9/8/2008 Neumar - Emergency Care Research 1 Emergency Care Research Solutions for the U.S. Heath Care System Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians
Dec 14, 2015
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
9/8/2008 Neumar - Emergency Care Research 3
“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
9/8/2008 Neumar - Emergency Care Research 4
•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
9/8/2008 Neumar - Emergency Care Research 6
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?
9/8/2008 Neumar - Emergency Care Research 7
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?
9/8/2008 Neumar - Emergency Care Research 8
•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
9/8/2008 Neumar - Emergency Care Research 9
Emergency Care ResearchHypothesis
“Rapid diagnosis and early intervention in acute illness or
acutely decompensated chronic illness improves patient outcomes.”
Neumar, Ann Emerg Med, 2007
9/8/2008 Neumar - Emergency Care Research 11
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
9/8/2008 Neumar - Emergency Care Research 14
“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
9/8/2008 Neumar - Emergency Care Research 18
•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