The Effects of Global Budgeting on Emergency Department Admission Rates in Maryland.

Study Objective: In 2014, Maryland launched a population-based payment model that replaced fee-for-service payments with global budgets for all hospital-based services. This global budget revenue program gives hospitals strong incentives to tightly control patient volume and meet budget targets. We examine the effects of the global budget revenue model on rates of admission to the hospital from emergency departments (EDs).

The Impact of Maryland's Global Budget Payment Reform on Emergency Department Admission Rates in a Single Health System.

Background: In 2014, the state of Maryland (MD) moved away from fee-for-service payments and into a global budget revenue (GBR) structure where hospitals have a fixed revenue target, independent of patient volume or services provided. We assess the effects of GBR adoption on emergency department (ED) admission decisions among adult encounters.

Methods: We used hospital medical record and billing data from adult ED encounters from January 1, 2011, through December 31, 2015, with four MD hospitals and two District of Columbia (DC) hospitals within the same health system.

The 2013 Dip: Factors Influencing Falling Emergency Department Visits and Inpatient Admissions in District of Columbia and Maryland.

Background: Earlier reports have documented growth of United States emergency department (ED) visits since the early 1990s.

Objective: In this report, we describe recent trends in ED utilization and inpatient admissions in Maryland and District of Columbia hospitals from 2011 to 2013.

Methods: We analyzed monthly ED visit and inpatient admission volumes from 53 acute care hospitals in Maryland and the District of Columbia from 2011 to 2013.

Use of emergency medical services expedites in-hospital care processes in patients presenting with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.

To determine whether door-to-balloon (DTB) times of patients presenting with ST-elevation myocardial infarction (STEMI) were reduced in patients transported by emergency medical services (EMS) compared to those who were self-transported. DTB time is an important measure of hospital care processes in STEMI. Use of EMS may expedite in-hospital processing and reduce DTB times.

Emergency department variation in utilization and diagnostic yield of advanced radiography in diagnosis of pulmonary embolus.

Background: There is growing pressure to measure and reduce unnecessary imaging in the emergency department.

Objective: We study provider and hospital variation in utilization and diagnostic yield for advanced radiography in diagnosis of pulmonary embolism (PE) and to assess patient- and provider-level factors associated with diagnostic yield.

Methods: Retrospective chart review of all adult patients presenting to four hospitals from January 2006 through December 2009 who had a computed tomography or ventilation/perfusion scan to evaluate for PE.

Emergency department physician-level and hospital-level variation in admission rates.

Study Objective: We explore the variation in physician- and hospital-level admission rates in a group of emergency physicians in a single health system.

Methods: This was a cross-sectional study that used retrospective data during various periods (2005 to 2010) to determine the variation in admission rates among emergency physicians from 3 emergency departments (EDs) within the same health system. Patients who left without being seen or left against medical advice, patients treated in fast-track departments, patients with primary psychiatric complaints, and those younger than 18 years were excluded, as were physicians with fewer than 500 ED encounters during the study period.

The prevalence of quality issues and adverse outcomes among 72-hour return admissions in the emergency department.

Background: Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues.

Objectives: We explored 72-h return admissions and determined the prevalence and predictors for substandard management on the initial visit or any adverse outcome.

Methods: Retrospective review of quality assurance data from 72-h return admissions in three hospitals from 2006-2010 was performed.

Emergency department focused bedside echocardiography in massive pulmonary embolism.

Background: Massive pulmonary embolism (PE) is a common consideration in unstable patients presenting to the emergency department (ED) with chest pain, dyspnea, or cardiac arrest. It is a potentially lethal condition necessitating prompt recognition and aggressive management. Conventional diagnostic modalities in the ED, including chest computed tomography angiography and ventilation-perfusion scanning, require the unstable patient to leave the department, and raise concerns over renal injury.