An Explanatory Mixed-methods Study of "ICU net benefit": Triage and Trajectory for Sepsis and Acute Respiratory Failure.

Rationale: Patients with sepsis and/or acute respiratory failure are at high risk for death or long hospital stays, yet limited evidence exists to guide triage to intensive care units (ICUs) or general medical wards for the majority of these patients who do not initially require life support.

Objectives: To identify factors that influence how hospitals triage patients with capacity-sensitive conditions and those factors that may account for observed ICU relative to ward, or ward relative to ICU, benefits for such patients.

Methods: We conducted an explanatory sequential mixed-methods study.

Effect of providing at-home opioid disposal kits at discharge after an orthopaedic surgery.

Prescription opioids after surgery may pose a risk if left unused. However, prescribers rely on their best judgement in determining how much their patients need, often resulting in over-prescription of these medications. Opioid disposal is a strategy to reduce the risk of persistent use or misuse of opioids.

Opioid prescribing guidelines for spine surgery patients: a multisite analysis of guideline implementation and monitoring with an automated text messaging platform.

Objective: The aim of this study was to describe the effect of opioid prescribing guideline implementation for elective spine surgery cases on prescribing and consumption behaviors in a multisite academic hospital system. The effectiveness of an automated text messaging system as a tool to monitor postoperative opioid use and pain outcomes and inform guideline development and deployment is also evaluated.

Methods: The authors conducted a prospective study of postoperative opioid use behaviors and patient-reported outcomes for 2101 elective spine surgery cases between December 2018 and March 2022, prior to and following the implementation of opioid-prescribing guidelines in February 2021 at three urban hospital sites within a large academic health system.

Active Choice Nudge to Increase Screening for Primary Aldosteronism in At-Risk Patients.

Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension, yet screening remains startlingly infrequent. We describe (1) PA screening practices in a large, diverse health system, (2) the development of a computable phenotype for PA screening, and (3) the design and pilot deployment of an electronic health record (EHR)-based active choice nudge to recommend PA screening.

Study Design: A multidisciplinary team developed a multipronged intervention to improve PA screening informed by guidelines, expertise, and multivariable analyses of factors associated with screening.

Handheld Cellphone Use and Risky Driving in Adolescents.

Importance: Handheld cellphone use while driving is associated with increased motor vehicle crash risk among adolescents.

Objective: To examine the association of handheld cellphone use while driving with kinematic risky driving (KRD) events-hard braking and rapid acceleration-in adolescent drivers.

Design, Setting, Participants: Adolescents aged 16.

Preventive Health Services Offered in a Sampling of US Emergency Departments, 2022-2023.

Introduction: In the United States, more chronic and preventive healthcare is being delivered in the emergency department (ED) setting. Understanding the availability of preventive health services in the ED setting is crucial. Our goal was to understand the availability of a subset of preventive health services in US EDs and explore how that has changed over time.

Firearm violence and associated factors among young adults presenting to emergency departments in three cities: Baseline results from Project SPARK.

Objective: Recent shifts in U.S. violence dynamics call for updated violence epidemiology among general emergency department (ED) samples of young adults.

Emergency Medicaid enrollment after traumatic injury predicts long-term health care utilization.

Background: Injured patients have high rates of uninsurance, which is associated with worse outcomes. Insurance linkage programs that connect patients to Medicaid coverage can prevent catastrophic costs for patients. Less is known about the long-term impact of insurance enrollment.

Fatal and Nonfatal Firearm Injury Rates by Race and Ethnicity in the United States, 2019 to 2020.

Background: Racial disparities in firearm injury death in the United States are well established. Less is known about the magnitude of nonfatal and total firearm injury.

Objective: To combine health care data with death certificate data to estimate total firearm injuries in various racial and ethnic groups.

Feedback and Financial Incentives for Reducing Cell Phone Use While Driving: A Randomized Clinical Trial.

Importance: Handheld phone use while driving is a major factor in vehicle crashes. Scalable interventions are needed to encourage drivers not to use their phones.

Objective: To test whether interventions involving social comparison feedback and/or financial incentives can reduce drivers' handheld phone use.

Health Care Use Among Patients Retroactively Insured via a Hospital-Based Insurance Linkage Program.

Objective: Over 25% of the 27 million uninsured individuals in the United States are eligible for Medicaid. Many hospitals have insurance linkage programs that assist eligible patients with enrollment, but little is known about the impact of these programs on care utilization. This research assessed health care utilization and health outcomes among patients enrolled in Medicaid via a hospital-based insurance linkage program.

Association between patient-reported onset-to-door time and mortality in patients hospitalized with COVID-19 disease.

Introduction: Timely hospital presentation and treatment are critical for recovery from coronavirus disease (COVID-19). However, the relationship between symptom onset-to-door time and key clinical outcomes, such as inpatient mortality, has been poorly understood due to the difficulty of retrospectively measuring symptom onset in observational data. This study examines the association between patient-reported symptom onset-to-door time (ODT) and mortality among patients hospitalized and treated for COVID-19 disease.

Identifying Patient Characteristics Associated With Opioid Use to Inform Surgical Pain Management.

Objective: Balancing surgical pain management and opioid stewardship is complex. Identifying patient-level variables associated with low or no use can inform tailored prescribing.

Methods: A prospective, observational study investigating surgical procedures, prescription data, and patient-reported outcomes at an academic health system in Pennsylvania.

Frequency and Trends of Pre-Pandemic Surge Periods in U.S. Emergency Departments, 2006-2019.

Objectives: To quantify the frequency, outside of the pandemic setting, with which individual healthcare facilities faced surge periods due to severe increases in demand for emergency department (ED) care.

Design: Retrospective cohort study.

Setting: U.

Association of Urine Fentanyl Concentration With Severity of Opioid Withdrawal Among Patients Presenting to the Emergency Department.

Background And Aims: Fentanyl is involved in most US drug overdose deaths and its use can complicate opioid withdrawal management. Clinical applications of quantitative urine fentanyl testing have not been demonstrated previously. The aim of this study was to determine whether urine fentanyl concentration is associated with severity of opioid withdrawal.

How Physician Self-Perceptions Affect the Impact of Peer Comparison Feedback on Opioid Prescribing.

Peer comparison feedback is a promising strategy for reducing opioid prescribing and opioid-related harms. Such comparisons may be particularly impactful among underestimating clinicians who do not perceive themselves as high prescribers relative to their peers. But peer comparisons could also unintentionally increase prescribing among overestimating clinicians who do not perceive themselves as lower prescribers than peers.

How have firearm laws changed in states with unexpected decreases or increases in firearm homicide, 1990-2019?

Background: Firearm violence is one of the leading preventable causes of death and injury in the United States and is on the rise. While policies regulating access to firearms offer opportunities to prevent firearm-related deaths, an understanding of the holistic impact of changing state firearm policies on firearm homicide rates over the last 30 years is limited.

Objectives: To identify US states that showed unexpected decreases and increases in firearm homicide rates and summarise their firearm policy changes in the last three decades.