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
26 to 50 of 163 Research Studies DisplayedLe Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
The objective of the study was to compare in-hospital emergency medicine (EM) trainees' performance on endotracheal intubation (ETI) delivered from both the seated and standing positions. The study concluded that the position of the in-hospital provider, whether seated or standing, had no effect on the provider's ETI performance. Since environmental circumstances sometimes necessitate alternative positioning for effective ETI administration, the findings suggest that there may be value in training residents to perform ETI from both positions.
AHRQ-funded; HS021456.
Citation: Le Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM .
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
West J Emerg Med 2018 Jul;19(4):660-67. doi: 10.5811/westjem.2018.4.37227..
Keywords: Education: Continuing Medical Education, Emergency Medical Services (EMS), Patient Safety, Provider Performance
Joseph D, Vogel JA, Smith CS
Alcohol as a factor in 911 calls in Denver.
This study analyzed data from 911 calls in Denver, Colorado to determine the impact of excessive alcohol consumption on those calls. The number of calls made from July 1, 2012 to June 30, 2014 was 169,642 and of those calls 30% had alcohol consumption has a main factor, and 29% as a contribution factor. These calls were more likely associated with male sex, traumatic injuries, advanced monitoring, airway adjuncts, and medications for sedation.
AHRQ-funded; HS023901.
Citation: Joseph D, Vogel JA, Smith CS .
Alcohol as a factor in 911 calls in Denver.
Prehosp Emerg Care 2018 Jul-Aug;22(4):427-35. doi: 10.1080/10903127.2017.1413467..
Keywords: Alcohol Use, Emergency Department, Emergency Medical Services (EMS), Healthcare Utilization
Mistry B, Stewart De Ramirez S, Kelen G
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
This study assessed the accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. It found that the concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, its findings point to a need for more reliable ED triage tools.
AHRQ-funded; HS023641.
Citation: Mistry B, Stewart De Ramirez S, Kelen G .
Accuracy and reliability of emergency department triage using the emergency severity index: an international multicenter assessment.
Ann Emerg Med 2018 May;71(5):581-87.e3. doi: 10.1016/j.annemergmed.2017.09.036.
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Keywords: Decision Making, Emergency Department, Emergency Medical Services (EMS), Health Information Technology (HIT), Nursing
Richards CT, Huebinger R, Tataris KL
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
This study explores the hypothesize that a cut-off score of the Cincinnati Prehospital Stroke Scale (CPSS), an assessment tool currently used by emergency medical services (EMS) providers, can be used to identify large vessel occlusion (LVO). Patients with acute ischemic stroke arriving via EMS at a high-volume stroke center in a large city were identified in a prospective, single-center registry. LVO was confirmed via head and neck vessel imaging and CPSS scores were abstracted from pre-hospital EMS records. The researchers conclude that a CPSS score of 3 identifies LVO in AIS patients reliably, and that EMS providers may be able to use the CPSS with a cut-off score to screen for patients with suspected LVO.
AHRQ-funded; HS000078.
Citation: Richards CT, Huebinger R, Tataris KL .
Cincinnati prehospital stroke scale can identify large vessel occlusion stroke.
Prehosp Emerg Care 2018 May-Jun;22(3):312-18. doi: 10.1080/10903127.2017.1387629..
Keywords: Diagnostic Safety and Quality, Emergency Department, Emergency Medical Services (EMS), Stroke
Mbachu SN, Pieribone VA, Bechtel KA
Optimizing recruitment and retention of adolescents in ED research: findings from concussion biomarker pilot study.
The authors conducted a pilot study to optimize screening, recruitment, and enrollment strategies for a larger, fully-powered study that seeks to identify proteins in the blood of adolescent athletes following a concussion that are significantly and consistently altered compared with age- and gender-matched controls with isolated extremity injuries. They found that EHR-based notifications and financial incentives for participation in ED research on prolonged recovery in adolescents with concussion increased participant identification and enrollment and retention rates to inform and optimize the enrollment and recruitment strategies for a larger study. There was a clear trend for participants to present to the ED on nights or weekends, likely reflecting the time of sport play.
AHRQ-funded; HS021271.
Citation: Mbachu SN, Pieribone VA, Bechtel KA .
Optimizing recruitment and retention of adolescents in ED research: findings from concussion biomarker pilot study.
Am J Emerg Med 2018 May;36(5):884-87. doi: 10.1016/j.ajem.2017.09.014.
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Keywords: Children/Adolescents, Emergency Department, Emergency Medical Services (EMS), Health Services Research (HSR), Research Methodologies
Velopulos CG, Shihab HM, Lottenberg L
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).
