[ { "key": "NKEXP48H", "version": 314, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/NKEXP48H", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/NKEXP48H", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/IPMCRJNA", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "NKEXP48H", "version": 314, "parentItem": "IPMCRJNA", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2013-05-19T14:54:30Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/23295438", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2013-05-19T14:54:30Z", "dateModified": "2013-05-19T14:54:30Z" } }, { "key": "IPMCRJNA", "version": 314, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/IPMCRJNA", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/IPMCRJNA", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Pines et al.", "parsedDate": "2013-04", "numChildren": 1 }, "data": { "key": "IPMCRJNA", "version": 314, "itemType": "journalArticle", "title": "Variation in emergency department admission rates across the United States", "creators": [ { "creatorType": "author", "firstName": "Jesse M", "lastName": "Pines" }, { "creatorType": "author", "firstName": "Ryan L", "lastName": "Mutter" }, { "creatorType": "author", "firstName": "Mark S", "lastName": "Zocchi" } ], "abstractNote": "There were more than 19 million hospitalizations in 2008 from hospital-based emergency departments (EDs), representing nearly 50% of all U.S. admissions. Factors related to variation in hospital-level ED admission rates are unknown. Generalized linear models were used to assess patient-, hospital-, and community-level factors associated with ED admission rates across a sample of U.S. hospitals using Healthcare Cost and Utilization Project data. In 1,376 EDs, the mean ED admission rate, when defined as direct admissions and also transfers from one ED to another hospital, was 17.5% and varied from 9.8% to 25.8% at the 10th and 90th percentiles. Higher proportions of Medicare and uninsured patients, more inpatient beds, lower ED volumes, for-profit ownership, trauma center status, and higher hospital occupancy rates were associated with higher ED admission rates. Also, hospitals in counties with fewer primary care physicians per capita and higher county-level ED admission rates had higher ED admission rates.", "publicationTitle": "Medical care research and review: MCRR", "publisher": "", "place": "", "date": "Apr 2013", "volume": "70", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "218-231", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Med Care Res Rev", "DOI": "10.1177/1077558712470565", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1552-6801", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 23295438", "tags": [], "collections": [ "U9UKGE4F" ], "relations": {}, "dateAdded": "2013-05-19T14:54:30Z", "dateModified": "2013-05-19T14:54:30Z" } }, { "key": "IMFJXTDD", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/IMFJXTDD", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/IMFJXTDD", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/9V44N895", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "IMFJXTDD", "version": 1, "parentItem": "9V44N895", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Link", "accessDate": "2012-10-25T18:19:34Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/21146900", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2012-10-25T18:19:34Z", "dateModified": "2012-10-25T18:19:34Z" } }, { "key": "9V44N895", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/9V44N895", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/9V44N895", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Baumann et al.", "parsedDate": "2011-07", "numChildren": 1 }, "data": { "key": "9V44N895", "version": 1, "itemType": "journalArticle", "title": "Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure", "creators": [ { "creatorType": "author", "firstName": "Brigitte M", "lastName": "Baumann" }, { "creatorType": "author", "firstName": "Esther H", "lastName": "Chen" }, { "creatorType": "author", "firstName": "Angela M", "lastName": "Mills" }, { "creatorType": "author", "firstName": "Lindsey", "lastName": "Glaspey" }, { "creatorType": "author", "firstName": "Nicole M", "lastName": "Thompson" }, { "creatorType": "author", "firstName": "Molly K", "lastName": "Jones" }, { "creatorType": "author", "firstName": "Michael C", "lastName": "Farner" } ], "abstractNote": "STUDY OBJECTIVE\n\nWe describe patient perceptions of computed tomography (CT) and their understanding of radiation exposure and risk.\n\n\nMETHODS\n\nThis was a cross-sectional study of acute abdominal pain patients aged 18 years or older. Confidence in medical evaluations with increasing levels of laboratory testing and imaging was rated on a 100-point visual analog scale. Knowledge of radiation exposure was ascertained when participants compared the radiation dose of one abdomen-pelvis CT with 2-view chest radiography. To assess cancer risk knowledge, participants rated their agreement with these factual statements: \"Approximately 2 to 3 abdominal CTs give the same radiation exposure as experienced by Hiroshima survivors\" and \"2 to 3 abdominal CTs over a person's lifetime can increase cancer risk.\" Previous CT was also assessed.\n\n\nRESULTS\n\nThere were 1,168 participants, 67% women and mean age 40.7 years (SD 15.9 years). Median confidence in a medical evaluation without ancillary testing was 20 (95% confidence interval [CI] 16 to 25) compared with 90 (95% CI 88 to 91) when laboratory testing and CT were included. More than 70% of participants underestimated the radiation dose of CT relative to chest radiography, and cancer risk comprehension was poor. Median agreement with the Hiroshima statement was 13 (95% CI 10 to 16) and 45 (95% CI 40 to 45) with the increased lifetime cancer risk statement. Seven hundred ninety-five patients reported receiving a previous CT. Of 365 patients who reported no previous CT, 142 (39%) had one documented in our electronic medical record.\n\n\nCONCLUSION\n\nPatients are more confident when CT imaging is part of their medical evaluation but have a poor understanding of the concomitant radiation exposure and risk and underestimate their previous imaging experience.", "publicationTitle": "Annals of emergency medicine", "publisher": "", "place": "", "date": "Jul 2011", "volume": "58", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "1-7.e2", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "10.1016/j.annemergmed.2010.10.018", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1097-6760", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 21146900", "tags": [], "collections": [ "SZU7TTVR" ], "relations": {}, "dateAdded": "2012-10-25T18:19:34Z", "dateModified": "2012-10-25T18:19:34Z" } }, { "key": "PJP6UEEN", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/PJP6UEEN", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/PJP6UEEN", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/H7U5AP8B", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "PJP6UEEN", "version": 1, "parentItem": "H7U5AP8B", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Link", "accessDate": "2012-10-25T18:17:24Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/22195053", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2012-10-25T18:17:24Z", "dateModified": "2012-10-25T18:17:24Z" } }, { "key": "H7U5AP8B", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/H7U5AP8B", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/H7U5AP8B", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Adam et al.", "parsedDate": "2011", "numChildren": 1 }, "data": { "key": "H7U5AP8B", "version": 1, "itemType": "journalArticle", "title": "The effect of computerized provider order entry (CPOE) on ordering patterns for chest pain patients in the emergency department", "creators": [ { "creatorType": "author", "firstName": "Terrence J", "lastName": "Adam" }, { "creatorType": "author", "firstName": "Russ", "lastName": "Waitman" }, { "creatorType": "author", "firstName": "Ian", "lastName": "Jones" }, { "creatorType": "author", "firstName": "Dominik", "lastName": "Aronsky" } ], "abstractNote": "This study addressed the effect of CPOE implementation on chest pain ordering patterns for patients in the emergency department. Retrospective order data was collected to assess the implementation. 