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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 139 Research Studies DisplayedHorng S, Joseph JW, Calder S
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
The purpose of this cohort study was to determine whether a simple visual aid was associated with a reduction in duplicate ordering of tests and medications. An interrupted time series model was used to analyze a series of consecutive patients who visited the emergency department of a large volume academic hospital. The researchers conclude that passive visual cues that provided just-in-time decision support were associated with reductions in unintentional duplicate orders for laboratory and radiology tests but not in unintentional duplicate medication orders.
AHRQ-funded; HS024288.
Citation: Horng S, Joseph JW, Calder S .
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
JAMA Netw Open 2019 Dec 2;2(12):e1916499. doi: 10.1001/jamanetworkopen.2019.16499..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Patient-Centered Outcomes Research, Medication
Schoenfeld EM, Shieh MS, Pekow PS
Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic.
Little is known about the timing of urologic interventions in patients with renal colic discharged from the emergency department. Understanding patients' likelihood of a subsequent urologic intervention could inform decision-making in this population. The objective of this study was to examine the rate and timing of urologic procedures performed after an emergency department visit for renal colic and the factors associated with receipt of an intervention.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Shieh MS, Pekow PS .
Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic.
JAMA Netw Open 2019 Dec 2;2(12):e1916454. doi: 10.1001/jamanetworkopen.2019.16454..
Keywords: Emergency Department, Kidney Disease and Health, Decision Making
Schoenfeld EM, Probst MA, Quigley
Does shared decision making actually occur in the emergency department? Looking at it from the patients' perspective.
In this study the investigators sought to assess the frequency, content, and quality of shared decision making (SDM) in the emergency department (ED), from patients' perspectives. The investigators found that fewer than half of ED patients surveyed reported they were involved in SDM. The most common decision for which SDM was used was around ED disposition (admission vs. discharge). When SDM was employed, patients generally rated the discussion highly.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Probst MA, Quigley .
Does shared decision making actually occur in the emergency department? Looking at it from the patients' perspective.
Acad Emerg Med 2019 Dec;26(12):1369-78. doi: 10.1111/acem.13850..
Keywords: Decision Making, Emergency Department, Clinician-Patient Communication, Patient and Family Engagement
Zins ZP, Wheeler KK, Brink F
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
The purpose of this study was to determine if US child physical abuse and neglect injury rates changed from 2006 to 2014, whether definitive diagnoses of physical abuse and neglect were used more often over time, and what patient factors influenced definitive physical maltreatment diagnoses. The investigators found that definitive diagnoses of physical abuse and neglect increased over the study period and were associated with hospital volume and patient characteristics which may reflect provider experience and possible bias.
AHRQ-funded; HS024263.
Citation: Zins ZP, Wheeler KK, Brink F .
Trends in US physician diagnosis of child physical abuse and neglect injuries, 2006-2014.
Child Abuse Negl 2019 Dec;98:104179. doi: 10.1016/j.chiabu.2019.104179..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Diagnostic Safety and Quality, Domestic Violence, Injuries and Wounds, Emergency Department, Hospitalization
Sun EC, Mello MM, Moshfegh J
Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals.
This retrospective analysis used data from the Clinformatics Data Mart database (Optum) to examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals. The investigators found that out-of-network billing appeared to have become common for privately insured patients even when they soughttreatment at in-network hospitals. They indicated that the mean amounts billed appeared to be sufficiently large that they may create financial strain for a substantial proportion of patients.
AHRQ-funded; HS026128.
Citation: Sun EC, Mello MM, Moshfegh J .
Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals.
JAMA Intern Med 2019 Nov;179(11):1453-612. doi: 10.1001/jamainternmed.2019.3451..
Keywords: Health Insurance, Healthcare Costs, Payment, Hospitals, Emergency Department
Griffey RT, Schneider RM, Peterson C
Diabetic ketoacidosis management in the emergency department: implementation of a protocol to reduce variability and improve safety.
