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
51 to 75 of 569 Research Studies DisplayedRay EM, Hinton SP, Reeder-Hayes KE
Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer.
The objectives of this study were to examine the patterns of care and risk factors for subsequent acute care utilization among patients with hospital-diagnosed advanced lung cancer (ALC). Researchers identified patients with incident ALC from 2007-13 and an index hospitalization within 7 days of diagnosis in Surveillance, Epidemiology, and End Results-Medicare. Results showed that more than half of the incident ALC patients were hospitalized around the time of diagnosis; among those who survived to discharge, only 37% received systemic cancer treatment. Many patients experienced an early readmittance and most died within 6 months. The researchers conclude that such patients may benefit from increased access to palliative and other supportive care during hospitalization to prevent subsequent health care utilization.
AHRQ-funded; HS000032.
Citation: Ray EM, Hinton SP, Reeder-Hayes KE .
Risk factors for return to the emergency department and readmission in patients with hospital-diagnosed advanced lung cancer.
Med Care 2023 Apr;61(4):237-46. doi: 10.1097/mlr.0000000000001829.
Keywords: Emergency Department, Hospital Readmissions, Cancer: Lung Cancer, Cancer, Risk
Roddy MK, Chen P, Jeffery AD
Telemental health in emergency care settings: a qualitative analysis of considerations for sustainability and spread.
The purpose of this study was to explore barriers and facilitators for the spread and sustainability of telemental health video (TMH-V) as precaution policies from the pandemic declined. The researchers conducted a qualitative study using semistructured interviews and observations guided by RE-AIM. Local clinicians, facility leadership, Veterans, and external partners were asked about barriers and facilitators impacting patient willingness to engage in telemental health video (TMH-V) (reach), quality of care (effectiveness), barriers and facilitators impacting provider uptake (adoption), possible adaptations to TMH-V (implementation), and possibilities for long-term use of TMH-V (maintenance). The researchers also observed TMH-V encounters in one emergency department (ED) and one urgent care (UC) to understand how clinicians and Veterans engaged with the technology. The study found that in 10 observations, all interviewees were satisfied with the TMH-V program, and interviewees emphasized greater comfort discussing difficult topics for Veterans (reach). Clinicians indicated that TMH-V provided cross-coverage across sites as well as greater safety and flexibility for clinicians (adoption). Opportunities for improvement include reducing technological responsibilities for on-site staff, electronic health record (EHR) adaptations to correctly depict workload and modality (telehealth vs. in-person), and standardizing protocols to improve efficiency in communication between on-site and remote clinical staff (implementation). Participants supported its dissemination to other sites (maintenance) and indicated there was significant possibility for expanding the service.
AHRQ-funded; HS026395.
Citation: Roddy MK, Chen P, Jeffery AD .
Telemental health in emergency care settings: a qualitative analysis of considerations for sustainability and spread.
Acad Emerg Med 2023 Apr; 30(4):368-78. doi: 10.1111/acem.14682..
Keywords: Emergency Department, Telehealth, Health Information Technology (HIT)
Kaufman EJ, Khatri U, Hall EC
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
This study surveyed members of the American Association for the Surgery of Trauma (AAST) to assess their perspectives on frequency, circumstances, and implications of law enforcement officer (LEO) presence in trauma bays nationwide. The survey was distributed electronically to AAST members in September and October 2020, with 234 responding. Of those respondents, 189 (80.7%) were attending surgeons, 169 (72.2%) identified as white, and 144 (61.5%) as male. 187 respondents (79.9%) observed LEO presence at least weekly. Respondents found LEOs helpful for public safety, followed by clinical care, and then for patients. Older respondents rated LEO presence as helpful more often than younger respondents. Respondents assessed severity of the patient's condition, the safety of emergency department staff, the safety of LEOs, and a patient's potential role as a threat to public safety when determining LEO access.
AHRQ-funded; HS026372.
Citation: Kaufman EJ, Khatri U, Hall EC .
Law enforcement in the trauma bay: a survey of members of the American Academy for the Surgery of Trauma.
Trauma Surg Acute Care Open 2023 Mar 13;8(1):e001022. doi: 10.1136/tsaco-2022-001022.
Keywords: Trauma, Emergency Department
Gripko M, Joseph A, MohammadiGorji S
Effects of the physical environment on children and families in hospital-based emergency departments: a systematic literature review.
