2023
Race and Ethnicity and Emergency Department Discharge Against Medical Advice
Tsai J, Janke A, Krumholz H, Khidir H, Venkatesh A. Race and Ethnicity and Emergency Department Discharge Against Medical Advice. JAMA Network Open 2023, 6: e2345437. PMID: 38015503, PMCID: PMC10685883, DOI: 10.1001/jamanetworkopen.2023.45437.Peer-Reviewed Original ResearchConceptsWhite patientsHispanic patientsEmergency departmentCross-sectional studyED visitsBlack patientsDAMA rateMedical adviceMAIN OUTCOMEEthnic disparitiesNationwide Emergency Department SampleNational cross-sectional studyHospital ED visitsEmergency department dischargeHospital-level variationEmergency Department SampleMetropolitan teaching hospitalHealth care resourcesMedian ageGreater morbidityHospital variationUnadjusted analysesTeaching hospitalAdditional adjustmentLower odds
2021
Impact of ST‐Segment–Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non–ST‐Segment–Elevation Myocardial Infarction
Montoy JCC, Shen Y, Brindis RG, Krumholz HM, Hsia RY. Impact of ST‐Segment–Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non–ST‐Segment–Elevation Myocardial Infarction. Journal Of The American Heart Association 2021, 10: e016932. PMID: 33470136, PMCID: PMC7955417, DOI: 10.1161/jaha.120.016932.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overCaliforniaCoronary AngiographyEarly DiagnosisElectrocardiographyFemaleFollow-Up StudiesHospitalizationHumansMaleMiddle AgedNon-ST Elevated Myocardial InfarctionPercutaneous Coronary InterventionPrognosisProgram EvaluationRegistriesRetrospective StudiesRisk FactorsST Elevation Myocardial InfarctionSurvival RateTreatment OutcomeConceptsOutcomes of patientsEarly angiographyMyocardial infarctionST segmentST-segment elevation myocardial infarctionSegment elevation myocardial infarctionProportion of patientsElevation myocardial infarctionRisk of deathRisk of mortalityRegionalization programIndex admissionEmergency departmentRegionalized careNonfederal hospitalsMAIN OUTCOMETimely carePatientsAngiographyOverall populationNSTEMIInfarctionStudy periodMortalityCare
2020
Unscheduled Care Access in the United States-A Tale of Two Emergency Departments
Venkatesh AK, Greenwood-Ericksen MB, Mei H, Rothenberg C, Lin Z, Krumholz HM. Unscheduled Care Access in the United States-A Tale of Two Emergency Departments. The American Journal Of Emergency Medicine 2020, 45: 374-377. PMID: 33143957, PMCID: PMC8076339, DOI: 10.1016/j.ajem.2020.08.095.Peer-Reviewed Original ResearchConceptsHospital referral regionsED visit ratesEmergency departmentCare ratesVisit ratesMedicare Chronic Conditions WarehouseHospital-based emergency departmentsRole of EDsChronic Conditions WarehouseProportion of beneficiariesDartmouth Atlas hospital referral regionHealthcare delivery systemED utilizationED visitsED useUnscheduled careReferral regionsUrban zip codesCare accessMedicare beneficiariesCare needsCare deliveryOffice settingCare capabilitiesDisproportionate barriersNational Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015
Pendyal A, Rothenberg C, Scofi JE, Krumholz HM, Safdar B, Dreyer RP, Venkatesh AK. National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015. Journal Of The American Heart Association 2020, 9: e017208. PMID: 33047624, PMCID: PMC7763391, DOI: 10.1161/jaha.120.017208.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionAcute myocardial infarctionMedian ED lengthUS emergency departmentsEmergency departmentED visitsMyocardial infarctionED administrationED lengthAMI careNational Hospital Ambulatory Medical Care SurveyCare processesAmbulatory Medical Care SurveyEvidence-based medicationsNonaspirin antiplatelet agentsEarly invasive strategyAnnual ED visitsRegionalization of careED care processesReal-world trendsAntiplatelet therapyAnnual incidenceAntiplatelet agentsYearly incidenceCare SurveyWhere Skilled Nursing Facility Residents Get Acute Care: Is the Emergency Department the Medical Home?
