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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 25 of 46 Research Studies DisplayedHuff NR, Liu G, Chimowitz H
COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study.
The objectives of this study were to investigate the relationship between emergency nurses' emotional experiences in response to the COVID-19 pandemic and their perceptions of risk to both patients and themselves, and also to investigate the extent to which the use of suppression and reappraisal processes for emotion management were associated with these perceptions. Nurses' negative emotions in response to the pandemic were associated with greater perceptions of both personal and patient safety risks. Chronic tendencies to suppress emotions uniquely predicted higher perceptions of risk. The authors concluded that understanding the factors that influence perceptions of risk are important, since these perceptions can motivate behaviors that may impact patient safety adversely.
AHRQ-funded; HS025752.
Citation: Huff NR, Liu G, Chimowitz H .
COVID-19 related negative emotions and emotional suppression are associated with greater risk perceptions among emergency nurses: a cross-sectional study.
Int J Nurs Stud Adv 2023 Dec; 5:100111. doi: 10.1016/j.ijnsa.2022.100111.
Keywords: COVID-19, Emergency Department, Provider: Nurse
James TG, Sullivan MK, McKee MM
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
The objectives of this qualitative study were to describe emergency department (ED) care-seeking and patient-centered care perspectives among deaf and hard-of-hearing (DHH) patients and to explain quantitative findings related to ED outcomes among DHH and non-DHH patients. Researchers conducted semi-structured interviews with four DHH American Sign Language (ASL)-users and six DHH English speakers from north central Florida. Two themes emerged: DHH patients engage in complex decisionmaking processes to determine ED utilization and patient-centered ED care differs between DHH ASL-users and English speakers. The researchers concluded that their study underscores the importance of better understanding and intervention in DHH patient ED care seeking and delivery to improve patient outcomes.
AHRQ-funded; HS027537.
Citation: James TG, Sullivan MK, McKee MM .
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
Health Expect 2023 Dec; 26(6):2374-86. doi: 10.1111/hex.13842..
Keywords: Emergency Department, Patient-Centered Healthcare, Disabilities, Vulnerable Populations
Michelson KA, Bachur RG, Rangel SJ
Emergency department volume and delayed diagnosis of pediatric appendicitis: a retrospective cohort study.
The objective of this study was to assess the association of emergency department (ED) volume of children and delayed appendicitis diagnoses and to compare complication rates by delayed diagnosis occurrence. HCUP data from eight states were studied on children under the age of 18 with appendicitis in all EDs. The results indicated that higher ED volumes were associated with lower risk of delayed diagnosis of pediatric appendicitis; delay was associated with complications.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Rangel SJ .
Emergency department volume and delayed diagnosis of pediatric appendicitis: a retrospective cohort study.
Ann Surg 2023 Dec 1; 278(6):833-38. doi: 10.1097/sla.0000000000005972..
Keywords: Children/Adolescents, Emergency Department, Diagnostic Safety and Quality
Hoffmann 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
Cavallaro SC, Michelson KA, D'Ambrosi G
Critical revisits among children after emergency department discharge.
This retrospective study’s objectives were to determine the rate of critical emergency department (ED) revisits among children discharged from the ED and to identify factors associated with critical revisits. Using the HCUP State ED Databases (SEDD) and State Inpatient Databases (SID), researchers examined data from six states, including patients under 21 years old. The findings indicated that critical ED revisits after discharge were uncommon and patient death within three days of ED discharge were rare; patients with complex chronic conditions were more likely to have a critical ED revisit. The researchers concluded that future research should focus on understanding higher risk among patients with asthma or a history of complex chronic conditions.
AHRQ-funded; HS026503.
Citation: Cavallaro SC, Michelson KA, D'Ambrosi G .
Critical revisits among children after emergency department discharge.
Ann Emerg Med 2023 Nov; 82(5):575-82. doi: 10.1016/j.annemergmed.2023.06.006..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Hospital Discharge
Song J, Min SH, Chae S
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
The purpose of this study was to characterize risk factor patterns documented in home health care (HHC) clinical notes and explore their relationships with hospitalizations or emergency department (ED) visits. The researchers analyzed data for 73,350 episodes of care from one large HHC organization utilizing dynamic time warping and hierarchical clustering analysis to characterize the patterns of risk factors over time documented in clinical notes. The study found that six temporal clusters emerged, reflecting varying patterns in how risk factors were documented. Patients with a sharp increase in documented risk factors over time had a 3 times greater probability of hospitalization or ED visit than patients with no documented risk factors. The majority of risk factors were found in the physiological domain, and a minority were found in the environmental domain.