The environment and nature of an emergency department (ED) can be counter-therapeutic to pediatric patients and their families. The purpose of this systematic literature review was to explore the complex dynamic of the ED environment and consider how it affects children and their families or guardians. The researchers utilized PRISMA methods to search four databases to identify and review 21 peer-reviewed articles that examined the effects of the physical environment of hospital-based EDs on children or their family members. The research identified several themes in the literature that highlight opportunities for future ED design, including positive distractions, family and social supports, control dynamics, and designing for a safe and comfortable experience.
AHRQ-funded; HS029109.
Citation: Gripko M, Joseph A, MohammadiGorji S .
Effects of the physical environment on children and families in hospital-based emergency departments: a systematic literature review.
J Environ Psychol 2023 Mar; 86. doi: 10.1016/j.jenvp.2023.101970..
Keywords: Children/Adolescents, Emergency Department, Healthcare Delivery
Zhang A, Spiegel T, Bundy A
Evaluation of a transitions clinic to bridge emergency department and primary care.
This paper evaluated the outcomes of using a clinical transition clinic (CTC) to bridge emergency department (ED) and primary care. Main outcomes were 30-day ED revisits and hospital readmissions. From March 2021 to March 2022, 373 patients were referred to the CTC totaling 405 appointments, with half (53%) completed with a median follow-up time of 4 days. The most common care types provided were wound care (44%) and clinical problem management (33%). Patients who completed their CTC appointment were 50% less likely to return to the ED in 30 days compared with those who did not complete their appointment. The same effect was not seen for CTC appointment completion on hospital readmission.
AHRQ-funded; HS027804.
Citation: Zhang A, Spiegel T, Bundy A .
Evaluation of a transitions clinic to bridge emergency department and primary care.
J Hosp Med 2023 Mar; 18(3):217-23. doi: 10.1002/jhm.13056..
Keywords: Transitions of Care, Emergency Department, Primary Care
Griffey RT, Schneider RM, Todorov AA
Near-miss events detected using the emergency department trigger tool.
The purpose of this study was to explore near misses and their significance for quality and safety in the emergency department (ED). This study presents a secondary analysis of data from a retrospective investigation of the ED Trigger Tool (EDTT) at an urban, academic ED. The EDTT, a computerized query for triggers, was applied to 13 months of ED visit data, and 5582 selected records were reviewed using a two-tiered approach. Events were categorized by occurrence (ED vs. present on arrival [POA]), severity, omission/commission, and type, employing a taxonomy featuring categories, subcategories, and cross-cutting modifiers. The researchers identified 1458 ED near misses in 1269 of the 5582 records and 80 near misses that were POA. Patient care events constituted the majority of ED near misses, including diagnostic delays, treatment delays, and monitoring failures, primarily influenced by ED boarding and overcrowding. Medication events ranked second in frequency (17%), with 80 medication administration errors identified. Among the 80 POA events, 42% were linked to overanticoagulation. It was estimated that 19.3% of all ED visits involved a near miss.
AHRQ-funded; HS027811; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
Near-miss events detected using the emergency department trigger tool.
J Patient Saf 2023 Mar 1; 19(2):59-66. doi: 10.1097/pts.0000000000001092..
Keywords: Emergency Department, Patient Safety, Adverse Events, Medical Errors
Sonik RA, Coleman-Jensen A, Creedon TB
SNAP participation and emergency department use.
The objectives of this study were to examine whether Supplemental Nutrition Assistance Program (SNAP) participation is associated with emergency department use among low-income children, and whether any such association is mediated by household food hardship and child health status and/or moderated by special health care needs (SHCN) status. Researched pooled cross-sectional samples of children in low-income households from 2016-19 National Survey of Children's Health. SNAP participation was found to be associated with lower likelihoods of emergency department use. The researchers concluded that food hardship relief may improve outcomes for vulnerable children as well as the health systems that serve them.
poverty food
Citation: Sonik RA, Coleman-Jensen A, Creedon TB .
SNAP participation and emergency department use.
Pediatrics 2023 Feb;151(2):e2022058247. doi: 10.1542/peds.2022-058247.