The authors studied the impact of a standardizing emergency department diabetic ketoacidosis management in two phases: rollout of a diabetic ketoacidosis pathway in their computerized order entry system followed by audit and feedback. They evaluated adherence, clinical process, operational, and safety measures following these interventions. They found that adherence to the pathway was initially slow, improving significantly after audit and feedback. They observed mixed improvements in clinical processes, no changes in operational metrics, and reductions in variability for several measures.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Peterson C .
Diabetic ketoacidosis management in the emergency department: implementation of a protocol to reduce variability and improve safety.
J Healthc Qual 2019 Nov/Dec;41(6):e61-e69. doi: 10.1097/jhq.0000000000000211..
Keywords: Emergency Department, Diabetes, Patient Safety, Care Management
Lauerman MH, Herrera AV, Albrecht JS
Percentage of mortal encounters transferred in emergency general surgery.
The purpose of this study was to describe individual hospital transfer rates of mortal encounters. Using data from the Maryland Health Services Cost Review Commission database, results showed broad variability in individual hospital practices for mortality transferred to other institutions. Application of this knowledge of percentage of mortal encounters transferred includes consideration in hospital quality metrics.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Percentage of mortal encounters transferred in emergency general surgery.
J Surg Res 2019 Nov;243:391-98. doi: 10.1016/j.jss.2019.05.040.
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Keywords: Emergency Department, Surgery, Mortality, Hospitals
Vogel JA, Rising KL, Jones J
Reasons patients choose the emergency department over primary care: a qualitative metasynthesis.
To enhance the acute care delivery system, a comprehensive understanding of the patient's perspectives for seeking care in the emergency department (ED) versus primary care (PC) is necessary. In this study, the investigators conducted a qualitative metasynthesis on reasons patients sought care in the ED instead of PC. The investigators concluded that reasons included: (1) urgency of the medical condition, (2) barriers to accessing primary care, (3) advantages of the ED, and (4) fulfillment of medical needs and quality of care in the ED.
AHRQ-funded; HS023901.
Citation: Vogel JA, Rising KL, Jones J .
Reasons patients choose the emergency department over primary care: a qualitative metasynthesis.
J Gen Intern Med 2019 Nov;34(11):2610-19. doi: 10.1007/s11606-019-05128-x..
Keywords: Emergency Department, Primary Care, Decision Making, Healthcare Delivery
Vakkalanka JP, Harland KK, Wittrock A
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.
The purpose of this retrospective propensity-matched cohort study was to evaluate the impact of telemedicine in clinical management and patient outcomes of patients presenting to rural critical access hospital emergency departments (EDs) with suicidal ideation or attempt. The authors suggest that the role of telemedicine in influencing access, quality and efficiency of care in underserved rural hospitals is critically important as these networks become more prevalent in rural healthcare environments.
AHRQ-funded; HS025753.
Citation: Vakkalanka JP, Harland KK, Wittrock A .
Telemedicine is associated with rapid transfer and fewer involuntary holds among patients presenting with suicidal ideation in rural hospitals: a propensity matched cohort study.
J Epidemiol Community Health 2019 Nov;73(11):1033-39. doi: 10.1136/jech-2019-212623..
Keywords: Telehealth, Rural Health, Access to Care, Behavioral Health, Health Information Technology (HIT), Healthcare Delivery, Care Management, Outcomes, Emergency Department
Andereck JW, Reuter QR, Allen KC
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
This study compared opioid prescribing rates in emergency departments before and after a quality improvement initiative featuring peer-comparison feedback. All 117 ED prescribers at an urban academic medical center were provided regular feedback on their opioid prescribing rate compared to their de-identified peers. Pre-intervention rates were 8.6% compared to post-intervention at 4.8%.
AHRQ-funded; HS023011.
Citation: Andereck JW, Reuter QR, Allen KC .
A quality improvement initiative featuring peer-comparison prescribing feedback reduces emergency department opioid prescribing.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):669-79. doi: 10.1016/j.jcjq.2019.07.008..
Keywords: Emergency Department, Opioids, Medication, Practice Patterns, Quality Improvement, Quality of Care
Bardach NS, Neel C, Kleinman LC
Depression, anxiety, and emergency department use for asthma.
