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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 425 Research Studies Displayed
Smulowitz PB, O'Malley AJ, McWilliams JM
Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels.
Rates of admission from the emergency department (ED) vary widely across regions of the country, hospitals within regions, and physicians within hospitals. The study objective was to determine the extent to which variation in admission decisions was described by differences in admission rates at these 3 levels. The investigators concluded that within-area variation, both across hospitals within a region and across physicians within a hospital, was a more substantial component of observed variation in admission rates from the ED than regional level variation.
AHRQ-funded; HS025408.
Citation:
Smulowitz PB, O'Malley AJ, McWilliams JM .
Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels.
Ann Emerg Med 2021 Oct;78(4):474-83. doi: 10.1016/j.annemergmed.2021.03.020..
Keywords:
Medicare, Hospitalization, Emergency Department, Practice Patterns
Werner NE, Rutkowski RA, Krause S
Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.
Care transitions that occur across healthcare system boundaries represent a unique challenge for maintaining high quality care and patient safety, as these systems are typically not aligned to perform the care transition process. In this article, the investigators explored healthcare professionals' mental models of older adults' transitions between the emergency department (ED) and skilled nursing facility (SNF).
AHRQ-funded; HS026624.
Citation:
Werner NE, Rutkowski RA, Krause S .
Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.
Appl Ergon 2021 Oct;96:103509. doi: 10.1016/j.apergo.2021.103509..
Keywords:
Elderly, Transitions of Care, Emergency Department, Nursing Homes, Healthcare Delivery
Vaghani V, Wei L, U
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
Diagnostic errors are major contributors to preventable patient harm. In this study, the investigators validated the use of an electronic health record (EHR)-based trigger (e-trigger) to measure missed opportunities in stroke diagnosis in emergency departments (EDs). The investigators concluded that a symptom-disease pair-based e-trigger identified missed diagnoses of stroke with a modest positive predictive value, underscoring the need for chart review validation procedures to identify diagnostic errors in large data sets.
AHRQ-funded; HS017820; HS024459.
Citation:
Vaghani V, Wei L, U .
Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments.
J Am Med Inform Assoc 2021 Sep 18;28(10):2202-11. doi: 10.1093/jamia/ocab121..
Keywords:
Stroke, Cardiovascular Conditions, Emergency Department, Diagnosis, Diagnostic Safety and Quality, Medical Errors, Adverse Events
Trent SA, George N, Havranek EP
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. The objective of this study was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. The investigators concluded that longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care.
AHRQ-funded; HS022400.
Citation:
Trent SA, George N, Havranek EP .
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Acad Emerg Med 2021 Sep;28(9):1051-60. doi: 10.1111/acem.14235..
Keywords:
Evidence-Based Practice, Guidelines, Emergency Department, Disparities, Quality of Care
Schulson L, Lin MY, Paasche-Orlow MK
Limited English proficient patient visits and emergency department admission rates for ambulatory care sensitive conditions in California: a retrospective cohort study.
Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients. The objective of this study was to estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates varied at hospitals with a high versus low proportion of LEP patients.
AHRQ-funded; HS022242.
Citation:
Schulson L, Lin MY, Paasche-Orlow MK .
Limited English proficient patient visits and emergency department admission rates for ambulatory care sensitive conditions in California: a retrospective cohort study.
J Gen Intern Med 2021 Sep;36(9):2683-91. doi: 10.1007/s11606-020-06523-5..
Keywords:
Emergency Department, Vulnerable Populations, Communications
Smulowitz PB, O'Malley AJ, Khidir H
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. In this study, the investigators examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not.
AHRQ-funded; HS025408.
Citation:
Smulowitz PB, O'Malley AJ, Khidir H .
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Health Aff 2021 Sep;40(9):1457-64. doi: 10.1377/hlthaff.2021.00561..
Keywords:
COVID-19, Public Health, Emergency Department, Hospitalization
Mahajan P, Pai CW, Cosby KS
Identifying trigger concepts to screen emergency department visits for diagnostic errors.
The diagnostic process is a vital component of safe and effective emergency department (ED) care. There are no standardized methods for identifying or reliably monitoring diagnostic errors in the ED, impeding efforts to enhance diagnostic safety. In this study, the investigators sought to identify trigger concepts to screen ED records for diagnostic errors and describe how they can be used as a measurement strategy to identify and reduce preventable diagnostic harm.
AHRQ-funded; HS024953; HS027363.
Citation:
Mahajan P, Pai CW, Cosby KS .
Identifying trigger concepts to screen emergency department visits for diagnostic errors.
Diagnosis 2021 Aug 26;8(3):340-46. doi: 10.1515/dx-2020-0122..