Keywords: Children/Adolescents, Nutrition, Vulnerable Populations, Low-Income, Emergency Department
Song J, Chae S, Bowles KH
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
The purpose of this retrospective cohort study was to identify risk factor clusters in home health care and assess whether the clusters are related with hospitalizations or emergency department visits. The researchers included 61,454 patients associated with 79,079 episodes receiving home health care from one of the largest home health care organizations in the U.S. The study found that a total of 11.6% of home health episodes resulted in hospitalizations or emergency department visits. Three clusters were formed by the risk factors: 1) Cluster 1- a combination of risk factors related to situations where patients may experience increased pain ("impaired physical comfort with pain"). 2) Cluster 2 - characterized by multiple comorbidities or other risks for hospitalization (e.g., prior falls, called "high comorbidity burden"). 3) Cluster 3 - "impaired cognitive/psychological and skin integrity" which includes dementia or skin ulcer. The risk of hospitalizations or emergency department visits increased by 1.95 times for Cluster 2 and by 2.12 times for Cluster 3 when compared to cluster 1. The study concluded that Varying combinations of risk factors affected the likelihood of negative outcomes.
AHRQ-funded; HS027742.
Citation: Song J, Chae S, Bowles KH .
The identification of clusters of risk factors and their association with hospitalizations or emergency department visits in home health care.
J Adv Nurs 2023 Feb; 79(2):593-604. doi: 10.1111/jan.15498..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Mohr NM, Okoro U, Harland KK
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
The objective of this multicenter cohort study was to test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments. Medical records of patients with sepsis were taken from rural hospitals in an established, on-demand, video tele-ED Midwestern network. Findings suggest that tele-ED cases did not have more 28-day hospital-free days or 28-day in-hospital mortality. A subgroup of patients treated by advanced practice providers suggest that mortality was lower in the cohort with tele-ED use in spite of no significant difference in complete SSC adherence. The researchers concluded that rural emergency department patients treated with provider-to-provider tele-ED care in a developed network showed similar clinical outcomes to those treated without.
AHRQ-funded; HS025753.
Citation: Mohr NM, Okoro U, Harland KK .
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
Ann Emerg Med 2023 Jan;81(1):1-13. doi: 10.1016/j.annemergmed.2022.07.024..
Keywords: Rural Health, Emergency Department, Telehealth, Health Information Technology (HIT), Sepsis, Outcomes
Moriya AS, Chakravarty S
AHRQ Author: Moriya AS
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, Medicaid, Health Insurance, Access to Care
Wachnik AA, Welch-Coltrane JL, Adams MCB
A standardized emergency department order set decreases admission rates and in-patient length of stay for adults patients with sickle cell disease.
The purpose of this 3-year prospective analysis study was to assess a quality improvement project to standardize Emergency Department (ED) care for patients presenting with pain associated with sickle cell disease (SCD). IN 2019 the researchers implemented an ED order set in to improve care and provide adequate management of analgesia. The primary outcome was the overall hospital admission rate for patients after the intervention, and the secondary outcome measures included ED disposition, rate of return to the ED within 72 hours, ED pain scores at admission and discharge, ED treatment time, in-patient length of stay, non-opioid medication use, and opioid medication use. The study found an overall 67% reduction in the hospital admission rate after implementation of the order set and a significant decrease in the percentage admission rate month over month. Time to the first non-opioid analgesic decreased by 71 minutes and there was no change in time to the first opioid medication. The rate of return to the ED within 72 hours did not change and the ED elopement rate did not change. There were significant increases in the prescribing of orally administered acetaminophen, celecoxib, and tizanidine, and intravenous ketamine and ketorolac. ED pain scores at discharge did not change for hospital-admitted and non-admitted patients. The possible reduction in costs was $193,440 during the 12-month observation period, and the average cost per visit decreased by $792. The researchers concluded that the ED order set decreased the rate of hospital admissions and the timeliness of analgesia administration without having a negative impact on the pain of the patients.
AHRQ-funded; HS028584.
Citation: Wachnik AA, Welch-Coltrane JL, Adams MCB .
A standardized emergency department order set decreases admission rates and in-patient length of stay for adults patients with sickle cell disease.
Pain Med 2022 Dec;23(12):2050-60. doi: 10.1093/pm/pnac096..
Keywords: Sickle Cell Disease, Emergency Department, Hospitalization
Soltani Batt, RJ Bavafa, H
Does what happens in the ED stay in the ED? The effects of emergency department physician workload on post-ed care use.
