Slide Presentation from the AHRQ 2008 Annual Conference
On September 8, 2008, Robert W. Neumar, MD, Ph.D., made this presentation
at the 2008 Annual Conference. Select to access the PowerPoint® presentation (680 KB).
Slide 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 (ACEP)
September 8, 2008
Slide 2
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
Institute of Medicine of the National Academies 2006
Advising the Nation. Improving Health.
Slide 3
Emergency Care Research AHRQ 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."
Slide 4
Emergency Care Research AHRQ 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
Slide 5
Emergency Care Research Problem or Solution?
An image of the ACEP Logo—a large square comprised of smaller blue
squares minus one which is located in the upper right quadrant.
Slide 6
Emergency Care Research Problem or Solution?
A chart made up of 3 rows of 5 blue rectangles, with the exception of the middle
rectangle which is white with "Emergency Department, 115,000,000". Both
the 3 vertical, middle rectangles and the 5 horizontal, middle,rectangles
are connected with a black line. The upper left hand rectangle and
the lower left hand rectangle are joined by a black line running to the right
of the rectangles. The middle rectangle in the last row on the right
has a line coming out from both the top and bottom and running along the
length of the middle, horizontal row until it connects to the line joining
the upper and lower left hand rectangles.
Slide 7
Emergency Care Research Problem or Solution?
The previous slide's chart
with a portion of the rectangles filled in.
- The first set of 3 vertical rectangles on the left read from top to bottom:
- Residence or Public Setting
- Ambulatory Care 1,000,000,000
- Managed Care Facility
- The middle set of 3 vertical rectangles read from top to bottom:
- Hospital Transfer 2,000,000
- Emergency Department 115,000,000
- Observation Unit 1,000,000
- The middle set of 5 horizontal rectangles read from left to right:
- Ambulatory Care 1,000,000,000
- Emergency Medical Services (EMS) System
- Emergency Department 115,000,000
- Hospital 14,000,000 (43% of total)
- Rehab Facility
Notes:
Slide 8
Emergency Care Research Fundamental Questions
- In patients with [symptom] does 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?
Slide 9
Emergency Care Research Hypothesis
"Rapid diagnosis and early intervention in acute illness or acutely decompensated
chronic illness improves patient outcomes."
Notes:
- A large, red oval circles "Rapid diagnosis."
Slide 10
The document image shows an article entitled "National Hospital Ambulatory
Medical Care Survey: 2005 Emergency Department Summary" from the
CDC's Advance Data: From Vital and Health Statistics, Number
386, June 29, 2007.
Slide 11
The document image shows "Table 9. Emergency department visits
principal reasons for visit: United States, 2005" from the CDC
Advanced Data No 386, 2007. The page shows the results for "Number
of Visits in Thousands" and "Percent Distribution" for the "Principal
Reasons for Visit". "Stomach and abdominal pain, cramps,
and spasms—7,833" and "Chest pain and related symptoms—5,812" are
highlighted.
- 13,600,000 Emergency Department (ED) visits for abdominal or chest pain.
Slide 12
The document image shows "Table 11. ED Visits by Primary ED Diagnosis
Groups: United States, 2005" from the CDC Advanced Data No
386, 2007. The page shows the results for "Number of Visits in
Thousands" and "Percent Distribution" for the "Primary
Diagnosis Group". "Abdominal pain—4,628" and "Chest
pain—4,438" are highlighted.
- 13,600,000 ED visits for abdominal or chest pain.
- 9,000,000 ED diagnosis abdominal or chest pain (66%).
Slide 13
The document image shows "Table 11. ED Visits by Hospital Discharge Diagnosis:
United States, 2005" from the CDC Advanced Data No 386, 2007. The page shows the
results for "Number of Visits in Thousands" and "Percent Distribution"
for the "Principal Diagnosis Group and ICD-9-CM code(s)¹". "Chest
pain...786.5: 786" and "Abdominal pain...789.0:
186" are highlighted.
- 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.
Slide 14
Emergency Care Research ACEP/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."
Slide 15
Emergency Care Research Undifferentiated Presentations
- Chest pain
- Dyspnea
- Abdominal pain
- Altered mental status
- Fever
- Headache
- Hypotension
- Shock
- Cardiac arrest
Slide 16
Emergency Care Research Challenges
- Undifferentiated presentations
- Unscheduled
- Multiple locations and providers
- Time sensitive diagnosis and treatment
- Consent
- Standardized data elements
- Interoperable data sets
- Investigator training infrastructure
Slide 17
Emergency Care Research Strengths
- 24/7/365 operation
- High acuity
- High volume
- Concentrated resources
- Patient access
- Integral part of health care system
Slide 18
Emergency Care Research AHRQ 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
Current as of January 2009
Internet Citation:
Emergency Care Research: Solutions for the U.S.
Heath Care System. Slide Presentation from the AHRQ 2008 Annual Conference
(Text Version). January 2009.
Agency for Healthcare Research and Quality,
Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090808slides/Neumar.htm
540 Gaither Road Rockville, MD 20850