AHRQ-funded; HS027742.
Citation: Song J, Min SH, Chae S .
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
J Am Med Inform Assoc 2023 Oct 19; 30(11):1801-10. doi: 10.1093/jamia/ocad101..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Georgette N, Michelson K, Monuteaux M
A temperature- and age-adjusted shock index for emergency department identification of pediatric sepsis.
The objective of this retrospective cohort study was to derive a temperature- and age-adjusted mean shock index (TAMSI) for early identification of sepsis and septic shock in children with suspected infection. Researchers analyzed data on children who presented with suspected infection to a single emergency department over a 10-year period. Test characteristics for the TAMSI cutoffs were compared with those for the Pediatric Advanced Life Support (PALS) tachycardia or systolic hypotension cutoffs. The results showed that TAMSI achieved a similar negative likelihood ratio and improved positive likelihood ratio compared with PALS vital sign cutoffs for the prediction of septic shock, but did not improve on PALS for sepsis prediction among children with suspected infection.
AHRQ-funded; HS026503.
Citation: Georgette N, Michelson K, Monuteaux M .
A temperature- and age-adjusted shock index for emergency department identification of pediatric sepsis.
Ann Emerg Med 2023 Oct; 82(4):494-502. doi: 10.1016/j.annemergmed.2023.03.026..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Diagnostic Safety and Quality
Chae S, Davoudi A, Song J
Predicting emergency department visits and hospitalizations for patients with heart failure in home healthcare using a time series risk model.
This study’s objective was to develop a time series risk model for predicting emergency department (ED) visits and hospitalizations in patients with heart failure (HF) using longitudinal electronic health record data. The authors explored which data sources yield the best-performing models over various time windows. They used data collected from 9362 patients from a large home healthcare (HHC) agency and iteratively developed risk models using both structured and unstructured data. They developed seven specific sets of variables including: (1) the Outcome and Assessment Information Set, (2) vital signs, (3) visit characteristics, (4) rule-based natural language processing-derived variables, (5) term frequency-inverse document frequency variables, (6) Bio-Clinical Bidirectional Encoder Representations from Transformers variables, and (7) topic modeling. Risk models for 18 time windows (1-15, 45, and 60 days) before an ED visit or hospitalization were developed. They compared risk prediction performances using recall, precision, accuracy, F1, and area under the receiver operating curve (AUC). The best-performing model was built using a combination of all 7 sets of variables and the time window of 4 days before an ED visit or hospitalization.
AHRQ-funded; HS027742.
Citation: Chae S, Davoudi A, Song J .
Predicting emergency department visits and hospitalizations for patients with heart failure in home healthcare using a time series risk model.
J Am Med Inform Assoc 2023 Sep 25; 30(10):1622-33. doi: 10.1093/jamia/ocad129..
Keywords: Hospitalization, Emergency Department, Risk
Kilaru AS, Scheulen JJ, Harbertson CA
Boarding in US academic emergency departments during the COVID-19 pandemic.
The purpose of this retrospective study was to characterize changes in emergency department (ED) boarding among U.S. academic EDs across the duration of the COVID-19 pandemic. From January 2019 to December 2021 the researchers utilized a convenience sample of academic departments of emergency medicine to conduct an analysis of monthly data. The primary outcome was total boarding hours, and secondary outcomes included patient volume stratified by ED disposition. Of the 73 academic departments of emergency medicine contacted, 46.6% participated, a total of 43 individual EDs in 25 states. The study found that the adjusted mean total boarding hours per month were significantly lower during the second quarter of 2020 compared to the first quarter of 2019. Beginning in the second quarter of 2021, total boarding hours were significantly higher than pre-pandemic levels, peaking during the fourth quarter of 2021.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Scheulen JJ, Harbertson CA .
Boarding in US academic emergency departments during the COVID-19 pandemic.
Ann Emerg Med 2023 Sep; 82(3):247-54. doi: 10.1016/j.annemergmed.2022.12.004..