The purpose of this study was to evaluate the effects of Emergency Department (ED) crowding on the performance of systems outside of the ED: specifically, on the use of post-ED care. The researchers also examined the mediating effects of care intensity in the ED on post-ED use of care. The study utilized microdata from a large U.S. hospital dataset gathered from over four years of exhaustive billing data in an integrated health system. The study found that when ED provider workload increased from the 5th percentile to the median, the number of medical services for patients who were discharged home from the ED increased by 5% and was stable after. The researchers also discovered that when a physician is busier, they order a greater number of tests for patients who are less severe. The study concluded that "extra" testing by providers results in "extra" post-ED care use for those patients, and that earlier studies estimating the cost of ED crowding underestimate the actual effect, because they do not take into account the "extra" post-ED care use.
AHRQ-funded; HS024558.
Citation: Soltani Batt, RJ Bavafa, H .
Does what happens in the ED stay in the ED? The effects of emergency department physician workload on post-ed care use.
Manuf Serv Oper Manag 2022 Nov-Dec;24(6):3079-98. doi: 10.1287/msom.2022.1110..
Keywords: Emergency Department, Healthcare Utilization
James TG, Miller MD, McKee MM
Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: a retrospective chart review.
This study assessed emergency department (ED) condition acuity, length of stay (LOS), and acute ED revisits among deaf and hard-of-hearing (DHH) patients. Findings identified that DHH American Sign Language users have longer ED LOS than non-DHH English-speakers.
AHRQ-funded; HS027537.
Citation: James TG, Miller MD, McKee MM .
Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: a retrospective chart review.
Acad Emerg Med 2022 Nov;29(11):1290-300. doi: 10.1111/acem.14573..
Keywords: Emergency Department, Disabilities, Vulnerable Populations
Ostrovsky D, Novack V, Smulowitz PB
Perspectives of emergency clinicians about medical errors resulting in patient harm or malpractice litigation.
This cross-sectional study examined survey responses about medical error outcomes completed by emergency department attending physicians and advanced practice clinicians regarding what might be considered excessive testing. The authors surveyed 1222 clinicians and the mean score was greater for fear of harm to patients than fear of a malpractice suit. This finding was true regardless of clinician subtype, experience, or sex.
AHRQ-funded; HS026730.
Citation: Ostrovsky D, Novack V, Smulowitz PB .
Perspectives of emergency clinicians about medical errors resulting in patient harm or malpractice litigation.
JAMA Netw Open 2022 Nov;5(11):e2241461. doi: 10.1001/jamanetworkopen.2022.41461..
Keywords: Emergency Department, Medical Errors, Adverse Events, Patient Safety
Scott Scott, Kempe A, Bajaj L
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Researchers sought to identify barriers and facilitators to pediatric sepsis care in general emergency departments (EDs), including care processes, the role of guidelines, and incentivized metrics. They interviewed medical directors, nurse managers, and quality coordinators. They found that leaders in general EDs were motivated to provide high-quality pediatric sepsis care but disagreed on whether reportable metrics would drive improvements. Leaders universally sought direct support from their nearest children's hospitals and actionable guidelines.
AHRQ-funded; HS025696.
Citation: Scott Scott, Kempe A, Bajaj L .
"These are our kids": qualitative interviews with clinical leaders in general emergency departments on motivations, processes, and guidelines in pediatric sepsis care.
Ann Emerg Med 2022 Oct;80(4):347-57. doi: 10.1016/j.annemergmed.2022.05.030..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Guidelines, Evidence-Based Practice
Hoonakker PLT, Carayon P, Brown RL
A systematic review of the Consumer Emergency Care Satisfaction Scale (CECSS).
In this study, researchers systematically reviewed the literature on the Consumer Emergency Care Satisfaction Scale (CECSS) and examined its psychometric properties. Their systematic literature search resulted in 28 articles in which the CECSS was used, demonstrating that, from a psychometric perspective, the CECSS is a valid and reliable instrument. However, their study also showed that the CECSS has several weaknesses, and they made recommendations for its improvement.
AHRQ-funded; HS026624.
Citation: Hoonakker PLT, Carayon P, Brown RL .
A systematic review of the Consumer Emergency Care Satisfaction Scale (CECSS).
J Nurs Care Qual 2022 Oct-Dec;37(4):349-55. doi: 10.1097/ncq.0000000000000636..
Keywords: Emergency Department, Patient Experience
Shah W, Villaflores CW, Chuong LH
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
This study investigated whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person versus telehealth encounters for post-ED follow-up care. This retrospective cohort study included adult patients who came to either of 2 in-system EDs of a single urban integrated academic system from April 2020 to September 2021, were discharged home, and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit. Overall, the study recorded 12,848 patients with 16,987 ED encounters (mean age 53 years; 57% women, 12% Black or African American; 22% Hispanic or Latinx; and 58% White) included. Overall, 17% of initial ED encounters led to returns to the ED, and 4% subsequent hospitalizations. Telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 more ED returns per 1000 encounters) and hospitalizations (10.6 more hospitalizations per 1000 encounters).
