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  • 1
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    Online Resource
    Does Numeracy Correlate With Measures of Health Literacy in the Emergency Department?
    Wiley ; 2014
    In:  Academic Emergency Medicine Vol. 21, No. 2 ( 2014-02), p. 147-153
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 21, No. 2 ( 2014-02), p. 147-153
    Abstract: Cuantificar la correlación entre el cálculo numérico general y la educación sanitaria en un servicio de urgencias ( SU ). Metodología Estudio transversal de una muestra prospectiva de conveniencia de pacientes adultos en un SU universitario urbano con 97.000 visitas anuales. El cálculo numérico general se evaluó usando cuatro preguntas validadas; y la educación sanitaria usando tres herramientas validadas frecuentemente utilizadas de despistaje (Short Test of Functional Health Literacy in Adults [S‐ TOFHLA ], Rapid Estimate of Adult Literacy in Medicine‐Revised [ REALM ‐R], y Newest Vital Sign [ NVS ]). Las puntuaciones se categorizaron en dos para los test de educación: educación sanitaria limitada ( ESL ) (baja o marginal) frente educación sanitaria adecuada ( ESA ), y la proporción de pacientes que contestaron todas las preguntas numéricas correctamente se calculó con la proporción media de respuestas correctas en estos grupos. La correlación entre las puntuaciones numéricas y las puntuaciones en las herramientas de despistaje de educación sanitaria se evaluaron mediante la correlación de Spearman. Resultados Se incluyeron 446 pacientes. El rendimiento en las preguntas que evaluaron el cálculo numérico general fue globalmente pobre. Sólo 18 pacientes (4%) contestaron todas las preguntas numéricas correctamente, 88 pacientes (20%) no contestaron a ninguna pregunta correctamente, y en general el número promedio de contestaciones correctas fue de 1 ( RIC 1). En los pacientes con ESL , con cualquiera de las tres herramientas de despistaje utilizadas, el número medio de preguntas numéricas correctas fue aproximadamente la mitad que la de los pacientes con ESA . Sin embargo, incluso en aquéllos con ESA , el número promedio de preguntas correctas a las preguntas numéricas fue de 1,6 a 2,4 dependiendo del test de despistaje utilizado. Cuando se categorizó en aquéllos que respondieron  〈  50% frente 〉 50% de las preguntas numéricas correctamente, hubo una diferencia significativa entre aquéllos con ESL y aquéllos que puntuaron  〈  50% en cálculos numéricos. Los resultados del despistaje en educación sanitaria se correlacionaron con el cálculo numérico general en el rango de bajo a moderado: S‐ TOFHLA r s =  0,428 (p  〈  0,0001); REALM , r s =  0,400 (p  〈  0,0001); y NVS , r s =  0,498 (p  〈  0,0001). Conclusiones Las correlaciones entre medidas de cálculo numérico general y de educación sanitaria están en un rango de bajo a moderado. El rendimiento en los test de cálculo numérico son por lo general pobres, incluso en los pacientes con buen rendimiento en educación sanitaria, con una proporción sustancial de los pacientes incapaces de contestar a la mitad de los ítems numéricos correctamente. Así como el cálculo numérico está considerado un subconjuto de la educación sanitaria, estos resultados indican que las herramientas de despistaje de formación sanitaria comúnmente utilizadas en los estudios basados en los SU evalúan de forma inadecuada y sobrestiman lo numérico. Esto indica la necesidad potencial para separar el despistaje del cálculo numérico cuando estas habilidades son importantes para los resultados de salud de interés. Los proveedores sanitarios deberían ser sensibles a los déficits numéricos potenciales en aquéllos pacientes que pueden tener una educación sanitaria normal.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.2014.21.issue-2
    DOI: 10.1111/acem.12310
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 2
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    Impact of Hospital “Best Practice” Mandates on Prescription Opioid Dispensing After an Emergency Department Visit
    Wiley ; 2017
    In:  Academic Emergency Medicine Vol. 24, No. 8 ( 2017-08), p. 905-913
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 24, No. 8 ( 2017-08), p. 905-913
