A5041273039- Emergency and Acute Care Studies
- Traumatic Brain Injury and Neurovascular Disturbances
- Venous Thromboembolism Diagnosis and Management
- Trauma and Emergency Care Studies
- Atrial Fibrillation Management and Outcomes
- Electronic Health Records Systems
- Acute Myocardial Infarction Research
- Ultrasound in Clinical Applications
- Healthcare Systems and Technology
- Sepsis Diagnosis and Treatment
- Cardiac Arrest and Resuscitation
- Appendicitis Diagnosis and Management
- Radiation Dose and Imaging
- Healthcare Policy and Management
- Cardiac Imaging and Diagnostics
- Central Venous Catheters and Hemodialysis
- Clinical practice guidelines implementation
- COVID-19 and healthcare impacts
- Acute Ischemic Stroke Management
- Neurosurgical Procedures and Complications
- Pediatric Urology and Nephrology Studies
- Clinical Reasoning and Diagnostic Skills
- Patient Satisfaction in Healthcare
- Cardiovascular Syncope and Autonomic Disorders
- Health Systems, Economic Evaluations, Quality of Life
Kaiser Permanente San Rafael Medical Center
2016-2025
Kaiser Permanente
2015-2024
Colorado Permanente Medical Group
2013-2024
University of California, Davis
2006-2024
Seattle University
2021
University of Washington
2021
Marin Health and Human Services
2015-2021
University of Southern California
2021
Eduardo Mondlane University
2021
Kaiser Permanente Oakland Medical Center
2018-2021
Importance Accurate emergency department (ED) triage is essential to prioritize the most critically ill patients and distribute resources appropriately. The used system in US Emergency Severity Index (ESI). Objectives To derive validate an algorithm assess rate of mistriage identify characteristics associated with mistriage. Design, Setting, Participants This retrospective cohort study created operational definitions for each ESI level that use ED visit electronic health record data classify...
Background: Differentiating between appropriate and inappropriate resource use represents a critical challenge in health services research. The New York University Emergency Department (NYU ED) visit severity algorithm attempts to classify visits the ED based on diagnosis, but it has not been formally validated. Objective: To assess validity of NYU algorithm. Research Design: A longitudinal study single integrated delivery system from January 1999 December 2001. Subjects: total 2,257,445...
Background: Many low-risk patients with acute pulmonary embolism (PE) in the emergency department (ED) are eligible for outpatient care but hospitalized nonetheless. One impediment to home discharge is difficulty of identifying which can safely forgo hospitalization. Objective: To evaluate effect an integrated electronic clinical decision support system (CDSS) facilitate risk stratification and making at site PE. Design: Controlled pragmatic trial. (ClinicalTrials.gov: NCT03601676) Setting:...
OBJECTIVES: We sought to develop and validate a clinical calculator that can be used quantify risk for appendicitis on continuous scale patients with acute abdominal pain. METHODS: The pediatric (pARC) was developed validated through secondary analyses of 3 distinct cohorts. derivation sample included visits 9 emergency departments between March 2009 April 2010. validation single department from 2003 2004 2013 2015. Variables evaluated were as follows: age, sex, temperature, nausea and/or...
The US federal government is spending billions of dollars in physician incentives to encourage the meaningful use electronic health records (EHRs).Although EHRs has potential improve patient outcomes, existing evidence been limited and inconsistent.OBJECTIVE To examine association between implementing a commercially available outpatient EHR emergency department (ED) visits, hospitalizations, office visits for patients with diabetes mellitus.DESIGN, SETTING, AND POPULATION Staggered...
OBJECTIVES: We determined whether implementing the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prediction rules and providing risks of clinically important TBIs (ciTBIs) with computerized clinical decision support (CDS) reduces computed tomography (CT) use for children minor head trauma. METHODS: Nonrandomized trial concurrent controls at 5 pediatric emergency departments (PEDs) 8 general EDs (GEDs) between November 2011 June 2014. Patients were...
Background For patients with diabetes, many multiple complex chronic conditions, using a patient portal can support self-management and coordination of health care services, may impact the frequency in-person visits. Objective To examine access on number outpatient visits, emergency preventable hospitalizations. Design Observational study comparing patients' visit rates without access, marginal structural modeling inverse probability weighting estimates to account for potential bias due...
ABSTRACT Aim The study aim was to develop an age‐appropriate definition of sport and exercise in children adolescents for use concussion research management. Methods A modified Delphi methodology, with three rounds consensus defined a priori as ≥ 80% agreement. Results Thirty‐one participants (13 male, 18 female) from 13 countries, including clinical psychologists, epidemiologists, implementation scientists, neurologists, neuropsychologists, neurosurgeons, paediatric emergency physicians,...
Abstract Objectives Appropriate use of cranial computed tomography (CT) scanning in patients with mild blunt head trauma and preinjury anticoagulant or antiplatelet is unknown. The objectives this study were: 1) to identify risk factors for immediate traumatic intracranial hemorrhage ( tICH ) warfarin clopidogrel 2) derive a clinical prediction rule at low . Methods This was prospective, observational two centers four community hospitals that enrolled adult emergency department (ED) (initial...
Field triage guidelines recommend transport of head-injured patients on anticoagulants or antiplatelets to a higher-level trauma center based studies suggesting high incidence traumatic intracranial hemorrhage (tICH). We compared the tICH in older adults transported by emergency medical services (EMS) with and without anticoagulation antiplatelet use evaluated accuracies different sets field criteria identify tICH. This was prospective, observational study at five EMS agencies 11 hospitals....
PC. Furthermore, only 3.8% of residents had an MDSdocumented prognosis less than 6 months' survival, unlikely scenario considering the health status these residents.Only 1.3% (2 157) were enrolled in hospice, even though a 6-month should trigger hospice referral.This finding suggests that accurate assessment is likely not occurring; as result, opportunity for enhanced discussion goals care missed.Increasing access to PC NH critical given mounting evidence confirming setting associated with...
Abstract Objectives The objective was to investigate clinician knowledge of and attitudes toward clinical decision support ( CDS ) its incorporation into the electronic health record EHR ). Methods This an survey emergency physicians EP s) within integrated care delivery system that uses a complete . Randomly assigned respondents completed one two questionnaires, both including hypothetical vignette self‐reported about One version included , other did not NCDS described scenario in which...
Introduction: We evaluated emergency physicians' (EP) current perceptions, practice, and attitudes towards evaluating stroke as a cause of dizziness among department patients.Methods: administered survey to all EPs in large integrated healthcare delivery system. The included clinical vignettes, perceived utility historical exam elements, about the value requisite post-test probability prediction rule for dizziness. calculated descriptive statistics probabilities such rule.Results: response...
Abstract Objective Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for exist, they do not address all considerations related triage, imaging, observation versus admission, transfer, discharge and follow‐up of mild moderate relevant the Australian New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out develop an evidence‐based, locally applicable,...
Physicians commonly hospitalize patients presenting to the emergency department (ED) with acute pulmonary embolism (PE), despite eligibility for safe outpatient management. Risk stratification using electronic health record-embedded clinical decision support systems can aid physician site-of-care decision-making and increase The long-term sustainability of early improvements after cessation trial-based, champion-led promotion is uncertain.To evaluate recommended 4 years initial interventions...