300 randomly selected, time matched patients with a chief complaint of chest pain were selected in a before/after study. Patient demographics, treatment and disposition data were collected on clinical orders. Order volume, completeness and completion times were assessed before and after implementation. Overall order volume increased significantly from 11.6 pre-CPOE to 19.9 post-implementation (p<.01). Order documentation deficiencies were noted pre-implementation with 35.6% containing all order elements. Order completion times were unchanged; however, laboratory completion times increased for admitted patients post-implementation. Order volume increased after CPOE implementation, likely due to improved ED-based admission order capture for admitted patients. Order completeness improved significantly including standing order documentation. Overall, CPOE implementation is associated with improved clinical documentation with limited effect on clinical testing turn-around times.", "publicationTitle": "AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium", "publisher": "", "place": "", "date": "2011", "volume": "2011", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "38-47", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "AMIA Annu Symp Proc", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1942-597X", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 22195053", "tags": [], "collections": [ "T756ZS2R" ], "relations": {}, "dateAdded": "2012-10-25T18:17:24Z", "dateModified": "2012-10-25T18:17:24Z" } }, { "key": "CK2QSXT2", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/CK2QSXT2", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/CK2QSXT2", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Bingisser et al.", "parsedDate": "2012-10", "numChildren": 1 }, "data": { "key": "CK2QSXT2", "version": 1, "itemType": "journalArticle", "title": "Cardiac troponin: a critical review of the case for point-of-care testing in the ED", "creators": [ { "creatorType": "author", "firstName": "Roland", "lastName": "Bingisser" }, { "creatorType": "author", "firstName": "Charles", "lastName": "Cairns" }, { "creatorType": "author", "firstName": "Michael", "lastName": "Christ" }, { "creatorType": "author", "firstName": "Pierre", "lastName": "Hausfater" }, { "creatorType": "author", "firstName": "Bertil", "lastName": "Lindahl" }, { "creatorType": "author", "firstName": "Johannes", "lastName": "Mair" }, { "creatorType": "author", "firstName": "Mauro", "lastName": "Panteghini" }, { "creatorType": "author", "firstName": "Christopher", "lastName": "Price" }, { "creatorType": "author", "firstName": "Per", "lastName": "Venge" } ], "abstractNote": "The measurement of cardiac troponin concentrations in the blood is a key element in the evaluation of patients with suspected acute coronary syndromes, according to current guidelines, and contributes importantly to the ruling in or ruling out of acute myocardial infarction. The introduction of point-of-care testing for cardiac troponin has the potential to reduce turnaround time for assay results, compared with central laboratory testing, optimizing resource use. Although, in general, many point-of-care cardiac troponin tests are less sensitive than cardiac troponin tests developed for central laboratory-automated analyzers, point-of-care systems have been used successfully within accelerated protocols for the reliable ruling out of acute coronary syndromes, without increasing subsequent readmission rates for this condition. The impact of shortened assay turnaround times with point-of-care technology on length of stay in the emergency department has been limited to date, with most randomized evaluations of this technology having demonstrated little or no reduction in this outcome parameter. Accordingly, the point-of-care approach has not been shown to be cost-effective relative to central laboratory testing. Modeling studies suggest, however, that reengineering overall procedures within the emergency department setting, to take full advantage of reduced therapeutic turnaround time, has the potential to improve the flow of patients through the emergency department, to shorten discharge times, and to reduce cost. To properly evaluate the potential contribution of point-of-care technology in the emergency department, including its cost-effectiveness, future evaluations of point-of-care platforms will need to be embedded completely within a local decision-making structure designed for its use.", "publicationTitle": "The American journal of emergency medicine", "publisher": "", "place": "", "date": "Oct 2012", "volume": "30", "issue": "8", "section": "", "partNumber": "", "partTitle": "", "pages": "1639-1649", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Am J Emerg Med", "DOI": "10.1016/j.ajem.2012.03.004", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1532-8171", "archive": "", "archiveLocation": "", "shortTitle": "Cardiac troponin", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 22633720", "tags": [], "collections": [ "T756ZS2R" ], "relations": {}, "dateAdded": "2012-10-25T18:15:49Z", "dateModified": "2012-10-25T18:15:49Z" } }, { "key": "NAU8CSTR", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/NAU8CSTR", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/NAU8CSTR", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/CK2QSXT2", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "NAU8CSTR", "version": 1, "parentItem": "CK2QSXT2", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Link", "accessDate": "2012-10-25T18:15:49Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/22633720", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2012-10-25T18:15:49Z", "dateModified": "2012-10-25T18:15:49Z" } }, { "key": "EMUJ2CTM", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/EMUJ2CTM", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/EMUJ2CTM", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Soremekun et al.", "parsedDate": "2012-10-17", "numChildren": 1 }, "data": { "key": "EMUJ2CTM", "version": 1, "itemType": "journalArticle", "title": "Utility of point-of-care testing in ED triage", "creators": [ { "creatorType": "author", "firstName": "Olanrewaju A", "lastName": "Soremekun" }, { "creatorType": "author", "firstName": "Elizabeth M", "lastName": "Datner" }, { "creatorType": "author", "firstName": "Simon", "lastName": "Banh" }, { "creatorType": "author", "firstName": "Lance B", "lastName": "Becker" }, { "creatorType": "author", "firstName": "Jesse M", "lastName": "Pines" } ], "abstractNote": "BACKGROUND: Triage systems are commonly used in emergency departments (ED) to prioritize patients. Laboratory testing is not typically used to help risk-stratify patients at triage. OBJECTIVES: We studied the utility of point-of-care (POC) testing at triage in ED patients with high-risk complaints. METHODS: We conducted a prospective observational study on a convenience sample of ED patients at an urban academic hospital with 