Impact of an Emergency Department-to-Home Transitional Care Intervention on Health Service Use in Medicare Beneficiaries: A Mixed Methods Study.

Background: Hospital-based acute care [emergency department (ED) visits and hospitalizations] that is preventable with high-quality outpatient care contributes to health care system waste and patient harm.

Objective: To test the hypothesis that an ED-to-home transitional care intervention reduces hospital-based acute care in chronically ill, older ED visitors.

Research Design: Convergent, parallel, mixed-methods design including a randomized controlled trial.

The Association of Health Literacy With Preventable Emergency Department Visits: A Cross-sectional Study.

Background: Policymakers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor, and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown.

A Framework Illustrating Care-Seeking Among Older Adults in a Hospital Emergency Department.

Background And Objectives: Older adults seeking emergency department (ED) care often have multiple, complex chronic conditions. We sought to understand factors that influence ED care-seeking by older adults and present a theoretical framework illustrating this process.

Research Design And Methods: In this grounded theory study, we interviewed 40 older adults with chronic illness within 90 days of an ED visit to explore their decision-making about seeking ED care.

Feasibility of an ED-to-Home Intervention to Engage Patients: A Mixed-Methods Investigation.

Introduction: Older, chronically ill patients with limited health literacy are often under-engaged in managing their health and turn to the emergency department (ED) for healthcare needs. We tested the impact of an ED-initiated coaching intervention on patient engagement and follow-up doctor visits in this high-risk population. We also explored patients' care-seeking decisions.

Measuring quality: caries-related emergency department visits and follow-up among children.

Objective: This study validated two Dental Quality Alliance system-level measures of oral healthcare quality for children - caries-related emergency department (ED) visits and timely follow-up of those visits with a dentist - including formal validation of diagnosis codes used to identify caries-related ED visits and measurement of follow-up care.

Methods: The measures were specified for implementation with administrative claims data and validated using data from the Florida and Texas Medicaid and Children's Health Insurance Programs. Measure specification testing and measure score validation used administrative data for 7,007,765 children.

Adapting Conceptual Frameworks for Patient Engagement in Emergency Department Research.

For many people the emergency department (ED) is the first point of access to healthcare for acute needs and a recurring location for many with chronic healthcare needs. While the ED is well placed to identify unmet needs it can also be a net that people slip through when faced with uncoordinated and expensive healthcare challenges. Thus the ED has a responsibility to set patients on a safe and meaningful care trajectory, which can only be done in consultation and partnership with the patients themselves.

Trends in dental-related use of hospital emergency departments in Florida.

Objectives: The inability to access regular dental care may lead to care seeking at hospital emergency departments (EDs). However, EDs generally are not equipped or staffed to provide definitive dental services. This study examined trends and patterns of hospital ED use for dental-related reasons in Florida, a large, diverse state with serious barriers to accessing dental care.

Primary Care Experiences of Emergency Department Patients With Limited Health Literacy.

It is unclear why patients with limited health literacy have fewer visits with a personal doctor and more emergency department (ED) visits than patients with adequate health literacy. We identified significant differences in perceived access to a personal doctor and high-quality provider interactions among adults with limited compared to adequate health literacy presenting for emergency treatment. Practice and provider strategies to ensure that patients have timely access to care and high-quality provider interactions may address some of the reasons patients with limited health literacy use more emergency department-based and less preventive care than those with adequate health literacy.

Assessing patient activation and health literacy in the ED.

Background: Low health literacy and patient activation are linked to unmet health needs, excess emergency department (ED) use, and hospital admission. However, most studies have assessed these measures in non-ED populations.

Objective: The objective of the study is to assess health literacy and patient activation in the ED.

Evaluation of healthcare use trends of high-risk female intimate partner violence victims.

Introduction: Practitioners need more information about intimate partner violence (IPV) victims' healthcare use trends. We used a novel data-linkage method and complaint categorization allowing us to evaluate IPV victims healthcare use trends compared to the date of their victimization.

Methods: This was a retrospective case series using data-linking techniques cross-referencing databases of Medicaid-eligible women between the ages of 16 and 55 years, an IPV Case Database for 2007 and the Florida State Agency for Healthcare Administration, which tracks hospital inpatient, ambulatory and emergency department (ED) use within the State of Florida.

Perioperative and acute care outcomes in morbidly obese patients with acetabular fractures at a Level 1 trauma center.

Background: Controversy exists regarding obesity-related injury severity and clinical outcomes after orthopedic trauma.

Purpose: The purposes of this study were to expand our understanding of the effect of morbid obesity on perioperative and acute care outcomes after acetabular fracture.

Methods: This was a retrospective review of patients with acetabular fracture after trauma.

Emergency department crowding and time to antibiotic administration in febrile infants.

Introduction: Early antibiotic administration is recommended in newborns presenting with febrile illness to emergency departments (ED) to avert the sequelae of serious bacterial infection. Although ED crowding has been associated with delays in antibiotic administration in a dedicated pediatric ED, the majority of children that receive emergency medical care in the United States present to EDs that treat both adult and pediatric emergencies. The purpose of this study was to examine the relationship between time to antibiotic administration in febrile newborns and crowding in a general ED serving both an adult and pediatric population.

Potentially preventable use of emergency services: the role of low health literacy.

Background: Limited health literacy is a barrier for understanding health information and has been identified as a risk factor for overuse of the emergency department (ED). The association of health literacy with access to primary care services in patients presenting to the ED has not been fully explored.

Objective: To examine the relationship between health literacy, access to primary care, and reasons for ED use among adults presenting for emergency care.

Statistics for the nonstatistician: Part II.

