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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
76 to 100 of 569 Research Studies DisplayedHinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Shared Decision Making
Doty AM, Rising KL, Hsiao T
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
This study’s objective was to describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated emergency department (ED) discharge discussion. Most residents in the simulation explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients’ feelings. However, 28% of residents did not discuss diagnostic uncertainty in any form. All residents were reassuring. Those who did discuss diagnostic uncertainty used explicit and implicit language with similar frequency.
AHRQ-funded; HS025651.
Citation: Doty AM, Rising KL, Hsiao T .
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
Patient Educ Couns 2022 Jul;105(7):2053-57. doi: 10.1016/j.pec.2021.12.002..
Keywords: Clinician-Patient Communication, Emergency Department, Communication, Diagnostic Safety and Quality
Hoffmann JA, Johnson JK, Pergjika A
Development of quality measures for pediatric agitation management in the emergency department.
This study’s objective was to develop quality measures for pediatric emergency department (ED) agitation management informed by multidisciplinary perspectives. A multidisciplinary panel was created to develop quality measures for pediatric ED agitation management through the modified Delphi method. The panelists included 36 physicians, nurses, social workers, security, child life specialists, hospital data analysts, and parents. Measures were ranked by panelists in importance and feasibility on a 9-point scale during 2 survey rounds, with a teleconference discussion between surveys. Consensus was defined at >75% of panelists ranking a quality measure greater or equal to 7 in importance and median feasibility of greater or equal to 4. Consensus was reached on 20 quality measures that incorporated multidisciplinary perspectives.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Johnson JK, Pergjika A .
Development of quality measures for pediatric agitation management in the emergency department.
J Healthc Qual 2022 Jul-Aug;44(4):218-29. doi: 10.1097/jhq.0000000000000339..
Keywords: Children/Adolescents, Quality Measures, Quality Indicators (QIs), Quality of Care, Emergency Department
James TG, McKee MM, Miller MD
Emergency department utilization among deaf and hard-of-hearing patients: a retrospective chart review.
This retrospective study investigated the differences in emergency department (ED) utilization among deaf and hard-of-hearing (DHH) patients compared to non-DHH patients. A chart review was conducted using data from a large academic medical center in the southeastern United States. A total of 277 DHH ASL-users, 1000 DHH English speakers, and 1000 non-DHH English speakers were included. DHH ASL users and DHH English speakers had higher adjusted odds ratio of using the ED in the past 36 months than non-DHH English speakers. Abdominal pain was the most common principal diagnosis code for DHH English speakers.
AHRQ-funded; HS027537.
Citation: James TG, McKee MM, Miller MD .
Emergency department utilization among deaf and hard-of-hearing patients: a retrospective chart review.
Disabil Health J 2022 Jul;15(3):101327. doi: 10.1016/j.dhjo.2022.101327..
Keywords: Emergency Department, Disabilities
Ward MJ, Shuster JL, Mohr NM
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
The purpose of this AHRQ-funded, mixed-methods study was to evaluate an emergency telehealth intervention in emergency department (ED) and urgent care clinic (UCC) settings within the Veterans Health Administration (VHA) in March 2020. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was utilized to compare the 3 months preimplementation of the telehealth intervention (December 1, 2019 through February 29, 2020) with the 3 months postimplementation of the telehealth intervention (April 1, 2020 through June 30, 2020), and then assess sustainability through January 31, 2021. Qualitative data from surveys and semistructured interviews were conducted and analyze. The telemental health intervention was used in 83% (319) of unscheduled mental health consultations in the postimplementation phase, with no adverse trends in length of stay, 7-day revisits, or 30-day mortality. In the sustainability phase, use of the intervention was high with 82% (n = 1,010) of all unscheduled mental health consultations performed by telemental health. The study concluded that the use of unscheduled telemental health intervention was highly acceptable and sustainable in ED and UCC settings and did not impact the safety and efficacy of mental health consultations.
AHRQ-funded; HS025753.