60,000 annual visits. Patients who were triaged to the waiting area with any of the following criteria were approached for enrollment: (1) chest pain or shortness of breath in patients older than 40 years, (2) possible infection in the presence of two or more systemic inflammatory response system criteria in patients older than 18 years, and (3) patients >65 years with non-traumatic complaints. A total of 300 subjects were enrolled. All enrolled patients received POC testing that included a combination of Chem8+, hemoglobin, troponin, B-type natriuretic peptide, and lactate. The triage nurse completed a survey after receiving the results. RESULTS: POC results was reported to be helpful in 56% of patients, changed the triage level in 15% of patients and led to 6% of patients being brought back for rapid physician evaluation. Overall, 50% of patients had one or more abnormal POC laboratory tests. There was no relationship between ED census and the likelihood of being helpful, changing the triage level, changing management, or bringing patients back any faster. CONCLUSION: POC testing at triage is a helpful adjunct in triage of patients with high-risk ED complaints.", "publicationTitle": "The American journal of emergency medicine", "publisher": "", "place": "", "date": "Oct 17, 2012", "volume": "", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Am J Emerg Med", "DOI": "10.1016/j.ajem.2012.07.025", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1532-8171", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 23083886", "tags": [], "collections": [ "T756ZS2R" ], "relations": {}, "dateAdded": "2012-10-25T18:14:38Z", "dateModified": "2012-10-25T18:14:38Z" } }, { "key": "6SPT2GDF", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/6SPT2GDF", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/6SPT2GDF", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/EMUJ2CTM", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "6SPT2GDF", "version": 1, "parentItem": "EMUJ2CTM", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Link", "accessDate": "2012-10-25T18:14:38Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/23083886", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2012-10-25T18:14:38Z", "dateModified": "2012-10-25T18:14:38Z" } }, { "key": "SPUTX6GX", "version": 3, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/SPUTX6GX", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/SPUTX6GX", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Hwang et al.", "parsedDate": "2010-05", "numChildren": 0 }, "data": { "key": "SPUTX6GX", "version": 3, "itemType": "journalArticle", "title": "Emergency department patient volume and troponin laboratory turnaround time", "creators": [ { "creatorType": "author", "firstName": "U", "lastName": "Hwang" }, { "creatorType": "author", "firstName": "Kevin M", "lastName": "Baumlin" }, { "creatorType": "author", "firstName": "Neal", "lastName": "Chawla" }, { "creatorType": "author", "firstName": "Dan", "lastName": "Handel" }, { "creatorType": "author", "firstName": "Kennon", "lastName": "Heard" }, { "creatorType": "author", "firstName": "E", "lastName": "Livote" }, { "creatorType": "author", "firstName": "Jesse M", "lastName": "Pines" }, { "creatorType": "author", "firstName": "Morgan", "lastName": "Valley" } ], "abstractNote": "OBJECTIVES: Increases in emergency department (ED) visits may place a substantial burden on both the ED and hospital-based laboratories. Studies have identified laboratory turnaround time (TAT) as a barrier to patient process times and lengths of stay. Prolonged laboratory study results may also result in delayed recognition of critically ill patients and initiation of appropriate therapies. The objective of this study was to determine how ED patient volume itself is associated with laboratory TAT.\nMETHODS: This was a retrospective cohort review of patients at five academic, tertiary care EDs in the United States. Data were collected on all adult patients seen in each ED with troponin laboratory testing during the months of January, April, July, and October 2007. Primary predictor variables were two ED patient volume measures at the time the troponin test was ordered: 1) number of all patients in the ED/number of beds (occupancy) and 2) number of admitted patients waiting for beds/beds (boarder occupancy). The outcome variable was troponin turnaround time (TTAT). Adjusted covariates included patient characteristics, triage severity, season (month of the laboratory test), and site. Multivariable adjusted quantile regression was carried out to assess the association of ED volume measures with TTAT.\nRESULTS: At total of 9,492 troponin tests were reviewed. Median TTAT for this cohort was 107 minutes (interquartile range [IQR] = 73-148 minutes). Median occupancy for this cohort was 1.05 patients (IQR = 0.78-1.38 patients) and median boarder occupancy was 0.21 (IQR = 0.11-0.32). Adjusted quantile regression demonstrated a significant association between increased ED patient volume and longer times to TTAT. For every 100% increase in census, or number of boarders over the number of ED beds, respectively, there was a 12 (95% confidence interval [CI] = 9 to 14) or 33 (95% CI = 24 to 42)-minute increase in TTAT.\n\nCONCLUSIONS: Increased ED patient volume is associated with longer hospital laboratory processing times. Prolonged laboratory TAT may delay recognition of conditions in the acutely ill, potentially affecting clinician decision-making and the initiation of timely treatment. Use of laboratory TAT as a patient throughput measure and the study of factors associated with its prolonging should be further investigated.", "publicationTitle": "Academic emergency medicine: official journal of the Society for Academic Emergency Medicine", "publisher": "", "place": "", "date": "May 2010", "volume": "175", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "501-7", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [ "T756ZS2R" ], "relations": {}, "dateAdded": "2012-10-25T18:10:56Z", "dateModified": "2012-10-25T18:12:58Z" } }, { "key": "GZ6WVT6I", "version": 3, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/GZ6WVT6I", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/GZ6WVT6I", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Mohanty and Washington", "parsedDate": "2006", "numChildren": 0 }, "data": { "key": "GZ6WVT6I", "version": 3, "itemType": "journalArticle", "title": "Predictors of on-call specialist response times in California emergency departments", "creators": [ { "creatorType": "author", "firstName": "Sarita A", "lastName": "Mohanty" }, { "creatorType": "author", "firstName": "D", "lastName": "Washington" } ], "abstractNote": "", "publicationTitle": "Academic emergency medicine: official journal of the Society for Academic Emergency Medicine", "publisher": "", "place": "", "date": "2006", "volume": "13", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "505-12", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [ "QDJWPDTK" ], "relations": {}, "dateAdded": "2012-10-25T18:06:34Z", "dateModified": "2012-10-25T18:07:35Z" } }, { "key": "JF6RZJZF", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/JF6RZJZF", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/JF6RZJZF", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Lee et al.", "parsedDate": "2008", "numChildren": 0 }, "data": { "key": "JF6RZJZF", "version": 1, "itemType": "journalArticle", "title": "Counsultations in the emergency department: a systematic review of the literature", "creators": [ { "creatorType": "author", "firstName": "Rene", "lastName": "Lee" }, { "creatorType": "author", "firstName": "Rob", "lastName": "Woods" }, { "creatorType": "author", "firstName": "Michael", "lastName": "Bullard" }, { "creatorType": "author", "firstName": "Brian R", "lastName": "Holroyd" }, { "creatorType": "author", "firstName": "Brian H", "lastName": "Rowe" } ], "abstractNote": "Objectives: Consultation is a common and important aspect of emergency department (ED) practice which can lead to delays in patient flow. Little is known about ED consultations and this review systematically evaluated the literature on ED consultations. Methods: Comprehensive searches of MEDLINE, PUBMED, SCIRUS, Cochrane Library, Web of Science, Health Star and other databases from 1966 to 2007 were performed. The grey literature and reference lists were searched and authors were contacted to identify other eligible studies. Published and unpublished studies reporting the proportion of consultations in the ED using any type of design were considered for this review. Eligible studies were required to involve patients presenting to the ED. Studies reporting on the proportion of consultation in a specific subpopulation of patients and interventions to improve consultations were also con- sidered for inclusion. Two reviewers independently selected studies and extracted data from included studies regarding the proportion of consultations in the ED or the patient subgroup. Individual study proportions were calculated together with 95% confidence intervals (CI). Results: From more than 15 000 pre-screened citations, 12 studies were finally included in the review. All but three of the included studies were published. Overall, four studies examined ED consultation proportions, six identified the rate of consultation for special populations of ED presentations and two examined interventions to improve consultations. Consultation varied from 20% to 40% for all patients, with lower proportions in the selected populations studied and a high rate of hospitalisation for consulted patients. Limited research on interventions to improve the ED consultation process has also been completed. Conclusions: Consultation research in the emergency setting is limited and variable; however, high consultation rates exist in some centres. This systematic review outlines the current state of the literature and suggests that further research is urgently needed.", "publicationTitle": "Emerg Med J", "publisher": "", "place": "", "date": "2008", "volume": "25", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "4-9", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "", "callNumber": "", "rights": "", "extra": "", "tags": [], "collections": [ "QDJWPDTK" ], "relations": {}, "dateAdded": "2012-10-25T18:02:50Z", "dateModified": "2012-10-25T18:04:38Z" } }, { "key": "RU38NITQ", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/RU38NITQ", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/RU38NITQ", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/PGPCQPT8", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "RU38NITQ", "version": 1, "parentItem": "PGPCQPT8", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Link", "accessDate": "2012-10-25T17:59:44Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/21620608", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2012-10-25T17:59:44Z", "dateModified": "2012-10-25T17:59:44Z" } }, { "key": "PGPCQPT8", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/PGPCQPT8", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/PGPCQPT8", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Kessler et al.", "parsedDate": "2012-06", "numChildren": 1 }, "data": { "key": "PGPCQPT8", "version": 1, "itemType": "journalArticle", "title": "Consultation in the emergency department: a qualitative analysis and review", "creators": [ { "creatorType": "author", "firstName": "Chad", "lastName": "Kessler" }, { "creatorType": "author", "firstName": "Bradley M", "lastName": "Kutka" }, { "creatorType": "author", "firstName": "Christian", "lastName": "Badillo" } ], "abstractNote": "BACKGROUND\n\nNo studies have evaluated the consultation process or attempted to define a standardized approach that could improve communication and patient outcomes.\n\n\nOBJECTIVE\n\nTo perform a qualitative analysis of emergency medicine (EM) consultation to reveal its complexity and elucidate strategies and frameworks for physician-to-physician communication.\n\n\nMETHODS\n\nData were collected in three phases: informal interviews conducted in an emergency department (ED), 10-question surveys given to a subset of EM and specialty physicians, and semi-structured 1-h group interviews using open-ended questions to further explore issues and trends elicited from the survey responses. In addition, we conducted an extensive literature search focused on health care and business consultation and communication.\n\n\nRESULTS\n\nSeventy-six percent (29 of 38) of emergency and specialty physicians completed the 10-question survey in its entirety. Three themes were identified from the survey responses: organizational skills, interpersonal and communication skills, and medical knowledge. Of 95 total comments, 41 (43%) focused on organizational skills, 26 (27%) on interpersonal and communication skills, and 28 (30%) on medical knowledge. There were 29 comments regarding poor consultations: 15 issues with organization, 6 with interpersonal and communication skills, and 8 with medical knowledge. The literature search revealed several models and types of consultation, but no standard algorithm currently exists.\n\n\nCONCLUSIONS\n\nWe recommend focusing on organizational skills, interpersonal and communication skills, and medical knowledge when teaching ED consultation and present a conceptual framework of the Five Cs Consultation Model: contact, communication, core question, collaboration, and closing the loop.", "publicationTitle": "The Journal of emergency medicine", "publisher": "", "place": "", "date": "Jun 2012", "volume": "42", "issue": "6", "section": "", "partNumber": "", "partTitle": "", "pages": "704-711", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Emerg Med", "DOI": "10.1016/j.jemermed.2011.01.025", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0736-4679", "archive": "", "archiveLocation": "", "shortTitle": "Consultation in the emergency department", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 21620608", "tags": [], "collections": [ "QDJWPDTK" ], "relations": {}, "dateAdded": "2012-10-25T17:59:44Z", "dateModified": "2012-10-25T17:59:44Z" } }, { "key": "FX6TQ6XJ", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/FX6TQ6XJ", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/FX6TQ6XJ", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Crouch et al.", "parsedDate": "2002-02", "numChildren": 1 }, "data": { "key": "FX6TQ6XJ", "version": 1, "itemType": "journalArticle", "title": "Developing benchmark inventories to assess the content of telephone consultations in accident and emergency departments: use of the Delphi technique", "creators": [ { "creatorType": "author", "firstName": "Robert", "lastName": "Crouch" }, { "creatorType": "author", "firstName": "Jeremy", "lastName": "Dale" }, { "creatorType": "author", "firstName": "Rosemary", "lastName": "Crow" } ], "abstractNote": "The provision of telephone advice to members of the general public from staff based in accident and emergency departments is common practice. However, it is largely conducted on an ad hoc basis without the use of formal guidelines or decision support. The evidence base from which to derive guidelines for the telephone assessment and advice of many common conditions is lacking. This study, using the Delphi technique, was undertaken to develop a number