AHRQ-funded; HS026372.
Citation: Shah W, Villaflores CW, Chuong LH .
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
JAMA Netw Open 2022 Oct;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Hospitals
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
AHRQ-funded; HS02717.
Citation: Dutta S, McEvoy DS, Rubins DM .
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Odeh Couvertier V, Patterson Patterson, Zayas-Cabán G
Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients.
The purpose of this retrospective, observational study was to evaluate abdominal pain patients discharged from the ED to determine the association between advanced emergency department (ED) imaging on subsequent outpatient imaging and on revisits. The researchers utilized the electronic health records of Medicare patients who presented with a complaint of abdominal pain at a United States academic emergency department. The study found that participants who were not imaged at the ED had significantly higher adjusted odds of being imaged outside of the ED within 7, 14, and 28 days of being discharged, and had a significantly higher adjusted odds of returning to the study ED and visiting any ED within 30 days of being discharged. The study concluded that receiving abdominal imaging services in the ED was related with significantly lower imaging use after discharge.
AHRQ-funded; HS024558.
Citation: Odeh Couvertier V, Patterson Patterson, Zayas-Cabán G .
Association between advanced image ordered in the emergency department on subsequent imaging for abdominal pain patients.
Acad Emerg Med 2022 Sep;29(9):1078-83. doi: 10.1111/acem.14541..
Keywords: Imaging, Emergency Department, Diagnostic Safety and Quality, Hospital Readmissions
Bell N, Lòpez-De Fede A, Cai B
Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures.
This retrospective cohort study examined geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures for pediatric patients with either attention deficit/hyperactivity disorder (ADD, ages 6-12) or asthma (MMA, ages 5-18) defined using Healthcare Effectiveness Data and Information Set (HEDIS) performance measures. The authors investigated differences in avoidable and potentially avoidable ED visits by the beneficiary's primary care medical home (PCMH) attribution type and in relation to differences in proximity to their primary care providers versus hospitals. There was a 2.4 percentage point reduction in risk of avoidable emergency department (ED) visits among children in the ADD cohort who attended a PCMH versus those who did not which increased to 3.9 to 7.2 percentage points as relative proximity to primary care providers versus hospitals improved. Children in the ADD and MMA cohorts who were enrolled in a PCMH but did not attend one for primary care services exhibited a 5.4 and 3.0 percentage point increase in avoidable ED visits compared to children who were unenrolled and did not attend medical homes, but these differences were only observed when geographic proximity to hospitals was more convenient than primary care providers.
AHRQ-funded; HS026263.
Citation: Bell N, Lòpez-De Fede A, Cai B .
Geographic proximity to primary care providers as a risk-assessment criterion for quality performance measures.
PLoS One 2022 Sep 6;17(9):e0273805. doi: 10.1371/journal.pone.0273805..
Keywords: Children/Adolescents, Primary Care, Asthma, Medicaid, Emergency Department
Encinosa W, Lane K, Cornelio N
AHRQ Author: Encinosa W
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
This article discusses the 2022 No Surprises Act whose goal was to prevent patients from receiving unexpected emergency department (ED) out-of-network physician bills and restrict out-of-network co-payments to in-network co-payment levels. Similar state bans were examined to determine whether the large reduction in out-of-pocket payments under bans will have an unintended consequence of an increase in ED visits and spending. The authors examined 16 million nonelderly, fully funded, privately insured health maintenance organization (HMO) enrollees between 2007 and 2018 from 15 states with balance billing bans for HMO ED visits and 16 states without bans as the control group. They found that the bans reduced spending per visit by 14% but spurred a demand response with an increase of 3 percentage points in ED visits which wiped away the cost savings. The authors predict that the federal ban will result in $5.1 billion in savings but 3.5 million more ED visits at $4.2 billion in extra spending per year, largely negating expected savings.
AHRQ-authored; AHRQ-funded; HS027698.
Citation: Encinosa W, Lane K, Cornelio N .
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
Am J Manag Care 2022 Sep;28(9):e333-e38. doi: 10.37765/ajmc.2022.89226..