Citation: Ward MJ, Shuster JL, Mohr NM .
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
Telemed J E Health 2022 Jul;28(7):985-93. doi: 10.1089/tmj.2021.0263..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Behavioral Health, Emergency Department
Balamuth F, Scott HF, Weiss SL
Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department.
This study analyzed whether a measure used to quantity organ dysfunction, the Sequential Organ Failure Assessment (SOFA) in adults can also be used for critically ill children in an emergency department (ED) population. This retrospective cohort study took place in 9 US children’s hospitals included in the Pediatric Emergency Care Applied Research Network (PECARN registry from January 2012 to January 31, 2020. A score of 2 or more can indicate an infection. Almost 4 million ED visits were included, with 3.2% having a pSOFA score of 2 or more. The pSOFA score showed poor sensitivity as a screening tool for hospital mortality but children with a pSOfA score of 2 or less were at very low risk of death, with high specificity and negative predictive value.
AHRQ-funded; HS020270.
Citation: Balamuth F, Scott HF, Weiss SL .
Validation of the pediatric Sequential Organ Failure Assessment score and evaluation of Third International Consensus Definitions for Sepsis and Septic Shock Definitions in the pediatric emergency department.
JAMA Pediatr 2022 Jul;176(7):672-78. doi: 10.1001/jamapediatrics.2022.1301..
Keywords: Children/Adolescents, Sepsis, Emergency Department
Probst MA, Janke AT, Haimovich AD
Development of a novel emergency department quality measure to reduce very low-risk syncope hospitalizations.
The purpose of this study was to develop a new quality measure to apply with very low risk adult emergency department patients under 50 years of age and with no history of heart disease presenting with syncope. The study found that of the 3,292 patients meeting the study criteria, .46% suffered serious adverse events within 30 days after discharge. When the criteria were applied to the 2019 Nationwide Emergency Department Sample (NEDS) to assess its potential effect (assessing for hospital-level factors associated with hospitalization variation), of the 566,031 patients meeting the criteria, 2.7% were hospitalized. The researchers identified factors associated with increased hospitalization rates, which included a yearly ED volume of more than 80,000 and metropolitan teaching status. The study concluded that the novel syncope quality measure developed by the researchers can evaluate variation in low-value hospitalizations for unexplained syncope.
AHRQ-funded; HS022882.
Citation: Probst MA, Janke AT, Haimovich AD .
Development of a novel emergency department quality measure to reduce very low-risk syncope hospitalizations.
Ann Emerg Med 2022 Jun;79(6):509-17. doi: 10.1016/j.annemergmed.2022.03.008..
Keywords: Emergency Department, Quality Measures, Hospitalization, Quality Indicators (QIs), Quality of Care
Kim HS, Muschong KM, Fishman IL KM, Fishman IL
Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial.
This protocol paper discusses a study that will evaluate outcomes of having an embedded physical therapist in the emergency department (ED) for patients experiencing acute low back pain. The desired outcome is lower patient-reported opioid use post-discharge. The study will enroll patients with acute low back pain at an urban academic ED in Chicago, Illinois. This case-control study will randomize patients to either the embedded physical therapy or the usual care. The authors will follow the patients to a primary endpoint of 3 months and compare a primary outcome of change in PROMIS-Pain Interference score and secondary outcomes of change in modified Oswestry Disability Index score and patient-reported opioid use.
AHRQ-funded; HS027426.
Citation: Kim HS, Muschong KM, Fishman IL KM, Fishman IL .
Embedded emergency department physical therapy versus usual care for acute low back pain: a protocol for the NEED-PT randomised trial.
BMJ Open 2022 May 24;12(5):e061283. doi: 10.1136/bmjopen-2022-061283..