of benchmarks for use as objective measures against which the comprehensiveness of telephone assessments could be tested. Consensus views on the essential and desirable items to be considered for each of 10 presenting complaints was achieved. It is argued that establishing consensus views on clinical topics provides an effective means of developing an evidence base where other sources of evidence are lacking.", "publicationTitle": "International journal of nursing practice", "publisher": "", "place": "", "date": "Feb 2002", "volume": "8", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "23-31", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Int J Nurs Pract", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1322-7114", "archive": "", "archiveLocation": "", "shortTitle": "Developing benchmark inventories to assess the content of telephone consultations in accident and emergency departments", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 11831424", "tags": [], "collections": [ "QDJWPDTK" ], "relations": {}, "dateAdded": "2012-10-25T17:59:19Z", "dateModified": "2012-10-25T17:59:19Z" } }, { "key": "7MXG68Q2", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/7MXG68Q2", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/7MXG68Q2", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/FX6TQ6XJ", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "7MXG68Q2", "version": 1, "parentItem": "FX6TQ6XJ", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Link", "accessDate": "2012-10-25T17:59:19Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/11831424", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2012-10-25T17:59:19Z", "dateModified": "2012-10-25T17:59:19Z" } }, { "key": "9QUWDCPA", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/9QUWDCPA", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/9QUWDCPA", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Vosk", "parsedDate": "1998-11", "numChildren": 1 }, "data": { "key": "9QUWDCPA", "version": 1, "itemType": "journalArticle", "title": "Response of consultants to the emergency department: a preliminary report", "creators": [ { "creatorType": "author", "firstName": "A", "lastName": "Vosk" } ], "abstractNote": "STUDY OBJECTIVE\n\nTo determine the timeliness of response of consultants called to evaluate patients in the emergency department of a community hospital.\n\n\nMETHODS\n\nConsultation requests from an ED located in a medium-sized community hospital were studied for a 1-month period. Data collected included name and specialty of the consultant, urgency of patients' conditions, times of pages, and times of consultants' responses and arrival in the ED.\n\n\nRESULTS\n\nTwo hundred forty-one consultations were requested and 199 data forms relating to 21 staff physicians were analyzed. Mean number of pages required to reach a consultant was 1.5+/-.4. Mean time from the first page to telephone response was 8+/-6 minutes and from first page to ED arrival was 42+/-23 minutes. Mean time from the first page to the consultant's arrival in the ED was significantly shorter for emergency (17+/-10 minutes) than for urgent or nonurgent patients (50+/-41 and 41+/-23 minutes, respectively). There were wide variations in individual patterns of response; the 7 fastest consultants had a mean first page to arrival time of 25+/-10 minutes, and for the slowest 5 consultants the time was 56+/-24 minutes.\n\n\nCONCLUSION\n\nResponse times of consultants to the ED vary depending on the urgency of the patient's condition and individual behavior patterns.", "publicationTitle": "Annals of emergency medicine", "publisher": "", "place": "", "date": "Nov 1998", "volume": "32", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "574-577", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "0196-0644", "archive": "", "archiveLocation": "", "shortTitle": "Response of consultants to the emergency department", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 9795320", "tags": [], "collections": [ "QDJWPDTK" ], "relations": {}, "dateAdded": "2012-10-25T17:57:32Z", "dateModified": "2012-10-25T17:57:32Z" } }, { "key": "PKIJN7TT", "version": 1, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/PKIJN7TT", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/PKIJN7TT", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/9QUWDCPA", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } } }, "data": { "key": "PKIJN7TT", "version": 1, "parentItem": "9QUWDCPA", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed Link", "accessDate": "2012-10-25T17:57:32Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/9795320", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": {}, "dateAdded": "2012-10-25T17:57:32Z", "dateModified": "2012-10-25T17:57:32Z" } }, { "key": "V4G4VWBN", "version": 60, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/V4G4VWBN", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/V4G4VWBN", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Hsia and Shen", "parsedDate": "2011-10", "numChildren": 0 }, "data": { "key": "V4G4VWBN", "version": 60, "itemType": "journalArticle", "title": "Rising closures of hospital trauma centers disproportionately burden vulnerable populations", "creators": [ { "creatorType": "author", "firstName": "Renee Yuen-Jan", "lastName": "Hsia" }, { "creatorType": "author", "firstName": "Yu-Chu", "lastName": "Shen" } ], "abstractNote": "Closures of hospital trauma centers have accelerated since 2001. These closures may disproportionately affect disadvantaged communities. We evaluate how driving time between ZIP code areas and the nearest trauma centers-a proxy for access, given the time-sensitive nature of trauma care-changed nationwide during 2001-07. By 2007, sixty-nine million Americans (24 percent of the population) had to travel farther to the nearest trauma center than they did in 2001, and almost sixteen million people had to travel an additional thirty minutes or more. Communities with disproportionately high numbers of African American residents, uninsured people, and people living in poverty, as well as people living in rural areas, were more likely than others to be thus affected. Because mortality from traumatic injuries has also worsened for these vulnerable populations, policy makers should learn more about the possible connections-and consider such measures as paying trauma centers serving these communities higher amounts for treatment of injuries.", "publicationTitle": "Health affairs (Project Hope)", "publisher": "", "place": "", "date": "Oct 2011", "volume": "30", "issue": "10", "section": "", "partNumber": "", "partTitle": "", "pages": "1912-1920", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Health Aff (Millwood)", "DOI": "10.1377/hlthaff.2011.0510", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pubmed/21976335", "accessDate": "2012-09-16T19:39:06Z", "PMID": "", "PMCID": "", "ISSN": "1544-5208", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 21976335", "tags": [ { "tag": "Cost center: Hospital" }, { "tag": "Payor class: Uninsured" }, { "tag": "Triple Aims: Population Health" }, { "tag": "Triple Aims: cost" } ], "collections": [ "BB2VDCCF" ], "relations": {}, "dateAdded": "2012-10-12T00:35:42Z", "dateModified": "2012-10-25T17:57:04Z" } }, { "key": "QIUID9QE", "version": 53, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/QIUID9QE", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/QIUID9QE", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/95965/items/WTPV36V4", "type": "application/json" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "QIUID9QE", "version": 53, "parentItem": "WTPV36V4", "itemType": "note", "note": "

