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Acute Care Health Services Research Unit by Mahshid Abir

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Presentation delivered at William G. Barsan Emergency Medicine Research Forum, Ann Arbor, April 27, 2016

Published in: Health & Medicine
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Acute Care Health Services Research Unit by Mahshid Abir

  1. 1. Acute Care Health Services Research Unit Mahshid Abir, MD, MSc
  2. 2. • Virtual research unit under IHPI conducting multi- disciplinary, policy-relevant research around ACUTE care: • Access • Cost • Utilization • Transitions • Efficiency •Prioritize areas of inquiry pertinent to UMHS EMS TC
  3. 3. Unit Core Team & Members Unit Lead: Mahshid Abir, MD, MSc Statistician: Jason Goldstick, PhD Research Associate: Rekar Taymour, MS Members: Expressed interest from a few dozen faculty from across campus
  4. 4. Ongoing Unit Projects • Evaluating the Impact of High Occupancy Hospitalizations on Outcomes for Elderly Medicare Patients—NIH/NIA • Evaluating Patient-Centered Interventions to Reduce Pediatric Asthma-related Emergency Department Visits and Hospitalizations —EMF •A Mixed Methods Study to Evaluate Performance Measures for Medical Control Authority for the state of Michigan—MDHHS
  5. 5. Key Unit Activities • Quarterly member meetings to promote collaboration, present key policy issues and research priorities, discuss member ideas for proposals and ongoing projects. • Identify intra- and extramural funding opportunities pertinent to research foci of interest and identify teams of IHPI researchers who can competitively pursue such opportunities. • Quarterly student/trainee conferences with med/grad students and residents/fellows to promote interest in acute care research and related policy issues.
  6. 6. Evaluating Ambulatory-Care Sensitive Emergency Department Visits and Hospitalizations at the University of Michigan Health System Mahshid Abir, MD, MSc Jason Goldstick, PhD Tim Peterson, MD, MBA
  7. 7. Ambulatory Care Sensitive Conditions • Ambulatory care sensitive conditions (ACSC) comprise conditions that if treated appropriately in the ambulatory care setting should not result in a hospitalization; including cardiac, pulmonary, GU, infectious, nutritional, and dental conditions. • Improving management of ACSCs in the ambulatory care setting has been recognized as one strategy to reduce potentially avoidable ED visits and hospitalizations • In the state of Michigan, between 2008 and 2012, rates of hospitalizations per 10,000 population for ACSC for all ages was approximately 268 (265,627 average annual hospitalizations)
  8. 8. Methods • Retrospective, observational study using ambulatory care, ED, and inpatient data from electronic health records at UMHS from over a 20-month period between 2012-2014 • In patients 18 years and older, using ICD-9 codes for ACSCs, evaluated: • % of ED visits that are billed for ACSCs and proportion of those visits that are preceded by an ambulatory care visit in the prior 2 weeks • % of hospitalizations that are billed for ACSCs and proportion of those visits that are preceded by an ambulatory care visit in the prior 2 weeks
  9. 9. Results: UMHS ACSC ED Visits • 88,365 ED visits met our inclusion criteria • Approximately,19% had an ACSC-related ED visit • Among patients who had such visits: • 20% were seen in the ambulatory setting for any condition in the 2 weeks prior to their visit • 12% were seen in the ambulatory setting for an ACSC in the 2 weeks prior to their visit
  10. 10. Results: UMHS ACSC Hospitalizations • 391,657 hospitalizations met our inclusion criteria • Approximately, 25% had an ACSC-related hospitalization • Among patients who had such hospitalizations: • 36% were seen in the ambulatory setting for any condition in the 2 weeks prior to their hospitalization • 30% were seen in the ambulatory setting for an ACSC in the 2 weeks prior to their hospitalization
  11. 11. Next steps • Further characterize ACSC ED visits and hospitalizations • Evaluate barriers to improved management of ACSC in the ambulatory setting and potential related strategies

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