    Abstract: Washington State mandated seven hospital “best practices” in July 2012, several of which may affect emergency department ( ED ) opioid prescribing and provide a policy template for addressing the opioid prescription epidemic. We tested the hypothesis that the mandates would reduce opioid dispensing after an ED visit. We further assessed for a selective effect in patients with prior risky or chronic opioid use. Methods We performed a retrospective, observational analysis of ED visits by Medicaid fee‐for‐service beneficiaries in Washington State, between July 1, 2011, and June 30, 2013. We used an interrupted time‐series design to control for temporal trends and patient characteristics. The primary outcome was any opioid dispensing within 3 days after an ED visit. The secondary outcome was total morphine milligram equivalents ( MME s) dispensed within 3 days. Results We analyzed 266,614 ED visits. Mandates were associated with a small reduction in opioid dispensing after an ED visit (–1.5%, 95% confidence interval [ CI ] = –2.8% to –0.15%). The mandates were associated with decreased opioid dispensing in 42,496 ED visits by patients with prior risky opioid use behavior (–4.7%, 95% CI  = –7.1% to –2.3%) and in 20,238 visits by patients with chronic opioid use (–3.6%, 95% CI  = –5.6% to –1.7%). Mandates were not associated with reductions in MME s per dispense in the overall cohort or in either subgroup. Conclusions Washington State best practice mandates were associated with small but nonselective reductions in opioid prescribing rates. States should focus on alternative policies to further reduce opioid dispensing in subgroups of high‐risk and chronic users.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.2017.24.issue-8
    DOI: 10.1111/acem.13230
    Language: English
    Publisher: Wiley
    Publication Date: 2017
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  • 3
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    Impact of a Shared Decision Making Intervention on Health Care Utilization: A Secondary Analysis of the Chest Pain Choice Multicenter Randomized Trial
    Wiley ; 2018
    In:  Academic Emergency Medicine Vol. 25, No. 3 ( 2018-03), p. 293-300
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 25, No. 3 ( 2018-03), p. 293-300
    Abstract: Patients at low risk for acute coronary syndrome are frequently admitted for observation and cardiac testing, resulting in substantial burden and cost to the patient and the health care system. Objectives The purpose of this investigation was to measure the effect of the Chest Pain Choice ( CPC ) decision aid on overall health care utilization as well as utilization of specific services both during the index emergency department ( ED ) visit and in the subsequent 45 days. Methods This was a planned secondary analysis of data from a pragmatic multicenter randomized trial of shared decision making in adults presenting to the ED with chest pain who were being considered for observation unit admission for cardiac stress testing or coronary computed tomography angiography. The trial compared an intervention group engaged in shared decision making facilitated by the CPC decision aid to a control group receiving usual care. Hospital‐level billing data were used to measure utilization for the index ED visit and during the following 45 days. Patients in both groups also were asked to keep a diary recording health care utilization over the same 45‐day period. Outcomes assessed included length of time in the ED and observation, ED visits, office visits, hospitalizations, testing, imaging, and procedures. Results Of the 898 patients included in the original trial, we were able to contact 834 (92.9%) patients for 45‐day health care diary review. There was no difference in patient‐reported health care utilization between the study arms. Hospital‐level billing data were obtained for all 898 (100%) patients. During the initial ED visit the length of stay ( LOS ) was similar, and there was no difference in the frequency of observation unit admission between study arms. However, the mean observation unit LOS was 95 minutes (95% confidence interval [ CI ] = 40.8–149.8) shorter in the CPC arm and the mean number of tests was lower in the CPC arm (decrease in 19.4 imaging studies per 100 patients, 95% CI  = 15.5–23.3). When evaluating the entire encounter and follow‐up period, the intervention arm underwent fewer tests (decrease in 125.6 tests per 100 patients, 95% CI  = 29.3–221.6). More specifically, there were fewer advanced cardiac imaging tests completed (25.8 fewer per 100 patients, 95% CI  = 3.74–47.9) in the intervention arm. Conclusions Shared decision making in low‐risk chest pain can lead to decreased diagnostic testing without worsening outcomes measured over 45 days.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.2018.25.issue-3