This study examined whether pediatric patients with asthma who use the emergency department (ED) experience increased depression and anxiety in the same way that adult asthma patients do. Out of 65,342 patients identified from the Massachusetts All-Payer Claims Database for 2014 to 2015 who had ED visits, 24.7% had a diagnosis of anxiety, depression, or both. Asthma rates were shown to be higher than those of patients who had no diagnosis of anxiety or depression.
AHRQ-funded; HS025297; HS020518.
Citation: Bardach NS, Neel C, Kleinman LC .
Depression, anxiety, and emergency department use for asthma.
Pediatrics 2019 Oct;144(4). doi: 10.1542/peds.2019-0856..
Keywords: Asthma, Depression, Anxiety, Children/Adolescents, Emergency Department, Behavioral Health
Paredes AZ, Malik AT, Cluse M
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Emergency general surgery can have a profound impact on the functional status of even previously independent patients. In this study, the investigators examined the role and influence of discharging a patient to a skilled nursing facility. They concluded that after accounting for patient severity and perioperative course, discharge to a skilled nursing facility was an independent risk factor for death, readmission, and postdischarge complications.
AHRQ-funded; HS022694.
Citation: Paredes AZ, Malik AT, Cluse M .
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Surgery 2019 Oct;166(4):489-95. doi: 10.1016/j.surg.2019.04.034..
Keywords: Nursing Homes, Hospital Discharge, Elderly, Ambulatory Care and Surgery, Emergency Department, Outcomes, Hospital Readmissions, Outcomes, Risk
Ricci KB, Rushing AP, Ingraham AM
The association between self-declared acute care surgery services and operating room access: results from a national survey.
In this study, the investigators conducted a national survey on emergency general surgery (EGS) structures and processes to examine if implementation of acute care surgery (ACS) would improve OR accessibility compared with a traditional general surgeon on call (GSOC) approach.
AHRQ-funded; HS022694.
Citation: Ricci KB, Rushing AP, Ingraham AM .
The association between self-declared acute care surgery services and operating room access: results from a national survey.
J Trauma Acute Care Surg 2019 Oct;87(4):898-906. doi: 10.1097/ta.0000000000002394..
Keywords: Surgery, Emergency Department, Access to Care
Oslock WM, Paredes AZ, Baselice HE
Women surgeons and the emergence of acute care surgery programs.
The authors sought to examine predictors of women surgeons in emergency general surgery (EGS) generally, and in acute care surgery (ACS) particularly. They found that 50.4% of hospitals studied had zero women surgeons. Women were more likely to be among EGS surgeons at hospitals with ACS models. They concluded that their study highlighted the dearth of women representation within EGS hospitals nationally and illuminated some of the underlying characteristics of ACS that may draw women: urban, academic, and staffed by more recently trained surgeons.
AHRQ-funded; HS022694.
Citation: Oslock WM, Paredes AZ, Baselice HE .
Women surgeons and the emergence of acute care surgery programs.
Am J Surg 2019 Oct;218(4):803-08. doi: 10.1016/j.amjsurg.2019.07.008..
Keywords: Surgery, Provider: Physician, Provider, Emergency Department
Cochran AL, Rathouz PJ, Kocher KE
A latent variable approach to potential outcomes for emergency department admission decisions.
The authors sought to provide a general framework to evaluate admission decisions from electronic healthcare records. They estimated that while admitting a patient with higher latent needs reduced the 30-day risk of revisiting the emergency department or later being admitted through the emergency department by over 79%, admitting a patient with lower latent needs actually increased these 30-day risks by 3.0% and 7.6%, respectively.
AHRQ-funded; HS024160.
Citation: Cochran AL, Rathouz PJ, Kocher KE .
A latent variable approach to potential outcomes for emergency department admission decisions.
Stat Med 2019 Sep 10;38(20):3911-35. doi: 10.1002/sim.8210..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Clinical Decision Support (CDS), Decision Making, Hospitalization
Hanchate AD, Paasche-Orlow MK, Baker WE
Association of race/ethnicity with emergency department destination of emergency medical services transport.