Part I of this two-part article provides a foundation of statistical terms and analyses for clinicians who are not statisticians. Types of data, how data are distributed and described, hypothesis testing, statistical significance, sample size determination, and the statistical analysis of interval scale (numeric) data were reviewed. Some data are presented not as interval data, but as named categories, also called nominal or categorical data.

Compliance with outpatient stress testing in low-risk patients presenting to the emergency department with chest pain.

Recent evidence suggests that stress testing prior to emergency department (ED) release in low-risk chest pain patients identifies those who can be safely discharged home. When immediate stress testing is not feasible, rapid outpatient stress testing has been recommended. The objective of this study was to determine compliance rate and incidence of adverse cardiac events in patients presenting to the ED with low-risk chest pain referred for outpatient stress testing.

Emergency Department Activation of Interventional Cardiology to Reduce Door-to-Balloon Time.

Background: Despite American College of Cardiology (ACC) and American Heart Association (AHA) guidelines, many hospitals have door-to-balloon times in excess of 90 minutes. Emergency Department (ED) activation of interventional cardiology has been described as an important strategy to reduce door-to-balloon time. However, prior studies on ED activation have been in suburban hospitals with door-to-balloon times near the ACC/AHA targeted times.

Effect of compliance with quality performance measures for heart failure on clinical outcomes in high-risk patients.

Background: Although effects of the Joint Commission on Accreditation of Healthcare Organizations' (TJC) performance measures on national trends in patient outcomes have been reported, little information exists on the effects of these quality measures on patient outcomes in individual centers caring for high-risk patient populations.

Objectives: To determine the effects of compliance with TJC core quality measures for heart failure on patient outcomes at a university hospital caring for high-risk patients.

Methods: We reviewed data collected for TJC in patients admitted with heart failure at a university hospital serving an indigent population in Louisiana.

Health literacy and emergency department outcomes: a systematic review.

Study Objective: We assess emergency department (ED) patients' health literacy, the readability of ED patient materials, and the relationship between health literacy and ED outcomes through a systematic literature review.

Methods: PubMed, PsychInfo, CINAHL, Web of Knowledge, and ERIC were searched for studies published January 1, 1980, to July 15, 2010, conducted in the United States, reporting original data, and measuring ED patients' health literacy, the readability of ED materials, or the association between health literacy and ED-related outcomes. Two reviewers evaluated each study and abstracted information from included studies into evidence tables.

The number and nature of emergency department encounters in patients with deep brain stimulators.

Unlabelled: Deep brain stimulation (DBS) has become an increasingly common modality for control of several neurological disorders such as Parkinson's disease, dystonia, essential tremor (ET), and others. Our experience has demonstrated the need for emergency physicians to familiarize themselves with the potential complications of the DBS device as well as the device itself. Therefore, our aim in this paper was to elucidate the number and nature of DBS and non-DBS presentations to the emergency department (ED) and to educate and familiarize ED physicians about DBS devices and their potential complications.

Non-high-density lipoprotein cholesterol in patients with metabolic syndrome.

Background: Metabolic syndrome (MS) represents a cluster of cardiovascular risk factors that includes hypertriglyceridemia. Although low-density lipoprotein (LDL) cholesterol is the critical therapeutic target in patients with coronary artery disease, LDL cannot be calculated in those with excessive hypertriglyceridemia. Non-high-density lipoprotein (HDL) does not require LDL for calculation and may be an alternative therapeutic target in MS.

Outcomes of patients not transported after calling 911.

To compare the outcomes of patients who were denied transport by emergency medical services (EMS) with those who refused to be transported, all EMS non-transports were reviewed to determine who refused the transport and adherence to mandatory transport guidelines. Patients were contacted for telephone survey. Of 906 non-transported patients, 310 consented to the survey.

Protective effects of low respiratory frequency in experimental ventilator-associated lung injury.

Objective: To determine whether ventilator-associated lung hyperinflation injury can be attenuated by a reduction in respiratory frequency.

Design: Prospective comparative laboratory investigation.

Setting: University medical center research laboratory.

Tipping the scales: the effect of literacy on obese patients' knowledge and readiness to lose weight.

Objectives: The purpose of this study was to determine the association between the literacy level of overweight/obese patients and their weight-loss knowledge, attitudes, and readiness.

Methods: Structured patient interviews and a literacy screening instrument were administered in two primary care clinics at a university-based public hospital.

Results: A convenience sample of 210 overweight or obese adult outpatients (body mass index > or =25 kg/m2 or > or =30 kg/m2, respectively) were enrolled.

Near-infrared spectroscopy: a tool to monitor cerebral hemodynamic and metabolic changes after cardiac arrest in rats.

Introduction: Cardiac arrest (CA) is associated with poor neurological outcome and is associated with a poor understanding of the cerebral hemodynamic and metabolic changes. The objective of this study was to determine the applicability of near-infrared spectroscopy (NIRS), to observe the changes in cerebral total hemoglobin (T-Hb) reflecting cerebral blood volume, oxygenation state of Hb, oxidized cytochrome oxidase (Cyto-C), and brain water content following CA.

Methods: Fourteen rats were subjected to normothermic (37.

Cerebral cortical aquaporin-4 expression in brain edema following cardiac arrest in rats.

Objectives: Brain edema occurs following clinical as well as experimental cardiac arrest (CA) and predicts a poor neurologic outcome. The objective of this study was to determine the expression of cerebral cortex aquaporin (AQP)-4, a member of a family of membrane water-channel proteins, in brain edema formation following normothermic or hypothermic CA.

Methods: Twenty-four rats were subjected to time-matched normothermic (N-Sham, 37.