    DOI: 10.1111/acem.13355
    Language: English
    Publisher: Wiley
    Publication Date: 2018
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  • 4
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    Knowledge Translation and Barriers to Imaging Optimization in the Emergency Department: A Research Agenda
    Wiley ; 2015
    In:  Academic Emergency Medicine Vol. 22, No. 12 ( 2015-12), p. 1455-1464
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 22, No. 12 ( 2015-12), p. 1455-1464
    Abstract: Researchers have attempted to optimize imaging utilization by describing which clinical variables are more predictive of acute disease and, conversely, what combination of variables can obviate the need for imaging. These results are then used to develop evidence‐based clinical pathways, clinical decision instruments, and clinical practice guidelines. Despite the validation of these results in subsequent studies, with some demonstrating improved outcomes, their actual use is often limited. This article outlines a research agenda to promote the dissemination and implementation (also known as knowledge translation) of evidence‐based interventions for emergency department ( ED ) imaging, i.e., clinical pathways, clinical decision instruments, and clinical practice guidelines. We convened a multidisciplinary group of stakeholders and held online and telephone discussions over a 6‐month period culminating in an in‐person meeting at the 2015 Academic Emergency Medicine consensus conference. We identified the following four overarching research questions: 1) what determinants (barriers and facilitators) influence emergency physicians’ use of evidence‐based interventions when ordering imaging in the ED ; 2) what implementation strategies at the institutional level can improve the use of evidence‐based interventions for ED imaging; 3) what interventions at the health care policy level can facilitate the adoption of evidence‐based interventions for ED imaging; and 4) how can health information technology, including electronic health records, clinical decision support, and health information exchanges, be used to increase awareness, use, and adherence to evidence‐based interventions for ED imaging? Advancing research that addresses these questions will provide valuable information as to how we can use evidence‐based interventions to optimize imaging utilization and ultimately improve patient care.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.2015.22.issue-12
    DOI: 10.1111/acem.12830
    Language: English
    Publisher: Wiley
    Publication Date: 2015
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  • 5
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    Emergency clinician participation and performance in the Centers for Medicare & Medicaid Services Merit‐based Incentive Payment System
    Wiley ; 2022
    In:  Academic Emergency Medicine Vol. 29, No. 1 ( 2022-01), p. 64-72
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 29, No. 1 ( 2022-01), p. 64-72
    Abstract: The Merit‐based Incentive Payment System (MIPS) is the largest national pay‐for‐performance program and the first to afford emergency clinicians unique financial incentives for quality measurement and improvement. With little known regarding its impact on emergency clinicians, we sought to describe participation in the MIPS and examine differences in performance scores and payment adjustments based on reporting affiliation and reporting strategy. Methods We performed a cross‐sectional analysis using the Centers for Medicare & Medicaid Services 2018 Quality Payment Program (QPP) Experience Report data set. We categorized emergency clinicians by their reporting affiliation (individual, group, MIPS alternative payment model [APM]), MIPS performance scores, and Medicare Part B payment adjustments. We calculated performance scores for common quality measures contributing to the quality category score if reported through qualified clinical data registries (QCDRs) or claims‐based reporting strategies. Results In 2018, a total of 59,828 emergency clinicians participated in the MIPS—1,246 (2.1%) reported as individuals, 43,404 (72.5%) reported as groups, and 15,178 (25.4%) reported within MIPS APMs. Clinicians reporting as individuals earned lower overall MIPS scores (median [interquartile range {IQR}] = 30.8 [15.0–48.2] points) than those reporting within groups (median [IQR] = 88.4 [49.3–100.0] ) and MIPS APMs (median [IQR] = 100.0 [100.0–100.0] ; p   〈  0.001) and more frequently incurred penalties with a negative payment adjustment. Emergency clinicians had higher measure scores if reporting QCDR or QPP non–emergency medicine specialty set measures. Conclusions Emergency clinician participation in national value‐based programs is common, with one in four participating through MIPS APMs. Those employing specific strategies such as QCDR and group reporting received the highest MIPS scores and payment adjustments, emphasizing the role that reporting strategy and affiliation play in the quality of care.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v29.1
