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.

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.