Edward Norton

Understanding the Causes and Consequences of Variation in Emergency Department Hospitalization Practices Across the United States

Research Project Description
Keith E. Kocher, Brahmajee K. Nallamothu, Kenneth M. Langa, Laurence F. McMahon Jr, Edward Norton, Justin B. Dimick

Hospitalizations are common and costly, representing over 30% of national health expenditures, the largest share of health care spending. Understanding the emergency department?s (ED) role in contributing to hospitalizations would substantially improve the health and quality of care for patients requiring emergency services. The ED is now the chief source of hospitalizations, responsible for more than half of total admissions in the US and far surpassing the ambulatory setting in this regard, yet generally has been overlooked as the critical juncture in the admission decision. Our work to date demonstrates up to 6-fold variation in how hospitalizations from the ED are used for some conditions, suggesting that these decisions may in part be discretionary and potentially influenced by non-clinical factors. Confirmation of these preliminary findings would have enormous implications for the quality and cost of care given that the downstream effects of hospitalization are considerable, including exposure to a sometimes adverse inpatient environment. Alternatively, inappropriately discharging patients who would benefit from hospitalization may also imperil patient welfare. The research proposed in this application is designed to advance the science in understanding the costs and consequences of variation in ED hospitalization practices for the US public.

With the help and guidance of his mentorship team, this proposal is also intended to support the continued career development of Dr. Keith Kocher, an extremely promising emergency physician and clinician-investigator, within the field of emergency care health services research. During the period of support, he will pursue didactic instruction in several disciplines, including doctoral-level courses in advanced statistical and econometric methods, health care organization, and health policy. He will also pursue a health policy fellowship designed for health services researchers to explore and strengthen the connections between public policy and their research as well as develop critical leadership and advocacy skills.

The research plan has three related specific aims. Aim 1 will determine the hospital and system factors associated with variability in ED hospitalizations. Aim 2 will determine whether patient non-clinical factors predict variability in ED hospitalizations. Aim 3 will evaluate the effect of ED hospitalization patterns on outcomes and costs. Understanding the sources of ED hospitalization practice variation and its implication for patient outcomes and cost will inform the design of future interventions to improve emergency care delivery for all Americans. This will be the subject of a future R01 by the applicant.

Agency for Health Care Research and Quality, HHS
(1 K08 HS 024160 01)

Funding Period: 8/1/2015 to 7/31/2020

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