Abstract

\n

STUDY OBJECTIVE:

\n

We compare the association between barriers to timely primary care and emergency department (ED) utilization among adults with Medicaid versus private insurance. 

\n

METHODS:

\n

We analyzed 230,258 adult participants of the 1999 to 2009 National Health Interview Survey. We evaluated the association between 5 specific barriers to timely primary care (unable to get through on telephone, unable to obtain appointment soon enough, long wait in the physician's office, limited clinic hours, lack of transportation) and ED utilization (≥1 ED visit during the past year) for Medicaid and private insurance beneficiaries. Multivariable logistic regression models adjusted for demographics, socioeconomic status, health conditions, outpatient care utilization, and survey year.

\n

RESULTS:

\n

Overall, 16.3% of Medicaid and 8.9% of private insurance beneficiaries had greater than or equal to 1 barrier to timely primary care. Compared with individuals with private insurance, Medicaid beneficiaries had higher ED utilization overall (39.6% versus 17.7%), particularly among those with barriers (51.3% versus 24.6% for 1 barrier and 61.2% versus 28.9% for ≥2 barriers). After adjusting for covariates, Medicaid beneficiaries were more likely to have barriers (adjusted odds ratio [OR] 1.41; 95% confidence interval [CI] 1.30 to 1.52) and higher ED utilization (adjusted OR 1.48; 95% CI 1.41 to 1.56). ED utilization was even higher among Medicaid beneficiaries with 1 barrier (adjusted OR 1.66; 95% CI 1.44 to 1.92) or greater than or equal to 2 barriers (adjusted OR 2.01; 95% CI 1.72 to 2.35) compared with that for individuals with private insurance and barriers.

\n

CONCLUSION:

\n

Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated ED utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access.