Keywords: Emergency Department, Back Health and Pain, Pain
Newgard CD, Lin A, Caughey AB
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
The purpose of this study was to assess the prognoses, healthcare use, transitions to skilled nursing or hospice, and mortality of older, community-living adults after a fall. The researchers conducted a secondary analysis of all adults in 7 Northwest U.S. counties greater than or equal to 65 years of age who had been transported to one of 51 hospitals after a fall. The study analyzed Medicare claims, state trauma registry data, state inpatient data, and death records for outcomes which included healthcare use, new claims for skilled nursing and hospice for one year, and mortality. The researchers found that in 3,159 older adults there were 147 deaths within 30 days and 665 deaths within one year, and the following predictors of mortality: respiratory diagnosis, serious brain injury, having a baseline disability, or a score of greater than or equal to 2 on the Charlson Comorbidity Index. The study concluded that in the year after experiencing a fall, community-living older adults who require ambulance transport to the hospital have increases in institutionalized living, the utilization of health care, and mortality.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Caughey AB .
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
West J Emerg Med 2022 May 14;23(3):375-85. doi: 10.5811/westjem.2021.11.54327..
Keywords: Elderly, Falls, Emergency Department, Mortality, Healthcare Utilization
Green RK, Shah MN, Clark LR
Comparing emergency department use among individuals with varying levels of cognitive impairment.
This study compared the frequency of emergency department (ED) use among a cohort of individuals with mild to well-defined cognitive impairment. This retrospective cohort study of English-speaking, community-dwelling individuals was conducted at four health system-based multidisciplinary clinics from 2014 to 2016. The authors obtained demographic and clinical data, including neuropsychological testing results, through chart review and linkage to electronic health record data. They characterized the frequency and quantity of ED use within one year (6 months before and after) of cognitive evaluation and compared ED use between the three groups using bivariate and multivariate approaches. Of the 779 eligible patients, 89 were diagnosed as cognitively intact, 372 as having mild cognitive impairment (MCI), and 318 as having Alzheimer’s Disease and related dementias (ADRD). The proportion of subjects with any annual ED use did not significantly increase with greater cognitive impairment. The average number of ED visits also did not increase significantly with patients with MCI or ADRD having an elevated but non-significant risk of an ED visit compared to cognitively intact individuals.
AHRQ-funded; HS024558.
Citation: Green RK, Shah MN, Clark LR .
Comparing emergency department use among individuals with varying levels of cognitive impairment.
BMC Geriatr 2022 May 2;22(1):382. doi: 10.1186/s12877-022-03093-5..
Keywords: Emergency Department, Neurological Disorders, Healthcare Utilization
Mahony T, Harder VS, Ang N
Weekend versus weekday asthma-related emergency department utilization.
The objective of this study was to assess variation in pediatric asthma-related emergency department (ED) visits between weekends and weekdays. Data was taken from California 2016 Medicaid data and Vermont 2016 and Massachusetts 2015 all-payer claims sources for children and adolescents in stratified groups aged 3 to 21. The asthma-related ED visit rate was slightly lower on weekends. The authors concluded that their findings suggest the increase of access options during the weekend may not necessarily decrease asthma-related ED visits.
AHRQ-funded; HS025297; HS020518; 233201600221A; 233201550088A
Citation: Mahony T, Harder VS, Ang N .
Weekend versus weekday asthma-related emergency department utilization.
Acad Pediatr 2022 May-Jun;22(4):640-46. doi: 10.1016/j.acap.2021.09.005..
Keywords: Asthma, Respiratory Conditions, Emergency Department, Healthcare Utilization
Parast L, Burkhart Q, Bardach NS
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
The authors sought to develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. Using Medicaid administrative data, they concluded that this new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, they recommended future work in order to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
AHRQ-funded; HS025291.
Citation: Parast L, Burkhart Q, Bardach NS .
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
Acad Pediatr 2022 Apr;22(3s):S92-s99. doi: 10.1016/j.acap.2021.03.005..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Measures, Quality Indicators (QIs), Quality of Care
Bardach NS, Harder VS, McCulloch CE
Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization.
