Current Projects
To what extent to structurally marginalized populations have access to specialized Geriatric Emergency Department (GED) care? GEDs are a care delivery innovation Emergency Departments can voluntarily adopt to better meet the needs of older patients. GEDs have shown promise in reducing hospitalizations, readmissions, and costs among early adopter sites. GEDs have rapidly expanded in recent years, but little is known regarding what populations they serve. This project examines GED access among older adults living with Alzheimer's disease and dementia, who are more likely to be Black, Hispanic, and from lower socioeconomic status backgrounds. This project is supported by a Justice, Equity, Diversity, and Inclusion pilot award from the Stanford Alzheimer's Disease Research Center.
How often do emergency physicians miss serious diagnoses? Preliminary results quantifying potential ED misses preceding serious diagnoses suggest emergency physicians miss serious diagnoses much less often than previously reported. However, potentially missed cases are more frequent among women and racial/ ethnic minority groups and may be associated with higher mortality than those without potential misses. Our analyses are ongoing... stay tuned! This work is led by Dr. Laura Burke and funded by AHRQ.
How does one measure high-quality emergency care? Many existing metrics prioritize efficiency. But does a median length-of-stay of 91 minutes vs. 94 minutes truly matter to patients? In this NIH-funded project, we hypothesize that patient-reported outcomes are a valid indicator of quality of emergency care among adult asthma patients. We evaluate this novel outcome scale in the context of social and environmental risk factors, then see if it can predict subsequent ED visits and hospitalizations. NHLBI/ NIH K23 HL143042-01A1.
How easy is it to make a follow-up appointment after an emergency visit? Turns out, not so easy: 70% of Medicare beneficiaries had a follow-up visit within 30 days of ED discharge (40% within 7 days), with lower rates among Medicaid-eligible beneficiaries, Black beneficiaries, and those treated at rural emergency departments. Of note, those who completed follow-up visits had half (HR 0.49) the risk of 30-day mortality but a higher (HR 1.2) risk of subsequent hospitalization. Published in JAMA Network Open.
Past Projects
Evaluating ED Clinical Work Intensity and the Shift from Inpatient to Outpatient Care. Emergency Medicine Foundation Clinical Work Intensity Grant. This project aims to quantify the value of ED clinical work intensity by examining health care utilization and costs that previously occurred in inpatient settings, building on our prior work demonstrating a 10% decrease in ED admission rates from 2006 to 2014, Fig 2 ->
Early Adoption of Alternative Payment Models (APMs) for Emergency Medical Care: A Mixed Methods Study of Accountable Care Organizations (ACOs). In a national survey of 240 ACOs, we find ACOs prioritize primary care redesign to influence acute care, including incentives for PCPs to reduce avoidable hospitalizations, representing a missed opportunity to reduce hospitalization because emergency physicians are more likely to influence the decision to admit. A qualitative analysis of ED and ACO leaders at 7 national sites found ACOs have had limited engagement with EDs and have not impacted ED fee-for-service payment.
Identify and Intervene with Frequent Emergency Department Users. Brigham and Women’s Provider Organization Care Redesign & Incubator Startup Program (Lin, Schuur). and American Board of Medical Specialties Visiting Scholar Award (Lin). We performed a randomized control trial of an ED community health worker intervention, which led to fewer ED visits and hospitalizations in the intervention group compared to controls (usual care) during the 7-month follow-up period.
The Impact of Women-Focused Professional Organizations on Career Development. Academy for Women in Academic Emergency Medicine. Qualitative study and podcast series to assess the impact of a woman-focused professional organization for academic emergency physicians consisting of interviews with past leaders and women emergency physicians of varying career stages.
Identifying Best Practices to Reduce Hospital Admission from the Emergency Department. Blue Cross Blue Shield Foundation of Massachusetts (Schuur). This mixed-methods study identified common diagnoses with variation in ED admission rates (ex. atrial fibrillation) and identified best practices at high performing/ low admitting EDs.
Evaluating Choosing Wisely. Emergency Medicine Foundation Health Policy Scholar Award (Lin). We surveyed nearly 800 emergency physicians regarding knowledge, attitudes, and behaviors related to ACEP's Choosing Wisely recommendations.