This study reviewed the published evidence on prehospital spine immobilization or spinal motion restriction in adult patients with penetrating trauma in order to structure a practice management guideline. Using a Cochrane-style systematic review, 24 studies met inclusion criteria; five studies were used for the quantitative review. No study showed benefit to spine immobilization with regard to mortality and neurologic injury, even for patients with direct neck injuries. Increased mortality was associated with spine immobilization. The authors recommend that spine immobilization not be routinely used for adult patients with penetrating trauma.
AHRQ-funded; HS024547.
Citation: Velopulos CG, Shihab HM, Lottenberg L .
Prehospital spine immobilization/spinal motion restriction in penetrating trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma (EAST).
J Trauma Acute Care Surg 2018 May;84(5):736-44. doi: 10.1097/ta.0000000000001764..
Keywords: Care Management, Emergency Medical Services (EMS), Evidence-Based Practice, Guidelines, Trauma
Mullen MT, Pajerowski W, Messe SR
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
The purpose of this study was to evaluate the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and to use geographic modeling in order to evaluate expected changes for a comprehensive stroke center policy. Suspected stroke emergency medical services encounters in Philadelphia, PA, were identified, and transport times before and after the initiation of a PSC destination policy in October 2011 were compared. Geographic modeling was used to estimate the impact of bypassing the closest hospital for the closest PSC or comprehensive stroke centers, which was common before the official policy and increased steadily over time. The researchers conclude that the time taken to route patients to PSCs or comprehensive stroke centers is low.
AHRQ-funded; HS018362.
Citation: Mullen MT, Pajerowski W, Messe SR .
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
Stroke 2018 Apr;49(4):1021-23. doi: 10.1161/strokeaha.118.020691.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitals, Policy, Stroke
Newgard CD, Uribe-Leitz T, Haider AH
Undertriage remains a vexing problem for even the most highly developed trauma systems: The need for innovations in field triage.
This paper is a commentary on an article by Voskens FJ, et al., published in 2017 in JAMA Surgery, entitled “Accuracy of prehospital triage in selecting severely injured trauma patients.”
AHRQ-funded; HS023796.
Citation: Newgard CD, Uribe-Leitz T, Haider AH .
Undertriage remains a vexing problem for even the most highly developed trauma systems: The need for innovations in field triage.
AHRQ-funded; HS023796..
Keywords: Emergency Medical Services (EMS), Health Services Research (HSR), Trauma
Ray KN, Olson LM, Edgerton EA
Access to high pediatric-readiness emergency care in the United States.
The researchers determined the geographic accessibility of emergency departments (EDs) with high pediatric readiness by assessing the percentage of US children living within a 30-minute drive time of an ED with high pediatric readiness, as defined by collaboratively developed published guidelines. They concluded that a significant proportion of US children do not have timely access to EDs with high pediatric readiness.
AHRQ-funded; HS022989.
Citation: Ray KN, Olson LM, Edgerton EA .
Access to high pediatric-readiness emergency care in the United States.
J Pediatr 2018 Mar;194:225-32.e1. doi: 10.1016/j.jpeds.2017.10.074.
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Keywords: Access to Care, Children/Adolescents, Emergency Department, Emergency Medical Services (EMS), Children/Adolescents
Schoenfeld EM, Goff SL, Elia TR
A qualitative analysis of attending physicians' use of shared decision-making: implications for resident education.
This study explored emergency medicine (EM) attending physicians' use of shared decision-making (SDM) in the context of their experience as former residents and current educators and assessed the implications of these findings on learning opportunities for residents. The investigators concluded that a constellation of factors may diminish opportunities for residents to acquire and practice SDM skills. Further research should explore residents' perspectives, address the modifiable obstacles identified, and examine whether these issues generalize to other specialties.
AHRQ-funded; HS024311.
Citation: Schoenfeld EM, Goff SL, Elia TR .
A qualitative analysis of attending physicians' use of shared decision-making: implications for resident education.
J Grad Med Educ 2018 Feb;10(1):43-50. doi: 10.4300/jgme-d-17-00318.1..
Keywords: Decision Making, Education: Continuing Medical Education, Emergency Medical Services (EMS), Provider
Khubchandani JA, Shen C, Ayturk D
Disparities in access to emergency general surgery care in the United States.
This study examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. The study concluded that gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities and policy initiatives need to increase emergency general surgery capacity nationwide.
AHRQ-funded; HS022694.
Citation: Khubchandani JA, Shen C, Ayturk D .
Disparities in access to emergency general surgery care in the United States.
Surgery 2018 Feb;163(2):243-50. doi: 10.1016/j.surg.2017.07.026..
Keywords: Access to Care, Disparities, Emergency Medical Services (EMS), Surgery, Vulnerable Populations
Hinson JS, Martinez DA, Schmitz PSK
Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis.