Keywords:
Emergency Department, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety
Allen L, Cummings JR, Hockenberry JM
The impact of urgent care centers on nonemergent emergency department visits.
This study looked at the impact of urgent care centers on nonemergency emergency department (ED) use. Secondary data from a novel urgent care center database, linked to the HCUP State Emergency Department Databases (SEDD) from six states was used. Data from ZIP codes with no urgent care centers served as a control group compared to areas with local urgent care centers. Having an open urgent care center in a ZIP code reduced the total number of ED visits by residents by 17.2% largely due to visits for less urgent conditions. The effect was concentrated in areas with hospitals with the longest ED wait times. The total number of uninsured visits to the ED were reduced by 21% and for Medicaid visits by 29.1%.
AHRQ-funded; HS2484501.
Citation:
Allen L, Cummings JR, Hockenberry JM .
The impact of urgent care centers on nonemergent emergency department visits.
Health Serv Res 2021 Aug;56(4):721-30. doi: 10.1111/1475-6773.13631..
Keywords:
Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Access to Care
Hoffmann JA, Pergjika A, Konicek CE
Pharmacologic management of acute agitation in youth in the emergency department.
In this article, the authors reviewed the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. They also discussed the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
AHRQ-funded; HS026385.
Citation:
Hoffmann JA, Pergjika A, Konicek CE .
Pharmacologic management of acute agitation in youth in the emergency department.
Pediatr Emerg Care 2021 Aug;37(8):417-22. doi: 10.1097/pec.0000000000002510..
Keywords:
Children/Adolescents, Emergency Department, Medication, Care Management
Patterson BW, Johnson J, Ward MD
Effect of a split-flow physician in triage model on abdominal CT ordering rate and yield.
The objective of this study was to compare the rate and clinical yield of computed tomography (CT) imaging between patients presenting with abdominal pain initially seen by a physician in triage (PIT) versus those seen only by physicians working in the main emergency department (ED). For patients with abdominal pain, the investigators found no significant differences in rates of CT ordering or CT yield for patients seen in a PIT vs. traditional models.
AHRQ-funded; HS024558.
Citation:
Patterson BW, Johnson J, Ward MD .
Effect of a split-flow physician in triage model on abdominal CT ordering rate and yield.
Am J Emerg Med 2021 Aug;46:160-64. doi: 10.1016/j.ajem.2020.05.119..
Keywords:
Imaging, Emergency Department, Practice Patterns, Diagnostic Safety and Quality
Lord K, Rothenberg C, Parwani V
Association between emergency department chief complaint and adverse hospitalization outcomes: a simple early warning system?
Researchers sought to examine the association between the emergency department chief complaint and specific adverse outcomes after admission to a general medicine floor. They found that chief complaint may be an early identifier of those patients uniquely at risk for adverse hospitalization outcomes. Patients presenting with seizure, leg swelling, and shortness of breath who were subsequently admitted to a general medical floor were more likely to suffer care escalations, Rapid Response Team activation, or mortality. Conversely, patients with chief complaints of loss of consciousness, headache, and chest pain were at low risk of adverse outcomes.
AHRQ-funded; HS023554.
Citation:
Lord K, Rothenberg C, Parwani V .
Association between emergency department chief complaint and adverse hospitalization outcomes: a simple early warning system?
Am J Emerg Med 2021 Jul;45:548-50. doi: 10.1016/j.ajem.2020.07.040..
Keywords:
Emergency Department, Hospitalization, Adverse Events
Choi KR, Martinez-Hollingsworth A, Mead M
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
The purpose of this retrospective case series was to describe adolescent psychiatric emergencies precipitated by the coronavirus disease 2019 (COVID-19) pandemic. Findings showed that COVID-19-precipitated admissions were 24% of total admissions from March 15 to May 31, 2020; however, total admissions during this time period were reduced from the same time period in prior years. The COVID-19 pandemic and corresponding shelter-in-place orders may precipitate psychiatric emergencies among adolescents both with and without existing mental health disorders.
AHRQ-funded; HS026407.
Citation:
Choi KR, Martinez-Hollingsworth A, Mead M .
Adolescent psychiatric emergencies precipitated by the COVID-19 pandemic.
J Psychosoc Nurs Ment Health Serv 2021 Jul;59(7):17-21. doi: 10.3928/02793695-20201203-05..
Keywords:
Children/Adolescents, COVID-19, Behavioral Health, Emergency Department
Swanson MB, Miller AC, Ward MM MM
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (1) identify the impact of telemedicine on ED stroke care, (2) identify if telemedicine impact varied by network, and (3) describe the variation in process outcomes by telemedicine across EDs.