", "tags": [ { "tag": "Care giver: non-ED care" }, { "tag": "Care-giver: ED" }, { "tag": "Payor class: Medicaid" }, { "tag": "Triple Aims: Population Health" } ], "relations": {}, "dateAdded": "2012-10-12T00:35:42Z", "dateModified": "2012-10-25T17:57:04Z" } }, { "key": "SGTQRZVC", "version": 53, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/SGTQRZVC", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/SGTQRZVC", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Ludwick et al.", "parsedDate": "2009-05", "numChildren": 0 }, "data": { "key": "SGTQRZVC", "version": 53, "itemType": "journalArticle", "title": "Distances to emergency department and to primary care provider's office affect emergency department use in children", "creators": [ { "creatorType": "author", "firstName": "Annameika", "lastName": "Ludwick" }, { "creatorType": "author", "firstName": "Rongwei", "lastName": "Fu" }, { "creatorType": "author", "firstName": "Craig", "lastName": "Warden" }, { "creatorType": "author", "firstName": "Robert A", "lastName": "Lowe" } ], "abstractNote": "OBJECTIVES\n\nPatients of all ages use emergency departments (EDs) for primary care. Several studies have evaluated patient and system characteristics that influence pediatric ED use. However, the issue of proximity as a predictor of ED use has not been well studied. The authors sought to determine whether ED use by pediatric Medicaid enrollees was associated with the distance to their primary care providers (PCPs), distance to the nearest ED, and distance to the nearest children's hospital.\n\n\nMETHODS\n\nThis historical cohort study included 26,038 children age 18 and under, assigned to 332 primary care practices affiliated with a Medicaid health maintenance organization (HMO). Predictor variables were distance from the child's home to his or her PCP site, distance from home to the nearest ED, and distance from home to the nearest children's hospital. The outcome variable was each child's ED use. A negative binomial model was used to determine the association between distance variables and ED use, adjusted for age, sex, and race, plus medical and primary care site characteristics previously found to influence ED use. Distance variables were divided into quartiles to test for nonlinear associations.\n\n\nRESULTS\n\nOn average, children made 0.31 ED visits/person/year. In the multivariable model, children living greater than 1.19 miles from the nearest ED had 11% lower ED use than those living within 0.5 miles of the nearest ED (risk ratio [RR] = 0.89, 95% CI = 0.81 to 0.99). Children living between 1.54 and 3.13 miles from their PCPs had 13% greater ED use (RR = 1.13, 95% CI = 1.03 to 1.24) than those who lived within 0.7 miles of their PCP.\n\n\nCONCLUSIONS\n\nGeographical variables play a significant role in ED utilization in children, confirming the importance of system-level determinants of ED use and creating the opportunity for interventions to reduce geographical barriers to primary care.", "publicationTitle": "Academic emergency medicine: official journal of the Society for Academic Emergency Medicine", "publisher": "", "place": "", "date": "May 2009", "volume": "16", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "411-417", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Acad Emerg Med", "DOI": "10.1111/j.1553-2712.2009.00395.x", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pubmed/19388919", "accessDate": "2012-09-16T18:22:24Z", "PMID": "", "PMCID": "", "ISSN": "1553-2712", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 19388919", "tags": [ { "tag": "Care giver: non-ED care" }, { "tag": "Care-giver: ED" }, { "tag": "Cost center: Hospital" }, { "tag": "Cost center: medical home" }, { "tag": "Payor class: Medicaid" }, { "tag": "Triple Aims: Population Health" } ], "collections": [ "DJ4JCPZW" ], "relations": {}, "dateAdded": "2012-10-12T00:35:42Z", "dateModified": "2012-10-25T17:57:04Z" } }, { "key": "WTPV36V4", "version": 53, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/WTPV36V4", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/WTPV36V4", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Cheung et al.", "parsedDate": "2012-07", "numChildren": 1 }, "data": { "key": "WTPV36V4", "version": 53, "itemType": "journalArticle", "title": "National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries", "creators": [ { "creatorType": "author", "firstName": "Paul T", "lastName": "Cheung" }, { "creatorType": "author", "firstName": "Jennifer L", "lastName": "Wiler" }, { "creatorType": "author", "firstName": "Robert A", "lastName": "Lowe" }, { "creatorType": "author", "firstName": "Adit A", "lastName": "Ginde" } ], "abstractNote": "STUDY OBJECTIVE\n\nWe compare the association between barriers to timely primary care and emergency department (ED) utilization among adults with Medicaid versus private insurance.\n\n\nMETHODS\n\nWe analyzed 230,258 adult participants of the 1999 to 2009 National Health Interview Survey. We evaluated the association between 5 specific barriers to timely primary care (unable to get through on telephone, unable to obtain appointment soon enough, long wait in the physician's office, limited clinic hours, lack of transportation) and ED utilization (≥1 ED visit during the past year) for Medicaid and private insurance beneficiaries. Multivariable logistic regression models adjusted for demographics, socioeconomic status, health conditions, outpatient care utilization, and survey year.\n\n\nRESULTS\n\nOverall, 16.3% of Medicaid and 8.9% of private insurance beneficiaries had greater than or equal to 1 barrier to timely primary care. Compared with individuals with private insurance, Medicaid beneficiaries had higher ED utilization overall (39.6% versus 17.7%), particularly among those with barriers (51.3% versus 24.6% for 1 barrier and 61.2% versus 28.9% for ≥2 barriers). After adjusting for covariates, Medicaid beneficiaries were more likely to have barriers (adjusted odds ratio [OR] 1.41; 95% confidence interval [CI] 1.30 to 1.52) and higher ED utilization (adjusted OR 1.48; 95% CI 1.41 to 1.56). ED utilization was even higher among Medicaid beneficiaries with 1 barrier (adjusted OR 1.66; 95% CI 1.44 to 1.92) or greater than or equal to 2 barriers (adjusted OR 2.01; 95% CI 1.72 to 2.35) compared with that for individuals with private insurance and barriers.\n\n\nCONCLUSION\n\nCompared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated ED utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access.", "publicationTitle": "Annals of emergency medicine", "publisher": "", "place": "", "date": "Jul 2012", "volume": "60", "issue": "1", "section": "", "partNumber": "", "partTitle": "", "pages": "4-10.e2", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "10.1016/j.annemergmed.2012.01.035", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pubmed/22418570", "accessDate": "2012-09-16T16:24:56Z", "PMID": "", "PMCID": "", "ISSN": "1097-6760", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 22418570", "tags": [ { "tag": "Care giver: non-ED care" }, { "tag": "Care-giver: ED" }, { "tag": "Payor class: Medicaid" }, { "tag": "Triple Aims: Population Health" } ], "collections": [ "DJ4JCPZW" ], "relations": {}, "dateAdded": "2012-10-12T00:35:42Z", "dateModified": "2012-10-25T17:57:04Z" } }, { "key": "W3G347S5", "version": 50, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/W3G347S5", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/W3G347S5", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Forrest and Whelan", "parsedDate": "2000-10-25", "numChildren": 0 }, "data": { "key": "W3G347S5", "version": 50, "itemType": "journalArticle", "title": "Primary care safety-net delivery sites in the United States: A comparison of community health centers, hospital outpatient departments, and physicians' offices", "creators": [ { "creatorType": "author", "firstName": "C B", "lastName": "Forrest" }, { "creatorType": "author", "firstName": "E M", "lastName": "Whelan" } ], "abstractNote": "CONTEXT\n\nThe US primary care safety net is composed of a loose network of community health centers, hospital outpatient departments, and physicians' offices. National data on how the mix of patients and services differ across sites are needed.