This study sought to measure the frequency of under- and over-triage of patients by nurses using the Emergency Severity Index (ESI) in Brazil and to identify factors independently associated with each. It concluded that, despite rigorous and ongoing training of ESI users, a large number of patients in this cohort were under- or over-triaged. Advanced age, vital sign derangements, and specific chief complaints were particularly under-appreciated.
AHRQ-funded; HS023641.
Citation: Hinson JS, Martinez DA, Schmitz PSK .
Accuracy of emergency department triage using the Emergency Severity Index and independent predictors of under-triage and over-triage in Brazil: a retrospective cohort analysis.
Int J Emerg Med 2018 Jan 15;11(1):3. doi: 10.1186/s12245-017-0161-8.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare Delivery, Nursing
Hsuan C, Horwitz JR, Ponce NA
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
EMTALA, which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. Respondents identified 5 main causes of noncompliance as well as suggesting methods to improve compliance.
AHRQ-funded; HS024247.
Citation: Hsuan C, Horwitz JR, Ponce NA .
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
J Healthc Risk Manag 2018 Jan;37(3):31-41. doi: 10.1002/jhrm.21288.
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Keywords: Emergency Medical Services (EMS), Payment, Hospitals, Medicare, Uninsured
Chou R, Korthuis PT, McCarty D
Management of suspected opioid overdose with naloxone in out-of-hospital settings: a systematic review.
This review synthesized evidence on 1) the effects of naloxone route of administration and dosing for suspected opioid overdose in out-of-hospital settings on mortality, reversal of overdose, and harms, and 2) the need for transport to a health care facility. It concluded that higher-concentration intranasal naloxone (2 mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events.
AHRQ-funded; 290201500009I.
Citation: Chou R, Korthuis PT, McCarty D .
Management of suspected opioid overdose with naloxone in out-of-hospital settings: a systematic review.
Ann Intern Med 2017 Dec 19;167(12):867-75. doi: 10.7326/m17-2224.
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Keywords: Emergency Medical Services (EMS), Evidence-Based Practice, Medication, Opioids, Patient-Centered Outcomes Research
Raven MC, Guzman D, Chen AH
Out-of-network emergency department use among managed Medicaid beneficiaries.
The researchers examined factors associated with out-of-network ED use among Medicaid beneficiaries. They concluded that there are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care.
AHRQ-funded; HS021700.
Citation: Raven MC, Guzman D, Chen AH .
Out-of-network emergency department use among managed Medicaid beneficiaries.
Health Serv Res 2017 Dec;52(6):2156-74. doi: 10.1111/1475-6773.12604.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Medicaid, Primary Care, Social Determinants of Health
Juriga LL, Murray DJ, Boulet JR
Simulation and the diagnostic process: a pilot study of trauma and rapid response teams.
Simulation can be used to recreate conditions that engage teams in the diagnostic process. In contrast to most instruction about diagnostic error, teams learn through realistic experiences and receive timely feedback about their decision-making skills. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error.
AHRQ-funded; HS022265; HS018731.
Citation: Juriga LL, Murray DJ, Boulet JR .
Simulation and the diagnostic process: a pilot study of trauma and rapid response teams.
Diagnosis 2017 Nov 27;4(4):241-49. doi: 10.1515/dx-2017-0010..
Keywords: Diagnostic Safety and Quality, Emergency Medical Services (EMS), Injuries and Wounds, Training, Trauma
Branzetti JB, Adedipe AA, Gittinger MJ
Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.
The purpose of this study was to evaluate the impact of a novel Just-in-Time (JIT) intervention on transvenous pacemaker (TVP) placement during a simulated patient event. The authors concluded that a JIT intervention improved procedure performance, suggesting a role for JIT interventions in rarely performed procedures.
AHRQ-funded; HS020295
Citation: Branzetti JB, Adedipe AA, Gittinger MJ .
Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.
BMJ Qual Saf 2017 Nov;26(11):881-91. doi: 10.1136/bmjqs-2017-006656..
Keywords: Medical Devices, Patient Safety, Surgery, Training, Emergency Medical Services (EMS)
Probst MA, Kanzaria HK, Schoenfeld EM
Shared decisionmaking in the emergency department: a guiding framework for clinicians.
The authors developed a simple framework to illustrate how shared decisionmaking should be approached in clinical practice. They believe it should be the preferred or default approach to decisionmaking, except in clinical situations in which 3 factors interfere. These 3 factors are lack of clinical uncertainty or equipoise, patient decisionmaking ability, and time, all of which can render shared decisionmaking infeasible. The authors next discuss how to address each factor.
AHRQ-funded; HS021271; HS024311.
Citation: Probst MA, Kanzaria HK, Schoenfeld EM .
Shared decisionmaking in the emergency department: a guiding framework for clinicians.