The authors examined the patterns of emergency department (ED) destination of emergency medical services (EMS) transport according to patient race/ethnicity and compared the patterns between those transported by EMS and those who did not draw on EMS. Using Medicare claims data, they found race/ethnicity variation in ED destination for patients using EMS transport, with black and Hispanic patients more likely to be transported to a safety-net hospital ED compared with white patients living in the same zip code.
AHRQ-funded; HS022242.
Citation: Hanchate AD, Paasche-Orlow MK, Baker WE .
Association of race/ethnicity with emergency department destination of emergency medical services transport.
JAMA Netw Open 2019 Sep 4;2(9):e1910816. doi: 10.1001/jamanetworkopen.2019.10816..
Keywords: Emergency Medical Services (EMS), Emergency Department, Racial and Ethnic Minorities, Medicare, Disparities
Merritt C, Dietrich AM, Bogie AL
2018 Academic Emergency Medicine Consensus Conference: A Workforce Development Research Agenda for Pediatric Care in the Emergency Department.
Although the number of pediatric emergency medicine specialists continues to rise, the vast majority of children are cared for in general EDs outside of children's hospitals by a diverse workforce of care providers who must possess the knowledge, experience, skills, and systemic support necessary to deliver excellent pediatric emergency care. There is a crucial need to understand the factors that drive the professional development and support systems of this diverse workforce. In this paper the investigators identified five key research themes and prioritized a specific research agenda.
AHRQ-funded; HS026101.
Citation: Merritt C, Dietrich AM, Bogie AL .
2018 Academic Emergency Medicine Consensus Conference: A Workforce Development Research Agenda for Pediatric Care in the Emergency Department.
Acad Emerg Med 2019 Sep;26(9):1063-73. doi: 10.1111/acem.13638..
Keywords: Emergency Department, Research Methodologies, Children/Adolescents
Mower WR, Crisp JG, Krishnadasan A
Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management.
Researchers examined the utility of emergency department (ED) ultrasonography in treatment of skin and soft tissue infections. Study participants were ED patients with skin and soft tissue infections; the study also surveyed clinicians with regard to their pre-ultrasonography certainty about the presence or absence of an abscess, their planned management, post-ultrasonography findings, and actual management. The researchers found that ultrasonography rarely changed management when clinicians were certain about the presence or absence of an abscess. When clinicians were uncertain, ultrasonography changed drainage decisions in approximately one quarter of cases, of which most were appropriate.
AHRQ-funded; HS009699.
Citation: Mower WR, Crisp JG, Krishnadasan A .
Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management.
Ann Emerg Med 2019 Sep;74(3):372-80. doi: 10.1016/j.annemergmed.2019.02.002..
Keywords: Emergency Department, Imaging, Skin Conditions
Timbie JW, Kranz AM, Mahmud A
Federally qualified health center strategies for integrating care with hospitals and their association with measures of communication.
Federally qualified health centers have aligned clinical services and systems with local hospitals, but little is known about the specific care integration strategies health centers use or their impact on care. In this study, a research team examined the use of strategies by health centers to integrate care with hospitals and emergency departments (EDs) and their association with performance on measures of health center-hospital communication.
AHRQ-funded; HS024067.
Citation: Timbie JW, Kranz AM, Mahmud A .
Federally qualified health center strategies for integrating care with hospitals and their association with measures of communication.
Jt Comm J Qual Patient Saf 2019 Sep;45(9):620-28. doi: 10.1016/j.jcjq.2019.06.004..
Keywords: Patient-Centered Healthcare, Patient-Centered Outcomes Research, Hospitals, Communication, Emergency Department, Care Coordination, Healthcare Delivery
Moore CL, Carpenter CR, Heilbrun ME
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
This study conducted a Delphi process consensus on 29 specific clinical scenarios when kidney stones are suspected due to renal colic. The authors wanted to create an evidence-based, multispecialty consensus on optimal imaging for suspected renal colic in the acute setting. A 9-member panel was conducted with 3 physician representatives from the American College of Emergency Physicians (ACEP), 3 from the American College of Radiology, and 3 from the American Urology Association. First a systematic literature review was conducted. Out of 6,337 records, there were 232 relevant articles. Out of the 29 clinical scenarios examined, 15 were rated as perfect, 8 were excellent, and 3 good and 3 moderate.