Researchers sought to assess the association between follow-up after an asthma-related emergency department (ED) visit and the likelihood of subsequent asthma-related ED utilization. Using data from California Medicaid, Vermont, and Massachusetts all-payer claims databases, they found a protective association between outpatient 14-day follow-up and asthma-related ED revisits. They suggested that this may reflect improved asthma control as providers follow the NHLBI guideline stepwise approach.
AHRQ-funded; HS025297; HS020518.
Citation: Bardach NS, Harder VS, McCulloch CE .
Follow-up after asthma emergency department visits and its relationship with subsequent asthma-related utilization.
Acad Pediatr 2022 Apr;22(3S):S125-S32. doi: 10.1016/j.acap.2021.10.015..
Keywords: Children/Adolescents, Asthma, Emergency Department, Respiratory Conditions, Healthcare Utilization
Capone CA, Emerson B, Sweberg T
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
The purpose of this study was to describe Tracheal Intubation (TI) practice and outcomes in pediatric Emergency Departments as compared to those in intensive care units (ICUs) and use the resulting data to identify targets for quality improvement. The researchers analyzed consecutive TI encounters from pediatric EDs and ICUs in the National Emergency Airway Registry for Children (NEAR4KIDS) database from 2015 to 2018. The study found a total of 12,512 TIs in 51 pediatric/cardiac ICUs, and 756 TIs in 13 pediatric EDs and were reported. Proportion of TIs for shock (26% ED vs. 14% ICU), respiratory decompensation (52% vs. 64%), and neurologic deterioration (30% vs. 11%) also differed by location. Limited neck mobility was reported more often in the ED (16% vs. 6%). TIs in the ED were performed more often via video laryngoscopy (64% vs. 29%). Oxygen desaturation was less commonly reported in ED TIs (13.6%) than ICU TIs (17%). Among ED TIs, shock as an indication and limited mouth opening were independently associated with adverse TI-associated events (TIAEs). The study concluded that TI characteristics vary between pediatric EDs and ICUs, yet outcomes are similar.
AHRQ-funded; HS022464.
Citation: Capone CA, Emerson B, Sweberg T .
Intubation practice and outcomes among pediatric emergency departments: a report from National Emergency Airway Registry for Children (NEAR4KIDS).
Acad Emerg Med 2022 Apr;29(4):406-14. doi: 10.1111/acem.14431..
Keywords: Children/Adolescents, Emergency Department, Registries, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Critical Care, Intensive Care Unit (ICU)
Cabana MD, Robinson K, Plavin J
Partnering to improve pediatric asthma quality.
The purpose of this article was to explore the need for partnering between emergency departments (Eds) and primary care physicians (PCPs) to improve asthma quality measures, practice level improvements for both PCPs and EDs, and ultimately improve outcomes for children with asthma. Proper and timely management of asthma is thought to prevent ED visits, and the responsibility for addressing improvements in PCP performance should be shared by the PCP practices and health care payors and plans. The ability to measure the drivers of asthma-related visits to the ED may be outside of what a PCP practice can address, and so practices must be able to partner with health plans to successfully measure and develop system-wide interventions for quality and outcomes improvement. Although a child’s asthma may be managed in their PCP office, treatment of asthma issues often takes place in an ED setting or urgent care clinic that may be completely isolated from the patient’s PCP provider and system. Health plans can fill in the missing pieces to provide feedback on performance which can reduce ED visits, improve medication adherence and management, and provide actionable and timely data about hospital visits and discharge to PCP practices for quality improvements. Social determinants and comorbidities play a role in addressing ED visits for asthma. Health plan, public health systems, and provider coordination, integration, and partnerships are required to effectively address those issues and improve outcomes. The authors conclude that a systems approach and thoughtful partnerships across disciplines will be required beyond the PCP practice level to improve the outcomes of children with asthma.
AHRQ-funded; HS025297.
Citation: Cabana MD, Robinson K, Plavin J .
Partnering to improve pediatric asthma quality.
Acad Pediatr 2022 Apr;22(3S):S73-S75. doi: 10.1016/j.acap.2021.06.013..
