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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedGlober N, Supples M, Persaud S
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
This paper describes the outcomes of a pilot study that used novel emergency medical services (EMS) protocol to expedite transfer of patients with large vessel occlusions (LVOs) to a comprehensive stroke center (CSC). The pilot study took place from Oct. 1, 2020 to Feb. 22, 2021 with Indianapolis EMS providers. In patients with possible LVO, the providers remained at the bedside until the clinical assessment and CT angiography were complete. This 5-month mixed methods study measured case-control assessment of the protocol, number of transfers, safety during transport, and time saved in transfer compared to emergency transfers via conventional interfacility transfer agencies. The protocol was used 42 times during the study period, with four patients found to have LVOs and transferred to a CSC. Median time from decision-to-transfer to arrival at the CSC was 27.5 minutes compared to 314.5 minutes for acute non-stroke transfers during the same period.
AHRQ-funded; HS026390.
Citation: Glober N, Supples M, Persaud S .
A novel emergency medical services protocol to improve treatment time for large vessel occlusion strokes.
PLoS One 2022 Feb;17(2):e0264539. doi: 10.1371/journal.pone.0264539..
Keywords: Emergency Medical Services (EMS), Stroke, Cardiovascular Conditions, Critical Care
Kass-Hout T, Lee J, Tataris K
Prehospital comprehensive stroke center vs primary stroke center triage in patients with suspected large vessel occlusion stroke.
This study’s objective was to evaluate the association of a regional prehospital transport policy that directly triages patients with suspected large vascular occlusion (LVO) stroke to the nearest comprehensive stroke center with rates of endovascular therapy (EVT). This retrospective, multicenter preimplementation-postimplementation study used an interrupted time series analysis to compare treatment rates before and after implementation in patients with acute ischemic stroke (AIS) arriving at 15 primary stroke centers and 8 comprehensive stroke centers in Chicago, Illinois, via emergency medical services (EMS) transport from December 1, 2017, to May 31, 2019. Among 7709 individuals with stroke, 663 with AIS arrived within 6 hours of stroke onset by EMS transport. The EVT rate increased overall among patients with AIS postimplementation and among EMS-transported patients with AIS within 6 hours of onset. There were no differences in EVT rates in patients not arriving by EMS within the 6- to 24-hour window or by interhospital transfer or walk-in.
AHRQ-funded; HS025359.
Citation: Kass-Hout T, Lee J, Tataris K .
Prehospital comprehensive stroke center vs primary stroke center triage in patients with suspected large vessel occlusion stroke.
JAMA Neurol 2021 Oct;78(10):1220-27. doi: 10.1001/jamaneurol.2021.2485..
Keywords: Stroke, Cardiovascular Conditions, Critical Care, Emergency Medical Services (EMS)
Govindarajan P, Shiboski S, Grimes B
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Investigators sought to determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Studying two urban counties in the western region of US that regionalized acute stroke care, they found that in Santa Clara County, intravenous alteplase was administered to 1.7% of patients in the pre-regionalization period and 2.1% in the post-regionalization period, while in San Mateo County, the numbers were 1.3% and 3.2%, respectively. In the post-regionalization phase, San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers, and more frequent use of intravenous alteplase at stroke centers. They concluded that greater post-regionalization improvements in San Mateo County contributed to significantly improved county-level thrombolysis use than Santa Clara County.
AHRQ-funded; HS026207; HS017965.
Citation: Govindarajan P, Shiboski S, Grimes B .
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Prehosp Emerg Care 2020 Jul-Aug;24(4):505-14. doi: 10.1080/10903127.2019.1679303..
Keywords: Stroke, Cardiovascular Conditions, Urban Health, Access to Care, Emergency Medical Services (EMS), Critical Care
Bahr N, Meckler G, Hansen M
Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.
This study used simulation to evaluate Pediatric Advanced Life Support (PALS) guideline performance in pediatric emergency medical service (EMS) care and to introduce this easy-to-use tool to score guideline compliance and patient safety. Standard pediatric resuscitation simulations with a child manikin were created. The manikin was presented as a choking 6-year-old with a complex medical history who is unconscious and apneic, with bradycardic pulse. Teams were expected to monitor vitals, initiate airway management and CPR, and establish vascular access and administer epinephrine based on PALS guidelines. The authors observed 34 EMS teams providing care in P-OHCA simulations. Teams were found to be proficient in assessing vitals, using correct-sized equipment, intubation, and confirmation of tube placement. The teams were delayed in initiating positive pressure ventilation (PPV) and chest compressions, with many teams (53%) deviating from guidelines in chest compression. Half the teams performed continuous compressions before establishing an advanced airway and one team did not perform compressions. Twenty teams also deviated from medication guidelines with 12 teams failing to administer epinephrine, six teams underdosing, and two teams overdosing by more than 20%.
AHRQ-funded; HS025590.
Citation: Bahr N, Meckler G, Hansen M .
Evaluating pediatric advanced life support in emergency medical services with a performance and safety scoring tool.
Am J Emerg Med 2021 Oct;48:301-06. doi: 10.1016/j.ajem.2021.06.061.
AHRQ-funded; HS025590..
AHRQ-funded; HS025590..
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Critical Care, Cardiovascular Conditions
Corrado MM, Shi J, Wheeler KK
Emergency medical services (EMS) versus non-EMS transport among injured children in the United States.
