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Emergency Care Research Solutions 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.
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Emergency Care ResearchSolutions for the U.S. Heath Care System Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians Neumar - Emergency Care Research
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
Emergency Care ResearchAHRQ Mission http://www.ahrq.gov/about/highlt07.htm “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.” Neumar - Emergency Care Research
Emergency Care ResearchAHRQ Portfolio http://www.ahrq.gov/about/highlt07.htm 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 Neumar - Emergency Care Research
Emergency Care Research Problem or Solution? ACEP LOGO Neumar - Emergency Care Research
Emergency Care ResearchProblem or Solution? Hospital Transfer 2,000,000 Ambulatory Care 1,000,000,000 Emergency Department 115,000,000 Hospital 14,000,000 (43% of total) EMS System Rehab Facility Observation Unit 1,000,000 Managed Care CDC Advanced Data No 386, 2007 Neumar - Emergency Care Research
Emergency Care Research Problem or Solution? Residence or Public Setting Hospital Transfer 2,000,000 Ambulatory Care 1,000,000,000 Emergency Department 115,000,000 Hospital 14,000,000 (43% of total ) EMS System Rehab Facility Managed Care Facility Observation Unit 1,000,000 CDC Advanced Data No 386, 2007 http://hcupnet.ahrq.gov/HCUPnet.jsp Neumar - Emergency Care Research
Emergency Care ResearchFundamental Questions In patients with [symptom] does emergency medical services (EMS) carecompared 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? Neumar - Emergency Care Research
Emergency Care ResearchHypothesis • “Rapid diagnosis and early intervention in acute illness or acutely decompensated chronic illness improves patient outcomes.” Neumar, Ann Emerg Med, 2007 Neumar - Emergency Care Research
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 Neumar - Emergency Care Research
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%) Neumar - Emergency Care Research
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 Neumar - Emergency Care Research
Emergency Care ResearchACEP/SAEM Joint Research Task Force “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.” Neumar - Emergency Care Research
Emergency Care ResearchUndifferentiated Presentations Chest pain Dyspnea Abdominal pain Altered mental status Fever Headache Hypotension Shock Cardiac arrest Neumar - Emergency Care Research
Emergency Care ResearchChallenges Undifferentiated presentations Unscheduled Multiple locations and providers Time sensitive diagnosis and treatment Consent Standardized data elements Interoperable data sets Investigator training infrastructure Neumar - Emergency Care Research
Emergency Care ResearchStrengths 24/7/365 operation High acuity High volume Concentrated resources Patient access Integral part of health care system Neumar - Emergency Care Research
Emergency Care ResearchAHRQ Portfolio Emergency Care Investigator Training 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 http://www.ahrq.gov/about/highlt07.htm Neumar - Emergency Care Research