\n\n\nOBJECTIVE\n\nTo develop and contrast national profiles of patient and service mix for primary care.\n\n\nDESIGN, SETTING, AND PATIENTS\n\nComparative analyses of 3 national surveys of primary care visits occurring in 1994: for data on physician's office visits, the National Ambulatory Medical Care Survey (NAMCS); for hospital outpatient department data, the National Hospital Ambulatory Medical Care Survey (NHAMCS); and for data on community health centers, the Bureau of Primary Health Care's 1994 Survey of Visits to Community Health Centers. A time trend analysis also was conducted using the 1998 NAMCS and NHAMCS.\n\n\nMAIN OUTCOME MEASURES\n\nNational estimates of primary care visit rates, types of patient presentation, patient case-mix, disposition of patients, and management interventions in 1994, and compared with 1998 data.\n\n\nRESULTS\n\nThe US population made 1.3 primary care visits per person in 1994, which accounted for 43.5% of all ambulatory visits to physicians' offices, community health centers, and hospital outpatient departments. Primary care visits per person were 20% lower for Hispanics and 33% lower for black, non-Hispanic persons compared with white, non-Hispanic persons. Visits to community health centers were more likely to be made by ethnic minorities, patients with Medicaid or no insurance, and rural dwellers than visits made to the other delivery sites. Visits at hospital outpatient departments were made by sicker populations and were characterized by less continuity than the other delivery sites. Controlling for patient mix, visits made to hospital outpatient departments were more commonly associated with imaging studies, minor surgery, and specialty referrals than those made to physicians' offices. In 1998, the US population made an estimated 3. 4 visits per person, 45.6% of which were primary care visits. National estimates of primary care visit rates and patient mix and practice pattern comparisons between hospital outpatient departments and physicians' offices were similar in 1998 and 1994.\n\n\nCONCLUSIONS\n\nExpanding community health centers will likely improve access to primary care for vulnerable US populations. However, enhancing access to of physicians' offices is also needed to bolster the safety net. The greater service intensity and poorer continuity for primary care visits in hospital outpatient departments that we observed raises concern about the suitability of these clinics as primary care delivery sites. JAMA. 2000;284:2077-2083.", "publicationTitle": "JAMA: the journal of the American Medical Association", "publisher": "", "place": "", "date": "Oct 25, 2000", "volume": "284", "issue": "16", "section": "", "partNumber": "", "partTitle": "", "pages": "2077-2083", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "JAMA", "DOI": "", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pubmed/11042756", "accessDate": "2012-09-16T18:19:05Z", "PMID": "", "PMCID": "", "ISSN": "0098-7484", "archive": "", "archiveLocation": "", "shortTitle": "Primary care safety-net delivery sites in the United States", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 11042756", "tags": [ { "tag": "Cost center: FQHC" }, { "tag": "Cost center: Hospital" }, { "tag": "Cost center: medical home" }, { "tag": "Payor class: Medicaid" }, { "tag": "Payor class: Uninsured" }, { "tag": "Triple Aims: Population Health" } ], "collections": [ "3QUKI4Q2" ], "relations": {}, "dateAdded": "2012-10-12T00:35:42Z", "dateModified": "2012-10-25T17:57:04Z" } }, { "key": "KDAGEZ29", "version": 50, "library": { "type": "group", "id": 95965, "name": "empolicy", "links": { "alternate": { "href": "https://www.zotero.org/groups/empolicy", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/95965/items/KDAGEZ29", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/empolicy/items/KDAGEZ29", "type": "text/html" } }, "meta": { "createdByUser": { "id": 1123996, "username": "danakindermann", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/danakindermann", "type": "text/html" } } }, "creatorSummary": "Hsia et al.", "parsedDate": "2012-05", "numChildren": 0 }, "data": { "key": "KDAGEZ29", "version": 50, "itemType": "journalArticle", "title": "System-level health disparities in California emergency departments: minorities and Medicaid patients are at higher risk of losing their emergency departments", "creators": [ { "creatorType": "author", "firstName": "Renee Y", "lastName": "Hsia" }, { "creatorType": "author", "firstName": "Tanja", "lastName": "Srebotnjak" }, { "creatorType": "author", "firstName": "Hemal K", "lastName": "Kanzaria" }, { "creatorType": "author", "firstName": "Charles", "lastName": "McCulloch" }, { "creatorType": "author", "firstName": "Andrew D", "lastName": "Auerbach" } ], "abstractNote": "STUDY OBJECTIVE\n\nEmergency department (ED) closures threaten community access to emergency services, but few data exist to describe factors associated with closure. We evaluate factors associated with ED closure in California and seek to determine whether hospitals serving more vulnerable populations have a higher rate of ED closure.\n\n\nMETHODS\n\nThis was a retrospective cohort study of California hospital EDs between 1998 and 2008, using hospital- and patient-level data from the California Office of Statewide Health Planning and Development (OSHPD), as well as OSHPD patient discharge data. We examined the effects of hospital and patient factors on the hospital's likelihood of ED closure by using Cox proportional hazards models.\n\n\nRESULTS\n\nIn 4,411 hospital-years of observation, 29 of 401 (7.2%) EDs closed. In a model adjusted for total ED visits, hospital discharges, trauma center and teaching status, ownership, operating margin, and urbanicity, hospitals with more black patients (hazard ratio [HR] 1.41 per increase in proportion of blacks by 0.1; 95% confidence interval [CI] 1.16 to 1.72) and Medi-Cal recipients (HR 1.17 per increase in proportion insured by Medi-Cal by 0.1; 95% CI 1.02 to 1.34) had higher risk of ED closure, as did for-profit institutions (HR 1.65; 95% CI 1.13 to 2.41).\n\n\nCONCLUSION\n\nThe population served by EDs and hospitals' profit model are associated with ED closure. Whether our findings are a manifestation of poorer reimbursement in at-risk EDs is unclear.", "publicationTitle": "Annals of emergency medicine", "publisher": "", "place": "", "date": "May 2012", "volume": "59", "issue": "5", "section": "", "partNumber": "", "partTitle": "", "pages": "358-365", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Ann Emerg Med", "DOI": "10.1016/j.annemergmed.2011.09.018", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pubmed/22093435", "accessDate": "2012-09-16T19:37:21Z", "PMID": "", "PMCID": "", "ISSN": "1097-6760", "archive": "", "archiveLocation": "", "shortTitle": "System-level health disparities in California emergency departments", "language": "", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 22093435", "tags": [ { "tag": "Payor class: Medicaid" }, { "tag": "Payor class: Uninsured" }, { "tag": "Triple Aims: Population Health" } ], "collections": [ "BB2VDCCF" ], "relations": {}, "dateAdded": "2012-10-12T00:35:42Z", "dateModified": "2012-10-25T17:57:04Z" } } ]