    DOI: 10.1111/acem.14373
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 6
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    Feasibility and Diagnostic Accuracy of Brief Health Literacy and Numeracy Screening Instruments in an Urban Emergency Department
    Wiley ; 2014
    In:  Academic Emergency Medicine Vol. 21, No. 2 ( 2014-02), p. 137-146
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 21, No. 2 ( 2014-02), p. 137-146
    Abstract: Evaluar la certeza diagnóstica de cinco instrumentos de despistaje de educación sanitaria en los pacientes del servicio de urgencias ( SU ): el Rapid Evaluation of Adult Literacy in Medicine‐Revised ( REALM ‐R), el Newest Vital Sign ( NVS ), el Single Item Literacy Screens ( SILS ), los cálculos numéricos relacionados con la salud y un médico gestáltico. Un objetivo secundario fue evaluar la viabilidad de estos instrumentos medida por el tiempo de administración, el tiempo en la tarea y las interrupciones durante la administración del test. Metodología Estudio transversal de una muestra de conveniencia de pacientes adultos que acudieron durante marzo de 2011 y febrero de 2012 a un SU universitario y urbano. Los sujetos que consintieron fueron enfermos no críticos, de habla inglesa y mayores de 18 años de edad sin afasia, demencia, retraso mental o incapacidad para comunicarse. Las características de los tests diagnósticos REALM ‐R, NVS , SILS y cálculo numérico relativo a la salud y del médico gestáltico se evaluaron cuantitativamente mediante la forma abreviada del Test of Functional Health Literacy in Adults (S‐TOFHLA). Una puntuación de 22 o menos fue el criterio estándar para considerar una educación sanitaria limitada ( ESL ). Resultados Se incluyeron 435 participantes, con una media de edad de 45 años ( DE ), y un 18% tenía una formación inferior a la escuela secundaria. Como se definió por una puntuación de S‐TOFHLA de 22 o menos, la prevalencia de ESL fue un 23,9%. En comparación, el NVS , el REALM ‐R, y el médico gestáltico identificaron un 64,8%, un 48,5%, y un 35% de los participantes como ESL , respectivamente. Un NVS normal fue el test más útil para excluir ESL , con una razón de probabilidad negativa de 0,04 ( IC 95% = 0,01 a 0,17). Cuando fue anormal, ninguno de los instrumentos de despistaje, incluyendo el médico gestáltico, incrementó significativamente la probabilidad post‐test de ESL . El NVS y el REALM ‐R requieren 3 y 5 minutos menos de tiempo para administrase que el S‐TOFHLA. La administración del REALM ‐R se asocia con menos interrupciones del test. Conclusiones Una cuarta parte de los pacientes del SU tiene una educación sanitaria inadecuada o marginal. Entre los instrumentos de despistaje breves evaluados, un resultado normal en el NVS redujo certeramente la probabilidad de una ESL , aunque identificará dos tercios de los pacientes del SU como de alto riesgo para una ESL . Ninguno de los instrumentos breves de despistaje incrementa significativamente la probabilidad de ESL cuando es anormal.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.2014.21.issue-2
    DOI: 10.1111/acem.12315
    Language: English
    Publisher: Wiley
    Publication Date: 2014
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  • 7
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    Online Resource
    Use of a Computerized Forcing Function Improves Performance in Ordering Restraints
    Elsevier BV ; 2009
    In:  Annals of Emergency Medicine Vol. 53, No. 4 ( 2009-4), p. 469-476
    Details
    In: Annals of Emergency Medicine, Elsevier BV, Vol. 53, No. 4 ( 2009-4), p. 469-476
    Type of Medium: Online Resource
    ISSN: 0196-0644
    URL: Article
    DOI: 10.1016/j.annemergmed.2008.05.035
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2009
    detail.hit.zdb_id: 2003465-9
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  • 8
