9/8/2008 Neumar - Emergency Care Research 1

Emergency Care ResearchSolutions for the U.S. Heath Care System

Robert W. Neumar MD, PhD

Chair, Research Committee

American College of Emergency Physicians

Future of Emergency Care Series

Hospital-Based Emergency Care

At the Breaking Point

Committee on the Future of Emergency Care in the United States Health System

2006

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“The Agency for Healthcare Research and Quality (AHRQ) has a mission to improve the quality,

safety, efficiency, effectiveness, and cost-effectiveness of health care for all Americans.”

Emergency Care ResearchAHRQ Mission

http://www.ahrq.gov/about/highlt07.htm

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•Comparative effectiveness.•Patient safety/medical errors.•Health care quality.•Health information technology.•Evidence-based medicine.•Clinical practice.•Outcomes of care and effectiveness.•Primary care and care for priority populations.•Organization and delivery of care and use of health care resources.•Health care costs and financing.•Health care system and public health preparedness

Emergency Care ResearchAHRQ Portfolio

http://www.ahrq.gov/about/highlt07.htm

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Emergency Care Research Problem or Solution?

ACEP LOGO

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Emergency Department115,000,000

Ambulatory Care

1,000,000,000

ManagedCare

Observation Unit

1,000,000

Hospital14,000,000

(43% of total)

HospitalTransfer2,000,000

Rehab Facility

EMSSystem

CDC Advanced Data No 386, 2007

Emergency Care ResearchProblem or Solution?

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Emergency Department115,000,000

Ambulatory Care

1,000,000,000

Residence or

Public Setting

ManagedCare

Facility

Observation Unit

1,000,000

Hospital14,000,000

(43% of total )

HospitalTransfer2,000,000

Rehab Facility

EMSSystem

http://hcupnet.ahrq.gov/HCUPnet.jspCDC Advanced Data No 386, 2007

Emergency Care Research Problem or Solution?

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•In patients with [symptom] does emergency medical services (EMS) care compared to [alternative management] improve outcomes?

•In patients with [symptom] does emergency department care compared to [alternative management] improve outcomes?

•In emergency department patients with [symptom/diagnosis], does hospital admission compared to [alternative management] improve outcomes?

Emergency Care ResearchFundamental Questions

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Emergency Care ResearchHypothesis

“Rapid diagnosis and early intervention in acute illness or

acutely decompensated chronic illness improves patient outcomes.”

Neumar, Ann Emerg Med, 2007

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Table 9. Emergency department visits principal reasons for visit: United States, 2005

CDC Advanced Data No 386, 2007

13,600,000 ED visits for abdominal or chest pain

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Table 11. ED visits by primary ED diagnosis groups: United States, 2005

CDC Advanced Data No 386, 2007

13,600,000 ED visits for abdominal or chest pain

9,000,000 ED diagnosis abdominal or chest pain (66%)

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Table 11. ED visits by hospital discharge diagnosis: United States, 2005

CDC Advanced Data No 386, 2007

13,600,000 ED visits for abdominal or chest pain

9,000,000 ED diagnosis abdominal or chest pain

972,000 hospital discharge diagnosis abdominal or chest pain

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“Clinical research that improves the accuracy, speed, safety, and cost-

effectiveness of diagnosis in the emergency care setting has the potential to both improve outcomes and reduce resource utilization.”

Emergency Care ResearchACEP/SAEM Joint Research Task Force

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Emergency Care ResearchUndifferentiated Presentations

•Chest pain•Dyspnea•Abdominal pain•Altered mental status•Fever•Headache•Hypotension•Shock•Cardiac arrest

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•Undifferentiated presentations

•Unscheduled

•Multiple locations and providers

•Time sensitive diagnosis and treatment

•Consent

•Standardized data elements

•Interoperable data sets

•Investigator training infrastructure

Emergency Care ResearchChallenges

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•24/7/365 operation

•High acuity

•High volume

•Concentrated resources

•Patient access

•Integral part of health care system

Emergency Care ResearchStrengths

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•Comparative effectiveness.•Patient safety/medical errors.•Health care quality.•Health information technology.•Evidence-based medicine.•Clinical practice.•Outcomes of care and effectiveness.•Primary care and care for priority populations.•Organization and delivery of care and use of health care resources.•Health care costs and financing.•Health care system and public health preparedness

Emergency Care ResearchAHRQ Portfolio

http://www.ahrq.gov/about/highlt07.htm

Emergency Care Investigator Training