Keywords: COVID-19, Emergency Department, Public Health
Min SH, Song J, Evans L
Home healthcare patients with distinct psychological, cognitive, and behavioral symptom profiles and at-risk subgroup for hospitalization and emergency department visits using latent class analysis.
The purpose of this study was to explore subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits as an indicator of underdiagnosis or undertreatment. The three-class model applied in the study consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." The study found that Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments compared to Class 3. The researchers discovered significant differences in individual characteristics such as age, gender, race/ethnicity, and insurance.
AHRQ-funded; HS027742.
Citation: Min SH, Song J, Evans L .
Home healthcare patients with distinct psychological, cognitive, and behavioral symptom profiles and at-risk subgroup for hospitalization and emergency department visits using latent class analysis.
Clin Nurs Res 2023 Sep; 32(7):1021-30. doi: 10.1177/10547738231183026..
Keywords: Home Healthcare, Emergency Department, Hospitalization, Elderly
McGarry BE, Mao Y, Nelson D
Hospital proximity and emergency department use among assisted living residents.
The purpose of this retrospective cohort study was to explore the association between the distance of assisted living (AL) communities to the nearest hospital and AL residents' rates of emergency department (ED) utilization. The researchers hypothesized that when access to an ED is a shorter distance, AL-to-ED transfers are more common, especially for non-emergency conditions. The study found that among 540,944 resident-years from 16,514 AL communities, the median distance to the closest hospital was 2.5 miles. After statistical adjustment, a doubling of distance to the closest hospital was related with 43.5 fewer ED treat-and-release visits per 1000 resident years and no significant difference in the rate of ED visits resulting in an inpatient admission. Among ED treat-and-release visits, a doubling of distance was related with a 3.0% decrease in visits classified as nonemergent, and a 1.6% decrease in visits classified as emergent, not primary care treatable.
AHRQ-funded; HS026893.
Citation: McGarry BE, Mao Y, Nelson D .
Hospital proximity and emergency department use among assisted living residents.
J Am Med Dir Assoc 2023 Sep; 24(9):1349-55.e.5. doi: 10.1016/j.jamda.2023.05.002..
Keywords: Emergency Department, Elderly, Long-Term Care, Medicare, Hospitals
Hekman DJ, Cochran AL, Maru AP
Effectiveness of an emergency department-based machine learning clinical decision support tool to prevent outpatient falls among older adults: protocol for a quasi-experimental study.
This article described a research protocol for evaluating the effectiveness of an automated screening and referral intervention tool for patients receiving falls risk intervention. The study will attempt to quantify the impact of a machine learning (ML) clinical decision support intervention on patient behavior and outcomes. The primary analysis will obtain referral completion rates from different emergency departments. The findings will inform ongoing discussion on the use of ML and artificial intelligence to augment medical decision-making.
AHRQ-funded; HS027735.
Citation: Hekman DJ, Cochran AL, Maru AP .
Effectiveness of an emergency department-based machine learning clinical decision support tool to prevent outpatient falls among older adults: protocol for a quasi-experimental study.
JMIR Res Protoc 2023 Aug 3; 12:e48128. doi: 10.2196/48128..
Keywords: Clinical Decision Support (CDS), Emergency Department, Health Information Technology (HIT), Elderly, Falls
Smulowitz PB, Weinreb G, McWilliams JM
Association of functional status, cognition, social support, and geriatric syndrome with admission from the emergency department.
The objective of this cohort study was to determine the extent to which patient-level factors such as such as functional status, cognitive status, social supports, and geriatric syndromes are associated with rates of hospital admission following an emergency department (ED) visit. Survey data collected from participants or their proxies enrolled in the Health and Retirement Study were linked to Medicare fee-for-service claims data. The results suggested that key patient-level characteristics were associated with the decision to admit older patients to the hospital from the ED. The authors concluded that these factors will be critical to consider when devising strategies to reduce low-value admissions from the ED among older adult patients.
AHRQ-funded; HS025408.
Citation: Smulowitz PB, Weinreb G, McWilliams JM .
Association of functional status, cognition, social support, and geriatric syndrome with admission from the emergency department.
JAMA Intern Med 2023 Aug; 183(8):784-92. doi: 10.1001/jamainternmed.2023.2149..