AHRQ-funded; HS023778.
Citation: Moore CL, Carpenter CR, Heilbrun ME .
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
Ann Emerg Med 2019 Sep;74(3):391-99. doi: 10.1016/j.annemergmed.2019.04.021..
Keywords: Imaging, Diagnostic Safety and Quality, Emergency Department
Sabbatini AK, Wright B, Kocher K
Postdischarge unplanned care events among commercially insured patients with an observation stay versus short inpatient admission.
Observation stays are composing an increasing proportion of unscheduled hospitalizations in the United States, with unclear consequences for the quality of care. This study used a nationally representative data set of commercially insured patients hospitalized from the emergency department (ED) to compare 30-day postdischarge unplanned care events after an observation stay versus a short inpatient admission.
AHRQ-funded; HS024160.
Citation: Sabbatini AK, Wright B, Kocher K .
Postdischarge unplanned care events among commercially insured patients with an observation stay versus short inpatient admission.
Ann Emerg Med 2019 Sep;74(3):334-44. doi: 10.1016/j.annemergmed.2018.10.002..
Keywords: Emergency Department, Hospitalization, Quality of Care
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Ingraham AM, Ayturk MD, Kiefe CI
Adherence to 20 emergency general surgery best practices: results of a national survey.
The authors used a hybrid questionnaire to examine national adherence to emergency general surgery (EGS) best practices. They found that there was substantial room for performance improvement, and that adopting an acute care surgery model predicts better performance. They conclude that this novel overview of adherence to EGS best practices will enable surgeons and policymakers to address variations in EGS care nationally.
AHRQ-funded; HS022694.
Citation: Ingraham AM, Ayturk MD, Kiefe CI .
Adherence to 20 emergency general surgery best practices: results of a national survey.
Ann Surg 2019 Aug;270(2):270-80. doi: 10.1097/sla.0000000000002746..
Keywords: Surgery, Emergency Department, Guidelines, Quality of Care, Quality Improvement
Simon E, Miake-Lye IM, Smith SW
An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department.
The aim of this study was to determine rates of and possible reasons for guideline-discordant ordering of CT pulmonary angiography for the evaluation of suspected pulmonary embolism (PE) in the emergency department. The investigators concluded that many of the guideline-discordant orders were placed for patients who presented with evidence-based risk factors for PE that are not included in the risk stratification scores. They suggest that guideline-discordant ordering may indicate that in the presence of these factors, the assessment of risk made by current scoring systems may not align with clinical suspicion.
AHRQ-funded; HS024376.
Citation: Simon E, Miake-Lye IM, Smith SW .
An evaluation of guideline-discordant ordering behavior for CT pulmonary angiography in the emergency department.
J Am Coll Radiol 2019 Aug;16(8):1064-72. doi: 10.1016/j.jacr.2018.12.015..
Keywords: Respiratory Conditions, Emergency Department, Guidelines, Evidence-Based Practice, Blood Clots
Beiser DG, Ward CE, Vu M
Depression in emergency department patients and association with health care utilization.
Depression is one of the most common illnesses in the United States, with increased prevalence among people with lower socioeconomic status and chronic mental illness who often seek care in the emergency department (ED). The investigators sought to estimate the rate and severity of major depressive disorder (MDD) in a nonpsychiatric ED population and its association with subsequent ED visits and hospitalizations.
AHRQ-funded; HS000084; HS025889.
Citation: Beiser DG, Ward CE, Vu M .
Depression in emergency department patients and association with health care utilization.
Acad Emerg Med 2019 Aug;26(8):878-88. doi: 10.1111/acem.13726..
Keywords: Depression, Emergency Department, Healthcare Utilization, Hospitalization, Behavioral Health