AHRQ-funded; HS025753.
Citation:
Swanson MB, Miller AC, Ward MM MM .
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
J Telemed Telecare 2021 Jul;27(6):343-52. doi: 10.1177/1357633x19877746..
Keywords:
Emergency Department, Telehealth, Health Information Technology (HIT), Imaging, Stroke, Cardiovascular Conditions
Zachrison KS, Boggs KM, Gao j
Patient insurance status is associated with care received after transfer among pediatric patients in the emergency department.
The objective of this study was to determine whether frequency of interfacility transfer varied by insurance status among pediatric emergency department (ED) patients. Secondarily, the investigators tested for an association between insurance status and odds of transfer with discharge from the second ED without observation or admission. The investigators concluded that among ED-to-ED transfers, pediatric patients with public or without insurance were more often kept for observation or admission at the second hospital after transfer.
AHRQ-funded; HS024561.
Citation:
Zachrison KS, Boggs KM, Gao j .
Patient insurance status is associated with care received after transfer among pediatric patients in the emergency department.
Acad Pediatr 2021 Jul;21(5):877-84. doi: 10.1016/j.acap.2020.11.010..
Keywords:
Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Health Insurance, Emergency Department
Enayati M, Sir M, Zhang X
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
This study’s objective will be to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques. It will use trigger algorithms with electronic health record (EHR) data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on if they meet certain criteria. This study will be conducted by 2 academic medical centers with affiliated community hospitals.
AHRQ-funded; HS027363; HS026622.
Citation:
Enayati M, Sir M, Zhang X .
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
JMIR Res Protoc 2021 Jun 14;10(6):e24642. doi: 10.2196/24642..
Keywords:
Emergency Department, Diagnostic Safety and Quality, Patient Safety, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Piantino JA, Lin A, Luther M
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
This study’s objective was to determine the clinical value of using changes in heart rate variability (HRV) and electroencephalographic (EEG) background in children with acute trauma seen in the Emergency Department (ED) as early predictors of outcome. A novel wireless monitoring device was piloted in 17 patients with 15 patients having EEG data rated as appropriate for clinical interpretation. This was compared to EEG and HRV data successfully collected in 167 subjects. Results showed recording early HRV and EEG is feasible in children with acute injury. This new tool may offer an early, non-invasive marker for injury stratification and prognosis in children.
AHRQ-funded; HS022981.
Citation:
Piantino JA, Lin A, Luther M .
Simultaneous heart rate variability and electroencephalographic monitoring in children in the emergency department.
J Child Adolesc Trauma 2021 Jun;14(2):165-75. doi: 10.1007/s40653-020-00313-1..
Keywords:
Children/Adolescents, Emergency Department, Trauma, Outcomes
Worsham CM, Woo J, Jena AB
Adverse events and emergency department opioid prescriptions in adolescents.
Understanding the risks associated with opioid prescription in adolescents is critical for informing opioid policy, but the risks are challenging to quantify given the lack of randomized trial data. Using a regression discontinuity design, the investigators exploited a discontinuous increase in opioid prescribing in the emergency department (ED) when adolescents transitioned from "child" to "adult" at age eighteen to estimate the effect of an ED opioid prescription on subsequent opioid-related adverse events.
AHRQ-funded; HS026753.
Citation:
Worsham CM, Woo J, Jena AB .
Adverse events and emergency department opioid prescriptions in adolescents.
Health Aff 2021 Jun;40(6):970-78. doi: 10.1377/hlthaff.2020.01762..
Keywords:
Children/Adolescents, Emergency Department, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Practice Patterns
Wang X, Blumenthal HJ, Hoffman D
Modeling patient-related workload in the emergency department using electronic health record data.
Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study was to use electronic health record (EHR) data to predict the amount of work that individual patients contributed to clinician workload (patient-related workload).
AHRQ-funded; HS022542.
Citation:
Wang X, Blumenthal HJ, Hoffman D .
Modeling patient-related workload in the emergency department using electronic health record data.
Int J Med Inform 2021 Jun;150:104451. doi: 10.1016/j.ijmedinf.2021.104451..
Keywords:
Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Walter LA, Schoenfeld EM, Smith CH
Emergency department-based interventions affecting social determinants of health in the United States: a scoping review.
Emergency departments (EDs) function as the safety nets of the American health care system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of social emergency medicine (SEM) expands, a mapping and categorization of previous interventions may help shape future research. In this study, the investigators sought to identify, summarize, and characterize ED-based interventions aimed at mitigating negative social determinants of health.
AHRQ-funded; HS025701; HS013852.