Keywords: Elderly, Emergency Department
Nguyen JK, P P
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
This study’s objective was to compare level 1 and 2 trauma centers with similarly sized non-trauma centers on survival after major trauma among older adults. The authors used claims of 100% of 2012-2017 Medicare fee-for-service beneficiaries who received hospital care after major trauma. They assessed the roles of prehospital care, hospital quality, and volume. Thirty-day mortality was higher overall at level 1 versus non-trauma centers by 2.2 percentage points (pp). Thirty-day mortality was higher at level 1 versus non-trauma centers by 2.3 pp for falls and 2.3 pp for motor vehicle crashes. Outcomes were similar at level 1 and 2 trauma centers. The difference was not explained by hospital quality and volume. There were also no statistical differences in the ambulance-transported group, after adjusting for prehospital variables.
AHRQ-funded; HS025720.
Citation: Nguyen JK, P P .
Comparison of survival outcomes among older adults with major trauma after trauma center versus non-trauma center care in the United States.
Health Serv Res 2023 Aug; 58(4):817-27. doi: 10.1111/1475-6773.14148..
Keywords: Elderly, Trauma, Outcomes, Injuries and Wounds, Emergency Department, Hospitals
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Brajcich BC, Johnson JK, Holl JL
Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery.
The purpose of this study was to assess the incidence of, reasons for, and predictors of emergency department treat-and-release encounters after gastrointestinal cancer operations. The researchers identified patients who underwent elective colorectal, esophageal, gastric, hepatobiliary, pancreatic, or small intestinal operations for cancer from the 2015-2017 Healthcare Cost and Utilization Project State Inpatient and State Emergency Department Databases for New York, Maryland, and Florida. The study found that among 51,527 patients at 406 hospitals, 7.9% had an ED treat-and-release encounter, and 10.8% had an ED encounter with readmission. In total, 40.7% of ED encounters were treat-and-release encounters. 12% of ED treat-and-release encounters were for pain, 11.7% for device/ostomy complaints, and 11.4% were for wound complaints (11.4%). ED treat-and-release encounters predictors included non-Hispanic Black race/ethnicity and Medicare or Medicaid coverage.
AHRQ-funded; HS026385.
Citation: Brajcich BC, Johnson JK, Holl JL .
Evaluation of emergency department treat-and-release encounters after major gastrointestinal surgery.
J Surg Oncol 2023 Aug; 128(2):402-08. doi: 10.1002/jso.27292..
Keywords: Emergency Department, Digestive Disease and Health, Surgery, Hospital Readmissions
Kim HS, Strickland KJ, Seitz AL
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
This study’s purpose was to explore patient perspectives on visiting the emergency department (ED) for low back pain to inform a more patient-centered approach to emergency care. The authors conducted focus group discussions and individual interviews among patients visiting an urban academic ED for acute low back pain. They recruited participants from an ongoing prospective study of 101 patients receiving either ED-initiated physical therapy or usual care. They conducted 4 focus group discussions among 18 participants (median age 46.5 years, 66.7% women, 61.1% Black) and individual interviews with 27 participants (median age 45 years, 55.6% women, 44.4% White). They identified 5 summary themes: (1) the decision to seek emergency care for low back pain is motivated by severe pain, resulting disability, and fears about a catastrophic diagnosis, (2) participants sought various goals from their ED visit but emphasized the primacy of pain control, (3) participants were reluctant to use pain medications but also acknowledged their benefit, (4) participants perceived a number of benefits from direct access to an ED physical therapist in the ED, and (5) participation in physical therapy ultimately facilitated recovery, but the pain was a barrier to performing exercises.
AHRQ-funded; HS023011; HS027426.
Citation: Kim HS, Strickland KJ, Seitz AL .
Patient perspectives on seeking emergency care for acute low back pain and access to physical therapy in the emergency department.
Ann Emerg Med 2023 Aug; 82(2):154-63. doi: 10.1016/j.annemergmed.2022.12.028..
Keywords: Emergency Department, Back Health and Pain, Pain
Young AL, Monuteaux MC, Cooney TM
Predictors of delayed diagnosis of pediatric CNS tumors in the emergency department.