This study assessed the proportions of injured children transported to trauma centers by different transportation modes and evaluated the effect of transportation mode on inter-facility transfer rates using the US national trauma registry. Over one third of US pediatric trauma patients used non-EMS transport to arrive at trauma centers. Moderate to severely injured children benefit from EMS transport and professional field triage.
AHRQ-funded; HS024263.
Citation: Corrado MM, Shi J, Wheeler KK .
Emergency medical services (EMS) versus non-EMS transport among injured children in the United States.
Am J Emerg Med 2017 Mar;35(3):475-78. doi: 10.1016/j.ajem.2016.11.059.
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Keywords: Emergency Medical Services (EMS), Children/Adolescents, Trauma, Critical Care
Michelson KA, Bachur RG, Levy JA
The impact of critically ill children on paediatric ED medication timeliness.
The presence of critically ill patients may impact care for other ED patients. The researchers evaluated whether the presence of a critically ill child was associated with the time to (1) receipt of the first medication among other patients, and (2) administration of diagnosis-specific medications. They concluded that the presence of critically ill patients was associated with a delay in medication administration to others.
AHRQ-funded; HS000063.
Citation: Michelson KA, Bachur RG, Levy JA .
The impact of critically ill children on paediatric ED medication timeliness.
Emerg Med J 2017 Jan;34(1):8-12. doi: 10.1136/emermed-2016-205989.
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Keywords: Children/Adolescents, Critical Care, Medication, Emergency Medical Services (EMS), Healthcare Delivery
Moore CL, Broder J, Gunn ML
Comparative effectiveness research: alternatives to "traditional" computed tomography use in the acute care setting.
The goal was to seek consensus in identifying and prioritizing research questions and themes that involve the comparative effectiveness of "traditional" computed tomography use versus alternative diagnostic strategies in the acute care setting. A modified Delphi technique was used that included input from emergency physicians, emergency radiologists, medical physicists, and an industry expert to achieve this.
AHRQ-funded; HS021271; HS023498.
Citation: Moore CL, Broder J, Gunn ML .
Comparative effectiveness research: alternatives to "traditional" computed tomography use in the acute care setting.
Acad Emerg Med 2015 Dec;22(12):1465-73. doi: 10.1111/acem.12831.
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Keywords: Comparative Effectiveness, Imaging, Critical Care, Emergency Medical Services (EMS)
Sanghavi P, Jena AB, Newhouse JP
Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.
Patients with out-of-hospital cardiac arrest who received basic life support had a higher survival rate and had better neurological functioning at hospital discharge and at 90 days after discharge than those patients who received advanced life support.
AHRQ-funded; HS022798
Citation: Sanghavi P, Jena AB, Newhouse JP .
Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support.
JAMA Intern Med. 2015 Feb;175(2):196-204. doi: 10.1001/jamainternmed.2014.5420..
Keywords: Emergency Medical Services (EMS), Cardiovascular Conditions, Critical Care
Berner ES, Ray MN, Panjamapirom A
Exploration of an automated approach for receiving patient feedback after outpatient acute care visits.
The authors' objective was to provide post-visit feedback to physicians on patient outcomes following acute care visits. They found that many patients who do not improve as expected do not take action to further address unresolved problems. They suggested that systematic follow-up/feedback mechanisms can potentially identify and connect such patients to needed care.
AHRQ-funded; HS017060.
Citation: Berner ES, Ray MN, Panjamapirom A .
Exploration of an automated approach for receiving patient feedback after outpatient acute care visits.
J Gen Intern Med 2014 Aug;29(8):1105-12. doi: 10.1007/s11606-014-2783-3.
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Keywords: Critical Care, Emergency Medical Services (EMS), Health Information Technology (HIT), Ambulatory Care and Surgery, Cancer
Donnelly JP, Baddley JW, Wang HE
Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments.
Using national surveillance data for acute respiratory tract infections (ARTIs), this study characterized patterns of antibiotic usage in U.S. emergency departments between 2001 and 2010. It found significant progress toward reductions on inappropriate antibiotic use among children; however, adults with ARTI continued to receive inappropriately high amounts of antibiotics.
AHRQ-funded; HS013852
Citation: Donnelly JP, Baddley JW, Wang HE .
Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments.
Antimicrob Agents Chemother. 2014 Mar;58(3):1451-7. doi: 10.1128/AAC.02039-13..
Keywords: Antimicrobial Stewardship, Emergency Medical Services (EMS), Medication, Critical Care
Myers SR, Salhi RA, Lerner EB
A pilot study describing access to emergency care in two states using a model emergency care categorization system.
To improve regionalization of care and patient decisions when seeking emergency care, the researchers surveyed emergency departments (EDs) in 2 States. They found that 25 percent provided advanced care, 10.5 percent comprehensive care, and 1.6 percent pediatric critical care. Overall, 75.1 percent of the population could reach advanced or comprehensive ED within 60 minutes by ground transportation.
AHRQ-funded; HS017960; HS018604
Citation: Myers SR, Salhi RA, Lerner EB .
A pilot study describing access to emergency care in two states using a model emergency care categorization system.
Acad Emerg Med. 2013 Sep;20(9):894-903. doi: 10.1111/acem.12208..
Keywords: Emergency Medical Services (EMS), Access to Care, Critical Care, Shared Decision Making