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

1. Acute Care Health
Services Research Unit
Mahshid Abir, MD, MSc

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. 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. 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. 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. 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. 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. 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. 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. 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. Next steps
• Further characterize ACSC ED visits and hospitalizations
• Evaluate barriers to improved management of ACSC in the
ambulatory setting and potential related strategies