical Services (EMS), Guidelines, Patient-Centered Outcomes Research