Delays in the diagnosis of central nervous system (CNS) tumors in children may lead to adverse outcomes and undue burdens on families. The purpose of this study was to examine factors related with delayed emergency department (ED) diagnosis to identify approaches to reduce delays. Researchers included 2828 children, 76% were controls, 24% were cases). Among cases, 68% had 1 preceding ED visit, 21% had 2, and 11% had 3 or more. The study found significant predictors of delayed diagnosis included presence of a complex chronic condition, rural hospital location, nonteaching hospital status, age younger than 5 years, public insurance, and black race.
AHRQ-funded; HS026503.
Citation: Young AL, Monuteaux MC, Cooney TM .
Predictors of delayed diagnosis of pediatric CNS tumors in the emergency department.
Pediatr Emerg Care 2023 Aug; 39(8):617-22. doi: 10.1097/pec.0000000000002943..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Cancer, Emergency Department
Weekes AJ, Davison J, Lupez K
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
The objective of this prospective multicenter registry study was to determine whether any clinical or pathophysiologic features of pulmonary embolism were associated with worse Pulmonary Embolism Quality-of-Life (PEmb-QoL) scores after one month. Pulmonary embolism patients participated in QoL assessments and received PEmb-QoL questionnaires conducted by the researchers. Results indicated that acute clinical deterioration, right ventricular dysfunction, and pulmonary embolism PE severity were not predictors of QoL at 1 month post-embolism. Independent predictors of worsened QoL were COPD, rehospitalization, and hospital length of stay.
AHRQ-funded; HS025979.
Citation: Weekes AJ, Davison J, Lupez K .
Quality of life 1 month after acute pulmonary embolism in emergency department patients.
Acad Emerg Med 2023 Aug; 30(8):819-31. doi: 10.1111/acem.14692..
Keywords: Quality of Life, Respiratory Conditions, Emergency Department
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
Vest JR, Mazurenko O
Non-response bias in social risk factor screening among adult emergency department patients.
This study assessed differences between respondents and those refusing participation in social factor screening questionnaires to determine if non-response contributed to selection bias. Study subjects were patients from a mid-western state safety-net hospital's emergency department aged 18 or older, English or Spanish speakers, and able to complete a self-administered questionnaire. Results indicated that subjects with prior documentation of financial insecurity were less likely to respond to the screening questionnaire, but no other factors were significantly associated with response. The authors concluded that this study contributed to the growing social determinants of health literature by confirming that selection bias might exist within screening practices and research studies.
AHRQ-funded; HS028008.
Citation: Vest JR, Mazurenko O .
Non-response bias in social risk factor screening among adult emergency department patients.
J Med Syst 2023 Jul 22; 47(1):78. doi: 10.1007/s10916-023-01975-8..
Keywords: Emergency Department, Screening, Social Determinants of Health
Thakrar AP, Faude S, Perrone J
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
This study’s aim was to determine whether urine fentanyl concentration is associated with severity of opioid withdrawal. The study was conducted in 3 emergency departments in an urban, academic health system from January 1, 2020, to December 31, 2021. It included patients with opioid use disorder, detectable urine fentanyl or norfentanyl, and Clinical Opiate Withdrawal Scale (COWS) recorded within 6 hours of urine drug testing. Primary exposure measured was urine fentanyl concentration stratified as high (>400 ng/mL), medium (40-399 ng/mL), or low (<40 ng/mL). COWS was used to measure opioid withdrawal severity within 6 hours before or after urine specimen collection. A total of 1127 patients were included in the sample, with a mean age (SD) of 40.0 (10.7), 384 (34.1%) identified as female, 332 (29.5%) reported their race/ethnicity as non-Hispanic Black, and 658 (58.4%) reported their race/ethnicity as non-Hispanic White. For patients with high urine fentanyl concentrations, the adjusted mean COWS was 4.4 (3.9-4.8) compared with 5.5 (5.1-6.0) among those with medium and 7.7 (6.8-8.7) among those with low fentanyl concentrations.
AHRQ-funded; HS026372.
Citation: Thakrar AP, Faude S, Perrone J .
Association of urine fentanyl concentration with severity of opioid withdrawal among patients presenting to the emergency department.
J Addict Med 2023 Jul-Aug; 17(4):447-53. doi: 10.1097/adm.0000000000001155..
Keywords: Opioids, Medication, Emergency Department, Substance Abuse
Chen EH, Dessie AS, Druck J
Executive summary of the SAEM 2022 consensus conference to address racism in emergency medicine clinical research, training, and leadership.