Venkatesh AK, Gettel CJ, Mei H, Chou SC, Rothenberg C, Liu SL, D’Onofrio G, Lin Z, Krumholz HM. Where Skilled Nursing Facility Residents Get Acute Care: Is the Emergency Department the Medical Home? Journal Of Applied Gerontology 2020, 40: 828-836. PMID: 32842827, PMCID: PMC7904961, DOI: 10.1177/0733464820950125.Peer-Reviewed Original ResearchConceptsAcute care visitsCare visitsEmergency departmentMedicare beneficiariesSNF staySNF servicesSkilled nursing facility residentsNursing facility residentsSkilled nursing facility servicesAcute care capabilitiesCross-sectional analysisNursing facility servicesHigher proportionAcute careMedical homeFacility residentsCare capabilitiesVisitsNumber of daysStayCareDepartmentFacility servicesBeneficiariesProportionCross‐sectional Analysis of Emergency Department and Acute Care Utilization Among Medicare Beneficiaries
Venkatesh AK, Mei H, Shuling L, D’Onofrio G, Rothenberg C, Lin Z, Krumholz HM. Cross‐sectional Analysis of Emergency Department and Acute Care Utilization Among Medicare Beneficiaries. Academic Emergency Medicine 2020, 27: 570-579. PMID: 32302034, DOI: 10.1111/acem.13971.Peer-Reviewed Original ResearchConceptsMultiple chronic conditionsEmergency departmentUnscheduled careMedicare beneficiariesCross-sectional analysisVisit ratesCare servicesHighest ED visit ratesNumber of EDVulnerable subpopulationsSkilled nursing facility useAmbulatory office settingNon-ED settingsUnscheduled care servicesAcute care utilizationED visit ratesOffice-based visitsAcute care servicesClaims-based definitionNursing facility useMedicare beneficiaries age 65Dual-eligible beneficiariesOlder adult populationBeneficiaries age 65Care visitsPost-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States
Khera R, Wang Y, Bernheim SM, Lin Z, Krumholz HM. Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States. The BMJ 2020, 368: l6831. PMID: 31941686, PMCID: PMC7190056, DOI: 10.1136/bmj.l6831.Peer-Reviewed Original ResearchConceptsAcute care utilizationAcute myocardial infarctionRetrospective cohort studyHeart failureCare utilizationPost-discharge periodEmergency departmentMyocardial infarctionDay mortalityCohort studyHospital admissionObservation unitAcute careNational retrospective cohort studyPost-acute care utilizationHospital Readmissions Reduction ProgramObservation unit carePost-discharge mortalityDay readmission rateRisk of deathReadmissions Reduction ProgramReadmission reduction initiativesReadmission ratesUnit careInpatient unit
2016
2EMF Use of the Emergency Department for Acute, Unscheduled Care by Vulnerable Medicare Beneficiaries
Venkatesh A, Mei H, Spatz E, Eichenfeld J, Krumholz H, Lin Z. 2EMF Use of the Emergency Department for Acute, Unscheduled Care by Vulnerable Medicare Beneficiaries. Annals Of Emergency Medicine 2016, 68: s149-s150. DOI: 10.1016/j.annemergmed.2016.08.408.Peer-Reviewed Original ResearchDespite Federal Legislation, Shortages Of Drugs Used In Acute Care Settings Remain Persistent And Prolonged
Chen SI, Fox ER, Hall MK, Ross JS, Bucholz EM, Krumholz HM, Venkatesh AK. Despite Federal Legislation, Shortages Of Drugs Used In Acute Care Settings Remain Persistent And Prolonged. Health Affairs 2016, 35: 798-804. PMID: 27140985, PMCID: PMC6712565, DOI: 10.1377/hlthaff.2015.1157.Peer-Reviewed Original ResearchConceptsCare drugsNational drug shortageDrug information servicesDrug shortagesAcute unscheduled careAcute care settingShortage of drugsUtah Drug Information ServiceIll patientsEmergency departmentUnscheduled careDrug Administration SafetyCare settingsAdministration safetyStudy periodDrugsDrug supplyCareEarly evidenceTotal numberPatientsFibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study
Li J, Li X, Ross JS, Wang Q, Wang Y, Desai NR, Xu X, Nuti SV, Masoudi FA, Spertus JA, Krumholz HM, Jiang L, Group F. Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study. European Heart Journal Acute Cardiovascular Care 2016, 6: 232-243. PMID: 26787648, DOI: 10.1177/2048872615626656.Peer-Reviewed Original ResearchConceptsST-segment elevation myocardial infarctionElevation myocardial infarctionFibrinolytic therapyMyocardial infarctionPercutaneous coronary intervention capabilitySequential cross-sectional studiesChina PEACE-Retrospective AMI StudyPrimary reperfusion strategyPercutaneous coronary interventionLittle clinical evidenceCross-sectional studyQuality of careTwo-stage random samplingCoronary interventionHospital delayNeedle timeReperfusion strategySymptom onsetTherapy useClinical evidenceEmergency departmentMedian admissionIdeal patientPatientsWeighted proportion
2014
Hospital Variation in the Use of Noninvasive Cardiac Imaging and Its Association With Downstream Testing, Interventions, and Outcomes