Keywords: Healthcare Costs, Emergency Department, Policy, Healthcare Utilization
Kilaru AS, Illenberger N, Meisel ZF
Incidence of timely outpatient follow-up care after emergency department encounters for acute heart failure.
The purpose of this retrospective cohort study was to explore the incidence of outpatient follow-up care after presentation for acute heart failure at the emergency department (ED), and to present patient characteristics associated with receiving timely follow-up care. Using an administrative claims database from a United States commercial insurer, the researchers reviewed 52,732 adult patients with a mean age of 73.9 years discharged from the ED with the principal diagnosis of acute heart failure. The study found that within 30 days of the ED encounter, 23.2% of patients attended an outpatient clinic visit for heart failure, with 15.9% patients hospitalized before they could obtain an outpatient clinic visit. Patients that were younger, women, reporting non-Hispanic Black race, and had fewer previous clinic visits were less likely to obtain outpatient follow-up care. The study concluded that almost 20% of patients require hospitalization within 30 days of an ED for visit for heart failure, and few obtain timely outpatient follow-up after the initial visit.
AHRQ-funded; HS026372.
Citation: Kilaru AS, Illenberger N, Meisel ZF .
Incidence of timely outpatient follow-up care after emergency department encounters for acute heart failure.
Circ Cardiovasc Qual Outcomes 2022 Sep;15(9):e009001. doi: 10.1161/circoutcomes.122.009001..
Keywords: Ambulatory Care and Surgery, Emergency Department, Heart Disease and Health, Cardiovascular Conditions
Shankar LG, Habich M, Rosenman M
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Investigators described pediatric mental health emergency department (ED) visit rates and visit characteristics before and during the COVID-19 pandemic. They found that mental health ED visit rates by children increased during the COVID-19 pandemic.
AHRQ-funded; HS026385.
Citation: Shankar LG, Habich M, Rosenman M .
Mental health emergency department visits by children before and during the COVID-19 pandemic.
Acad Pediatr 2022 Sep-Oct;22(7):1127-32. doi: 10.1016/j.acap.2022.05.022..
Keywords: COVID-19, Children/Adolescents, Emergency Department, Behavioral Health, Healthcare Utilization, Public Health
Cutler GJ, Bergmann KR, Doupnik SK
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
The purpose of this study was to explore the author’s previous research findings on trends in pediatric emergency department (ED) visits for mental health (MH) vs non-mental health in light of more recent related data corresponding with the COVID-19 pandemic. The study found that recent research supports the dramatic increase in pediatric MH ED visits found in the author’s previous research and provides additional evidence that the increase has been driven by specific MH diagnoses. The researchers conclude that depressive disorders, self-harm behavior, and non-alcohol substance use disorders should be prioritized for the development of ED- and hospital-based strategies, and that EDs, hospitals, health systems, and the government urgently need to increase capacity for MH services and identify innovative solutions to improve access to high quality MH care for children.
AHRQ-funded; HS026385.
Citation: Cutler GJ, Bergmann KR, Doupnik SK .
Pediatric mental health emergency department visits and access to Inpatient care: a crisis worsened by the COVID-19 pandemic.
Acad Pediatr 2022 Aug;22(6):889-91. doi: 10.1016/j.acap.2022.03.015..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Emergency Department, Access to Care, Public Health, Inpatient Care
Pickens G, Smith MW, McDermott KW
Trends in treatment costs of U.S. emergency department visits.
In recent years, emergency department (ED) spending has been increasing more than in other areas of health care. Few studies have focused on changes in ED treatment costs. The purpose of this study was to analyze recent increases in emergency department treatment costs to highlight possibilities for reducing the growth of overall hospital costs. The researchers used data from the Healthcare Cost and Utilization Project (HCUP) and applied Cost-to-Charge Ratios for ED Files to the HCUP Nationwide Emergency Department Sample for 2012 through 2019. The study found that ED treatment costs experienced a 5.4% annual growth rate, increasing from $54 billion to $88 billion, with higher treatment cost per visit responsible for 4.4 of those percentage points. The researchers concluded that the study provides valuable information for decision- and policy-makers by bringing attention to components of the healthcare delivery system with the highest increasing costs as well as trends in overall ED costs.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Pickens G, Smith MW, McDermott KW .
Trends in treatment costs of U.S. emergency department visits.
Am J Emerg Med 2022 Aug;58:89-94. doi: 10.1016/j.ajem.2022.05.035..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Emergency Department