Ann Emerg Med 2017 Nov;70(5):688-95. doi: 10.1016/j.annemergmed.2017.03.063.
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Keywords: Decision Making, Emergency Department, Emergency Medical Services (EMS), Evidence-Based Practice, Guidelines
Zachrison KS, Hayden EM, Schwamm LH
Characterizing New England emergency departments by telemedicine use.
The primary objective of this study was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. It concluded that telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hayden EM, Schwamm LH .
Characterizing New England emergency departments by telemedicine use.
West J Emerg Med 2017 Oct;18(6):1055-60. doi: 10.5811/westjem.2017.8.34880.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare Delivery, Health Services Research (HSR), Telehealth
Patterson BW, Smith MA, Repplinger MD
Using chief complaint in addition to diagnosis codes to identify falls in the emergency department.
The researchers compared incidence of falls in an emergency department (ED) cohort using a traditional International Classification of Diseases, Ninth Revision (ICD-9) code-based scheme and an expanded definition that included chief complaint information. They concluded that identifying individuals in the ED who have fallen based on diagnosis codes underestimates the true burden of falls.
AHRQ-funded; HS024558.
Citation: Patterson BW, Smith MA, Repplinger MD .
Using chief complaint in addition to diagnosis codes to identify falls in the emergency department.
J Am Geriatr Soc 2017 Sep;65(9):E135-E40. doi: 10.1111/jgs.14982.
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Keywords: Falls, Emergency Medical Services (EMS), Emergency Department
Newgard CD, Platts-Mills TF
Can an out-of-hospital medication history save lives for injured older adults?
In this issue of Annals, Nishijima et al present a much-needed study evaluating the use of anticoagulation and antiplatelet medications as an additional triage criterion to aid in the identification of older adults with intracranial hemorrhage. The authors believe that the new study helps fill a critical void in suggesting that a targeted medication history, formally integrated as a field triage criterion, may be useful in identifying high-risk older adults.
AHRQ-funded; HS023796.
Citation: Newgard CD, Platts-Mills TF .
Can an out-of-hospital medication history save lives for injured older adults?
Ann Emerg Med 2017 Aug;70(2):139-41. doi: 10.1016/j.annemergmed.2017.02.005.
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Keywords: Blood Thinners, Elderly, Emergency Medical Services (EMS), Injuries and Wounds, Medication
Tiase VL, Crouch B, Bennett H
Descriptive analysis of communication patterns between a local poison control center and community emergency departments.
This study leverages a commercial call recording system to gain insight into the intensity and volume of communication between a poison control center and two rural emergency departments.
AHRQ-funded; HS021472.
Citation: Tiase VL, Crouch B, Bennett H .
Descriptive analysis of communication patterns between a local poison control center and community emergency departments.
2017 IEEE International Conference on Healthcare Informatics (ICHI) 2017 Aug:574. doi: 10.1109/ICHI.2017.89.
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Keywords: Communication, Emergency Department, Emergency Medical Services (EMS), Rural Health
Robinson M, Greenhawt M, Stukus DR
Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department.
Researchers evaluated factors associated with anaphylaxis management before arrival at the emergency department (ED) or urgent care center (UCC). Reactions occurring at home were less likely to be treated with epinephrine compared with reactions occurring at school. The odds of receiving epinephrine before arrival at the ED or UCC were significantly lower with a 2-organ system or 3-organ system presentation compared with 1-organ system involvement.
AHRQ-funded; HS024599.
Citation: Robinson M, Greenhawt M, Stukus DR .
Factors associated with epinephrine administration for anaphylaxis in children before arrival to the emergency department.
Ann Allergy Asthma Immunol 2017 Aug;119(2):164-69. doi: 10.1016/j.anai.2017.06.001.
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Keywords: Children/Adolescents, Emergency Medical Services (EMS), Healthcare Utilization, Medication, Patient-Centered Outcomes Research
Brown SM, Duggal A, Hou PC
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
The objective of the study was to validate the superiority of nonlinear imputation of PaO2/FIO2 (a clinical indicator of hypoxaemia) among mechanically ventilated patients and understand what factors influence the accuracy of imputation. It concluded that in mechanically ventilated patients, nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 seems accurate, especially for moderate-severe hypoxemia. Linear and log-linear imputations cannot be recommended.
AHRQ-funded; HS021456.
Citation: Brown SM, Duggal A, Hou PC .
Nonlinear imputation of PaO2/FIO2 from SpO2/FIO2 among mechanically ventilated patients in the ICU: a prospective, observational study.
Crit Care Med 2017 Aug;45(8):1317-24. doi: 10.1097/ccm.0000000000002514.
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Keywords: Diagnostic Safety and Quality, Respiratory Conditions, Intensive Care Unit (ICU), 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