Keywords: Children/Adolescents, Asthma, Chronic Conditions, Emergency Department, Quality Measures, Quality Improvement, Quality of Care
Murray E, Roosevelt GE, Vogel JA
Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic.
Researchers sought to evaluate a screening and referral program for health-related social needs (HRSN) in an emergency department. Using the Accountable Health Communities Screening Tool, they found that, during the COVID-19 pandemic, HRSN doubled, likely reflecting the economic impact of the pandemic.
AHRQ-funded; HS023901.
Citation: Murray E, Roosevelt GE, Vogel JA .
Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic.
Am J Emerg Med 2022 Apr;54:323.e1-23.e4. doi: 10.1016/j.ajem.2021.09.071..
Keywords: COVID-19, Social Determinants of Health, Emergency Department, Screening, Public Health
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
AHRQ-funded; HS024558.
Citation: Jacobsohn GC, Leaf M, Liao F .
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Shared Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)
Yadgir SR, Engstrom C, Jacobsohn GC
Machine learning-assisted screening for cognitive impairment in the emergency department.
Researchers developed and evaluated an automated screening tool to identify a subset of patients at high risk for cognitive impairment (CI). Using the Blessed Orientation Memory Concentration (BOMC) test, administered in the emergency department, they found that an algorithm based on electronic health record data can define a subset of patients at higher risk for CI. They recommended that incorporating such an algorithm into a screening workflow could allow screening efforts and resources to be focused where they have the most impact.
AHRQ-funded; HS024558.
Citation: Yadgir SR, Engstrom C, Jacobsohn GC .
Machine learning-assisted screening for cognitive impairment in the emergency department.
J Am Geriatr Soc 2022 Mar;70(3):831-37. doi: 10.1111/jgs.17491..
Keywords: Neurological Disorders, Screening, Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Elderly
Zhang NJ, Rameau P, Julemis M
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
The authors sought to create an automated process to calculate the Wells score for pulmonary embolism for emergency department patients, which might reduce unnecessary computed tomography pulmonary angiography (CTPA) testing. They designed the process using electronic health records data elements, including free-text fields, and calculated Wells scores for a sample of adult emergency department visits that resulted in a CTPA study for pulmonary embolism at two tertiary care hospitals in New York. After validation, the authors concluded that the development of the automated process to classify risk for pulmonary embolism in emergency department visits was successful.
AHRQ-funded; HS026196.
Citation: Zhang NJ, Rameau P, Julemis M .
Automated pulmonary embolism risk assessment using the Wells criteria: validation study.
JMIR Form Res 2022 Feb 28;6(2):e32230. doi: 10.2196/32230.
Keywords: Blood Clots, Respiratory Conditions, Risk, Emergency Department
Meisel ZF, Shofer F, Dolan A
AHRQ Author: Rhodes KV
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
The purpose of this trial was to compare the effectiveness of three approaches for communicating opioid risk during an emergency department visit for a common painful condition. Participants were adult patients with kidney stone or musculoskeletal back pain, randomly assigned to one of three risk communication strategies: a personalized probabilistic risk visual aid, a visual aid and video narrative, or general risk information. Findings showed that an emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall.
AHRQ-authored.
Citation: Meisel ZF, Shofer F, Dolan A .
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
Am J Public Health 2022 Feb;112(S1):S45-s55. doi: 10.2105/ajph.2021.306511..
Keywords: Pain, Emergency Department, Education: Patient and Caregiver, Opioids, Comparative Effectiveness, Clinician-Patient Communication, Communication
Michelson KA, Cushing AM, Bucholz EM
Association of county-level availability of pediatricians with emergency department visits.
This study examined whether children in counties with more pediatricians had fewer emergency department (ED) visits. The authors conducted a cross-sectional study of all ED visits among children younger than 18 years from 6 states. Each additional pediatrician per 1000 children was associated with a 13.7% decrease in ED visits in the state-adjusted model. In the full model however, there was no association. Other factors such as presence of an urgent care facility, high socioeconomic status, urban status and higher proportions of White race and nonpublic insurance were also associated with decreased ED visit rates.