Citation:
Walter LA, Schoenfeld EM, Smith CH .
Emergency department-based interventions affecting social determinants of health in the United States: a scoping review.
Acad Emerg Med 2021 Jun;28(6):666-74. doi: 10.1111/acem.14201..
Keywords:
Emergency Department, Social Determinants of Health, Vulnerable Populations, Low-Income
Cifra CL, Westlund E, Ten Eyck P
An estimate of missed pediatric sepsis in the emergency department.
AHRQ-funded; HS025753.
Citation:
Cifra CL, Westlund E, Ten Eyck P .
An estimate of missed pediatric sepsis in the emergency department.
Diagnosis 2021;8(2):193-98. doi: 10.1515/dx-2020-0023..
Keywords:
Children/Adolescents, Sepsis, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Risk
Lin CY, Xie J, Freedman SB
Predicting adverse outcomes for Shiga toxin-producing Escherichia coli infections in emergency departments.
Investigators assessed the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. They found that the HUS severity score was able to discriminate between high- and low-risk children less than 5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold.
AHRQ-funded; HS026503.
Citation:
Lin CY, Xie J, Freedman SB .
Predicting adverse outcomes for Shiga toxin-producing Escherichia coli infections in emergency departments.
J Pediatr 2021 May;232:200-06.e4. doi: 10.1016/j.jpeds.2020.12.077..
Keywords:
Children/Adolescents, Infectious Diseases, Emergency Department, Risk
Korach ZT, Gradwohl S, Messinger A
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Investigators compared knowledge-based and unsupervised statistical methods for ranking electronic health record (EHR) information by relevancy to a chief complaint of chest or back pain among emergency department patients. They found that a fully unsupervised statistical method can provide a reasonably accurate, low-effort, and scalable means for situation-specific ranking of clinical information within the EHR.
AHRQ-funded; HS024541.
Citation:
Korach ZT, Gradwohl S, Messinger A .
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Int J Med Inform 2021 May;149:104410. doi: 10.1016/j.ijmedinf.2021.104410.
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Keywords:
Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT)
Hua CL, Thomas KS, Peterson LJ
Emergency department use among assisted living residents after Hurricane Irma.
This retrospective cohort study examined whether rates of emergency department (ED) use for injuries and other medical reasons increased after Hurricane Irma in 2017 among assisted living (AL) residents in Florida. The researchers found that heart failure was a leading cause of ED visits within 90 days of September 1 in 2017, unlike in 2016. They recommended increased attention to AL communities in disaster preparedness and response efforts, given the increased likelihood of ED visits following a hurricane.
AHRQ-funded; T32 HS000011.
Citation:
Hua CL, Thomas KS, Peterson LJ .
Emergency department use among assisted living residents after Hurricane Irma.
J Am Med Dir Assoc 2021 Apr;22(4):918-22.e1. doi: 10.1016/j.jamda.2020.10.010..
Keywords:
Elderly, Emergency Department, Long-Term Care
Gettel CJ, Canavan ME, D'Onofrio G
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
This study looked at the clinical focus of emergency department (ED) workers using the 2017 Medicare Public Use Files for clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services for Medicare fee-for-service Part B. Clinicians were categorized as EM physicians, non-EM physicians, and advanced practice providers (APPs). Of the 65,710 unique clinicians providing care, 59.4% were classified as EM physicians, 12.4% as non-EM physicians, and 28.5% as APPs. EM physicians have twice as much clinician median focus in comparison to EM physicians providing emergency care (92.8% vs 45.2) and APPs are focused 100%.
AHRQ-funded; HS023614.
Citation:
Gettel CJ, Canavan ME, D'Onofrio G .
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
Am J Emerg Med 2021 Apr;42:228-32. doi: 10.1016/j.ajem.2020.11.069..
Keywords:
Emergency Department, Workforce, Provider: Physician, Provider: Clinician, Provider, Medicare
Hong AS, Chang H, Courtney DM
Patterns and results of triage advice before emergency department visits made by patients with cancer.
This study investigated the use of telephone triage for acute care for patients with cancer undergoing treatment. Findings showed that, although patients self-referred for six of every ten emergency department (ED) visits, self-referred visits were not more severe. When patients called for advice, clinicians regularly recommended the ED. Recommendations included better understanding of barriers that patients and clinicians experienced when trying to access non-ED acute care.
AHRQ-funded; HS022418.
Citation:
Hong AS, Chang H, Courtney DM .
Patterns and results of triage advice before emergency department visits made by patients with cancer.
JCO Oncol Pract 2021 Apr;17(4):e564-e74. doi: 10.1200/op.20.00617..
Keywords:
Emergency Department, Cancer