This article summarizes the executive summary of the 2022 Society for Academic Emergency Medicine (SAEM) consensus conference, "Diversity, Equity, and Inclusion: Developing a Research Agenda for Addressing Racism in Emergency Medicine”. The conference convened a diverse group of researchers, educators, administrative leaders, and health care providers to help address the impact of racism in three domains in academic emergency medicine: clinical research, education and training, and academic leadership. The planning committee identified the three fundamental domains to develop a research agenda and created workgroups who completed a literature search to identify gaps in knowledge domain to generate consensus recommendations for priority research. RESULTS: For clinical research, three research gaps with six questions were identified: remedies for bias and systematic racism (3), biases and heuristics in clinical care (2), and racism in study design (1). For education and training, the workgroup identified three research gaps with seven questions: curriculum and assessment (2), recruitment (1), and learning environment (4). For the academic leadership workgroup, three research gaps with five questions were identified: understanding the current diversity, equity, and inclusion (DEI) landscape and culture (1), analyzing programs that improve DEI and identifying factors that lead to improved diversity (3), and quantifying the value of professional stewardship activities (1).
AHRQ-funded; HS028770.
Citation: Chen EH, Dessie AS, Druck J .
Executive summary of the SAEM 2022 consensus conference to address racism in emergency medicine clinical research, training, and leadership.
Acad Emerg Med 2023 Jul; 30(7):765-72. doi: 10.1111/acem.14727..
Keywords: Emergency Department, Racial and Ethnic Minorities
Hoonakker PLT, Carayon P, Brown RL
Satisfaction of older patients with emergency department care: psychometric properties and construct validity of the Consumer Emergency Care Satisfaction Scale.
This study’s purpose to was examine the construct validity of the Consumer Emergency Care Satisfaction Scale (CECSS), designed to measure patient satisfaction in the emergency department (ED). The authors administered 2 surveys to older adults who presented with a fall to the ED and used electronic health record data to examine construct validity of the CECSS and ceiling effects. Using several criteria, they improved construct validity of the CECSS, reduced ceiling effects, and standardized scoring.
AHRQ-funded; HS026624.
Citation: Hoonakker PLT, Carayon P, Brown RL .
Satisfaction of older patients with emergency department care: psychometric properties and construct validity of the Consumer Emergency Care Satisfaction Scale.
J Nurs Care Qual 2023 Jul-Sep; 38(3):256-63. doi: 10.1097/ncq.0000000000000694..
Keywords: Elderly, Emergency Department, Patient Experience
Hoffman JA, Pergjika A, Liu L
Standardizing and improving care for pediatric agitation management in the emergency department.
In the U.S., pediatric mental health emergency department (ED) visits are increasing, with a greater number of visits involving the prescription of medication for acute agitation. Well timed, consistent application of behavioral strategies and medications may decrease the need for physical restraint of pediatric patients. The purpose of this study was to standardize agitation management in a pediatric ED and decrease pediatric patient time in physical restraints. From September 2020 to August 2021, researchers implemented a quality improvement initiative followed by a 6-month maintenance period. A barrier evaluation discovered that agitation triggers were not adequately recognized, there were few activities provided for children during lengthy ED visits, ED staff did not have confidence in techniques for verbally deescalating events, choices for medication were not consistent, and medication administered took time to take effect. Consecutive interventions included the development of a pathway and order set for agitation care, optimization of workflows for child life and psychiatry, implementation of personalized de-escalation plans, and adding the medication droperidol to the ED formulary. The measures utilize din the study included standardization of medication choice for severe agitation and time in physical restraints. The study found that during the intervention and maintenance components, there were 129 ED visits with medication administered for severe agitation and 10 ED visits where physical restraints were used. Among ED visits with medication given for severe agitation, there was an increase from 8% to 88% in standardized medication choice (olanzapine or droperidol), and a decrease in mean minutes in physical restraints from 173 to 71.
AHRQ-funded; HS026385.
Citation: Hoffman JA, Pergjika A, Liu L .
Standardizing and improving care for pediatric agitation management in the emergency department.
Pediatrics 2023 Jul 1; 152(1). doi: 10.1542/peds.2022-059586..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Improvement, Quality of Care