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152. Funding Research in Emergency Department Shared Decision Making: A Summary of the 2016Academic Emergency MedicineConsensus Conference Panel Discussion

Author

Dodd, Kenneth W., primary, Berman, Amy, additional, Brown, Jeremy, additional, Carr, Brendan G., additional, Dunn, Patrick, additional, Escobedo, Marcus, additional, Gayer, Christopher, additional, Grieser, Mira, additional, Carpenter, Christopher R., additional, Hess, Erik P., additional, and Grudzen, Corita R., additional

Published
2016
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154. Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.

Author

Lee, David C., Gupta, Vibha K., Carr, Brendan G., Malik, Sidrah, Ferguson, Brandy, Wall, Stephen P., Smith, Silas W., Goldfrank, Lewis R., Lee, David C., Gupta, Vibha K., Carr, Brendan G., Malik, Sidrah, Ferguson, Brandy, Wall, Stephen P., Smith, Silas W., and Goldfrank, Lewis R.

Abstract

OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy's landfall to utilization before the disaster in 2012. RESULTS: In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS: We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks.

Published
2016

167. Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers.

Author

Aparicio, Hugo J., Carr, Brendan G., Kasner, Scott E., Kallan, Michael J., Albright, Karen C., Kleindorfer, Dawn O., Mullen, Michael T., Aparicio, Hugo J., Carr, Brendan G., Kasner, Scott E., Kallan, Michael J., Albright, Karen C., Kleindorfer, Dawn O., and Mullen, Michael T.

Abstract

BACKGROUND: Primary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt-PA) than non-PSCs. The impact of PSCs on racial disparities in rt-PA use is unknown. METHODS AND RESULTS: We used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt-PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt-PA at PSCs than non-PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P CONCLUSIONS: Racial disparities in intravenous rt-PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.

Published
2015

185. Funding Research in Emergency Department Shared Decision Making: A Summary of the 2016 Academic Emergency Medicine Consensus Conference Panel Discussion.

Author

Dodd, Kenneth W., Berman, Amy, Brown, Jeremy, Carr, Brendan G., Dunn, Patrick, Escobedo, Marcus, Gayer, Christopher, Grieser, Mira, Carpenter, Christopher R., Hess, Erik P., Grudzen, Corita R., and Jang, Timothy B.

Subjects
CONFERENCES & conventions, HOSPITAL emergency services, POLICY sciences, DECISION making in clinical medicine
Abstract

As part of the 2016 Academic Emergency Medicine Consensus Conference, 'Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda,' a panel of representatives from the Office of Emergency Care Research, the Patient-Centered Outcomes Research Institute, the American Heart Association, the John A. Hartford Foundation, and the Emergency Care Coordination Center were assembled to discuss funding opportunities for future research in this field. This article summarizes their discussion of funding priorities and examples of successfully funded projects related to shared decision making in emergency medicine. [ABSTRACT FROM AUTHOR]

Published
2016
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