AHRQ-funded; HS026503.
Citation: Michelson KA, Cushing AM, Bucholz EM .
Association of county-level availability of pediatricians with emergency department visits.
Pediatr Emerg Care 2022 Feb;38(2):e953-e57. doi: 10.1097/pec.0000000000002502..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Workforce, Provider: Physician, Rural Health
Gutman CK, Lion KC, Fisher CL
Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care.
The authors discuss the issue of individuals with limited English proficiency (LEP) and the high risk for adverse outcomes in the US health care system, especially in the emergency department. They point out that, although professional language interpretation improves the quality of care for these patients, it remains underused. They find few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP and urge further high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
AHRQ-funded; HS026006.
Citation: Gutman CK, Lion KC, Fisher CL .
Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care.
J Am Coll Emerg Physicians Open 2022 Feb;3(1):e12639. doi: .
Keywords: Communication, Emergency Department, Cultural Competence, Clinician-Patient Communication
Marchese AL, Fine AM, Levy JA
Physician risk perception and testing behaviors for children with fever.
This study sought to determine whether physician risk perception was associated with the decision to obtain blood or imaging tests among children who present to the emergency department with fever. A retrospective, cross-section study was conducted at the Boston Children’s Hospital emergency department. Children aged 6 months to 18 years who presented with a fever from May 2014 to April 2019 were included. The authors assessed risk perception using 3 scales: the Risk Tolerance Scale (RTS), Stress from Uncertainty Scale (SUS), and Malpractice Fear Scale (MFS). Across 55 pediatric emergency physicians, there was no association found between risk perception and blood/imaging testing in febrile children for any of those scales.
AHRQ-funded; HS026503.
Citation: Marchese AL, Fine AM, Levy JA .
Physician risk perception and testing behaviors for children with fever.
Pediatr Emerg Care 2022 Feb;38(2):e805-e10. doi: 10.1097/pec.0000000000002413..
Keywords: Children/Adolescents, Provider: Physician, Emergency Department, Diagnostic Safety and Quality
Johnson TJ, Goyal MK, Lorch SA
Racial/ethnic differences in pediatric emergency department wait times.
The authors sought to determine whether racial/ethnic differences exist in wait times for children presenting to pediatric emergency departments (PEDs) and to examine between-site and within-site differences. They found that median wait time was 35 minutes. Further, in unadjusted analyses, non-White children experienced longer PED wait times than non-Hispanic White (NHW) children. After adjusting for illness severity, patient demographics, and overcrowding measures, wait times for non-Hispanic Black and other race children were largely determined by site of care. Hispanic children experienced longer within-site and between-site wait times compared with NHW children.
AHRQ-funded; HS020270.
Citation: Johnson TJ, Goyal MK, Lorch SA .
Racial/ethnic differences in pediatric emergency department wait times.
Pediatr Emerg Care 2022 Feb;38(2):e929-e35. doi: 10.1097/pec.0000000000002483..
Keywords: Children/Adolescents, Emergency Department, Racial and Ethnic Minorities
Schoenfeld EM, Soares WE, Schaeffer EM
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Despite evidence demonstrating the safety and efficacy of buprenorphine for the treatment of emergency department (ED) patients with opioid use disorder (OUD), incorporation into clinical practice has been highly variable. In this study, the investigators explored barriers and facilitators to the prescription of buprenorphine, as perceived by practicing ED clinicians. The investigators concluded that while some participants were hesitant to adopt a "new" role in treating patients with medications for OUD, many already had.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Soares WE, Schaeffer EM .
"This is part of emergency medicine now": a qualitative assessment of emergency clinicians' facilitators of and barriers to initiating buprenorphine.
Acad Emerg Med 2022 Jan;29(1):28-40. doi: 10.1111/acem.14369..
Keywords: Emergency Department, Opioids, Medication, Substance Abuse, Behavioral Health