9/8/2008Neumar - Emergency Care Research1 Emergency Care Research Solutions for the U.S. Heath Care System Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians

Future of Emergency Care Series Hospital-Based Emergency Care At the Breaking Point Committee on the Future of Emergency Care in the United States Health System 2006

9/8/2008Neumar - Emergency Care Research3 “The Agency for Healthcare Research and Quality (AHRQ) has a mission to improve the quality, safety, efficiency, effectiveness, and cost- effectiveness of health care for all Americans.” Emergency Care Research AHRQ Mission

9/8/2008Neumar - Emergency Care Research4 Comparative effectiveness. Patient safety/medical errors. Health care quality. Health information technology. Evidence-based medicine. Clinical practice. Outcomes of care and effectiveness. Primary care and care for priority populations. Organization and delivery of care and use of health care resources. Health care costs and financing. Health care system and public health preparedness Emergency Care Research AHRQ Portfolio

9/8/2008Neumar - Emergency Care Research5 Emergency Care Research Problem or Solution? ACEP LOGO

9/8/2008Neumar - Emergency Care Research6 Emergency Department 115,000,000 Ambulatory Care 1,000,000,000 Managed Care Observation Unit 1,000,000 Hospital 14,000,000 (43% of total) Hospital Transfer 2,000,000 Rehab Facility EMS System CDC Advanced Data No 386, 2007 Emergency Care Research Problem or Solution?

9/8/2008Neumar - Emergency Care Research7 Emergency Department 115,000,000 Ambulatory Care 1,000,000,000 Residence or Public Setting Managed Care Facility Observation Unit 1,000,000 Hospital 14,000,000 (43% of total ) Hospital Transfer 2,000,000 Rehab Facility EMS System Advanced Data No 386, 2007 Emergency Care Research Problem or Solution?

9/8/2008Neumar - Emergency Care Research8 In patients with [symptom] does emergency medical services (EMS) care compared to [alternative management] improve outcomes? In patients with [symptom] does emergency department care compared to [alternative management] improve outcomes? In emergency department patients with [symptom/diagnosis], does hospital admission compared to [alternative management] improve outcomes? Emergency Care Research Fundamental Questions

9/8/2008Neumar - Emergency Care Research9 Emergency Care Research Hypothesis “Rapid diagnosis and early intervention in acute illness or acutely decompensated chronic illness improves patient outcomes.” Neumar, Ann Emerg Med, 2007

9/8/2008Neumar - Emergency Care Research10

9/8/2008Neumar - Emergency Care Research11 Table 9. Emergency department visits principal reasons for visit: United States, 2005 CDC Advanced Data No 386, ,600,000 ED visits for abdominal or chest pain

9/8/2008Neumar - Emergency Care Research12 Table 11. ED visits by primary ED diagnosis groups: United States, 2005 CDC Advanced Data No 386, ,600,000 ED visits for abdominal or chest pain 9,000,000 ED diagnosis abdominal or chest pain (66%)

9/8/2008Neumar - Emergency Care Research13 Table 11. ED visits by hospital discharge diagnosis: United States, 2005 CDC Advanced Data No 386, ,600,000 ED visits for abdominal or chest pain 9,000,000 ED diagnosis abdominal or chest pain 972,000 hospital discharge diagnosis abdominal or chest pain

9/8/2008Neumar - Emergency Care Research14 “Clinical research that improves the accuracy, speed, safety, and cost- effectiveness of diagnosis in the emergency care setting has the potential to both improve outcomes and reduce resource utilization.” Emergency Care Research ACEP/SAEM Joint Research Task Force

9/8/2008Neumar - Emergency Care Research15 Emergency Care Research Undifferentiated Presentations Chest pain Dyspnea Abdominal pain Altered mental status Fever Headache Hypotension Shock Cardiac arrest

9/8/2008Neumar - Emergency Care Research16 Undifferentiated presentations Unscheduled Multiple locations and providers Time sensitive diagnosis and treatment Consent Standardized data elements Interoperable data sets Investigator training infrastructure Emergency Care Research Challenges

9/8/2008Neumar - Emergency Care Research17 24/7/365 operation High acuity High volume Concentrated resources Patient access Integral part of health care system Emergency Care Research Strengths

9/8/2008Neumar - Emergency Care Research18 Comparative effectiveness. Patient safety/medical errors. Health care quality. Health information technology. Evidence-based medicine. Clinical practice. Outcomes of care and effectiveness. Primary care and care for priority populations. Organization and delivery of care and use of health care resources. Health care costs and financing. Health care system and public health preparedness Emergency Care Research AHRQ Portfolio Emergency Care Investigator Training