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    Favorable Bed Utilization and Readmission Rates for Emergency Department Observation Unit Heart Failure Patients
    Wiley ; 2013
    In:  Academic Emergency Medicine Vol. 20, No. 6 ( 2013-06), p. 554-561
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 20, No. 6 ( 2013-06), p. 554-561
    Type of Medium: Online Resource
    ISSN: 1069-6563
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.2013.20.issue-6
    DOI: 10.1111/acem.12147
    Language: English
    Publisher: Wiley
    Publication Date: 2013
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  • 9
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    Repeat computed tomography in recurrent abdominal pain: An evidence synthesis for guidelines for reasonable and appropriate care in the emergency department
    Wiley ; 2022
    In:  Academic Emergency Medicine Vol. 29, No. 5 ( 2022-05), p. 630-648
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 29, No. 5 ( 2022-05), p. 630-648
    Abstract: Computed tomography (CT) imaging is frequently obtained for recurrent abdominal pain after a prior emergency department (ED) evaluation. We evaluate the utility of repeat CT imaging following an indeterminate index CT in low‐risk abdominal pain adult ED patients. Methods An electronic search was designed for the patient‐intervention‐control‐outcome‐timing (PICOT) question: (P) adult patients with low‐risk, recurrent, and previously undifferentiated atraumatic abdominal pain presenting to the ED after an index‐negative CT within 12 months; (I) repeat CT versus (C) no repeat CT; for (O) abdominal surgery or other invasive procedure, mortality, identification of potentially life‐threatening diagnosis, and hospital and intensive care unit admission rates; and return ED visit (T), all within 30 days. Four reviewers independently selected evidence for inclusion and then synthesized the results around the most prevalent themes of repeat CT timing, diagnostic yield, ionizing radiation exposure, and predictors of repetitive imaging. Results Although 637 articles and abstracts were identified, no direct evidence was found. Thirteen documents were synthesized as indirect evidence. None of the indirect evidence defined a low‐risk subset of abdominal pain nor did investigators describe whether reimaging occurred for complaints similar to the initial ED evaluation. Included studies did not describe the index CT findings and some reported explanatory findings noted on the original CT for which repeat CTs might have been indicated. The time frame for a repeat CT ranged from hours to 1 year. The frequency of repeat CTs (2%–47%) varied across studies as did the yield of imaging to alter downstream clinical decision making (range = 5%–67%). Conclusion Due to the absence of direct evidence our scoping review is unable to provide high‐quality evidence‐based recommendations upon which to confidently base an imaging practice guideline. There is no evidence to support or refute performing a CT for low‐risk recurrent abdominal pain.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v29.5
    DOI: 10.1111/acem.14427
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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  • 10
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    Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 ( GRACE‐2 ): Low‐risk, recurrent abdominal pain in the emergency department
    Wiley ; 2022
    In:  Academic Emergency Medicine Vol. 29, No. 5 ( 2022-05), p. 526-560
    Details
    In: Academic Emergency Medicine, Wiley, Vol. 29, No. 5 ( 2022-05), p. 526-560
    Abstract: This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE‐2) from the Society for Academic Emergency Medicine is on the topic “low‐risk, recurrent abdominal pain in the emergency department.” The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low‐risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid‐minimizing strategy for pain control. EXECUTIVE SUMMARY The GRACE‐2 writing group developed clinically relevant questions to address the care of adult patients with low‐risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient‐intervention‐comparison‐outcome‐time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low‐risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.
    Type of Medium: Online Resource
    ISSN: 1069-6563 , 1553-2712
    URL: Issue
    URL: Article
    DOI: 10.1111/acem.v29.5
    DOI: 10.1111/acem.14495
    Language: English
    Publisher: Wiley
    Publication Date: 2022
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