Safavi KC, Li SX, Dharmarajan K, Venkatesh AK, Strait KM, Lin H, Lowe TJ, Fazel R, Nallamothu BK, Krumholz HM. Hospital Variation in the Use of Noninvasive Cardiac Imaging and Its Association With Downstream Testing, Interventions, and Outcomes. JAMA Internal Medicine 2014, 174: 546-553. PMID: 24515551, PMCID: PMC5459406, DOI: 10.1001/jamainternmed.2013.14407.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionNoninvasive cardiac imagingDownstream testingReadmission ratesRevascularization proceduresCardiac imagingHospital variationCardiac ischemiaProportion of patientsNoninvasive imagingLower readmission ratesPrincipal discharge diagnosisCross-sectional studyCardiac biomarker testsQ4 hospitalsChest discomfortCoronary angiographyCoronary diseaseDischarge diagnosisCoronary angiogramEmergency departmentMyocardial infarctionSame hospitalCurrent guidelinesInpatient wardsHospital variation in risk-standardized hospital admission rates from US EDs among adults
Capp R, Ross JS, Fox JP, Wang Y, Desai MM, Venkatesh AK, Krumholz HM. Hospital variation in risk-standardized hospital admission rates from US EDs among adults. The American Journal Of Emergency Medicine 2014, 32: 837-843. PMID: 24881514, DOI: 10.1016/j.ajem.2014.03.033.Peer-Reviewed Original ResearchConceptsHospital admission ratesEmergency departmentAdmission ratesClinical characteristicsED visitsHospital factorsClinical factorsAdult ED visitsUS emergency departmentsHospital teaching statusCross-sectional analysisPatient characteristicsHospital admissionHospital variationPatientsTeaching statusHospitalED dataVisitsRepresentative sampleAdultsRural locationsAdmissionFactorsNational variations
2011
National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention
Herrin J, Miller LE, Turkmani DF, Nsa W, Drye EE, Bernheim SM, Ling SM, Rapp MT, Han LF, Bratzler DW, Bradley EH, Nallamothu BK, Ting HH, Krumholz HM. National Performance on Door-In to Door-Out Time Among Patients Transferred for Primary Percutaneous Coronary Intervention. JAMA Internal Medicine 2011, 171: 1879-1886. PMID: 22123793, PMCID: PMC4312661, DOI: 10.1001/archinternmed.2011.481.Peer-Reviewed Original ResearchConceptsPercutaneous coronary interventionDIDO timeCoronary interventionST-segment elevation acute myocardial infarctionMixed-effects multivariable modelElevation acute myocardial infarctionPrimary percutaneous coronary interventionMedian DIDO timeAcute myocardial infarctionFibrinolytic therapyPatient characteristicsMultivariable analysisEmergency departmentMyocardial infarctionHospital characteristicsMultivariable modelPatientsRural hospitalsHospitalMedicaid ServicesAge categoriesInterventionAfrican AmericansMinutesTreatment timeNational Trends in Use of Computed Tomography in the Emergency Department
Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National Trends in Use of Computed Tomography in the Emergency Department. Annals Of Emergency Medicine 2011, 58: 452-462.e3. PMID: 21835499, DOI: 10.1016/j.annemergmed.2011.05.020.Peer-Reviewed Original ResearchConceptsEmergency departmentCT useComputed tomographyED visitsRisk ratioNational Hospital Ambulatory Medical Care SurveyAmbulatory Medical Care SurveyShortness of breathLikelihood of admissionSpecific emergency departmentLarge nationwide surveyAbdominal painChest painFlank painAcute illnessED encountersRetrospective studyCare SurveyCommon complaintPatient visitsMultivariable modelingCT scanMAIN OUTCOMEED servicesPain
2006
Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction
Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA, Roumanis SA, Curtis JP, Nallamothu BK, Magid DJ, McNamara RL, Parkosewich J, Loeb JM, Krumholz HM. Strategies for Reducing the Door-to-Balloon Time in Acute Myocardial Infarction. New England Journal Of Medicine 2006, 355: 2308-2320. PMID: 17101617, DOI: 10.1056/nejmsa063117.Peer-Reviewed Original ResearchConceptsST-segment elevationBalloon timeCatheterization laboratoryMyocardial infarctionFaster doorEmergency departmentPrimary percutaneous coronary interventionHospital strategiesIntracoronary balloon inflationPercutaneous coronary interventionAcute myocardial infarctionMinority of hospitalsEmergency medicine physiciansReperfusion treatmentCoronary interventionBalloon inflationMedicine physiciansMultivariate analysisHospitalInfarctionPatientsMedicaid ServicesSignificant reductionReal-time data feedbackData feedback
2004
The association between emergency department crowding and time to antibiotic administration
Hwang U, Graff L, Radford M, Krumholz H. The association between emergency department crowding and time to antibiotic administration. Annals Of Emergency Medicine 2004, 44: s6-s7. DOI: 10.1016/j.annemergmed.2004.07.022.Peer-Reviewed Original ResearchPneumonia severity indexCAP patientsED lengthEmergency departmentED censusED crowdingAntibiotic administrationMean ageCAP casesSignificant associationRetrospective observational cohort studyPatients' mean ageHospital discharge diagnosisMedium-sized community hospitalObservational cohort studyPneumocystis carinii pneumoniaMean ED lengthNational quality measuresNational Hospital Quality MeasuresEmergency department (ED) crowdingNational performance measuresHospital quality measuresNation's emergency departmentsStay criteriaCohort study
2001
Symptom Predictors of Acute Coronary Syndromes in Younger and Older Patients
Milner K, Funk M, Richards S, Vaccarino V, Krumholz H. Symptom Predictors of Acute Coronary Syndromes in Younger and Older Patients. Nursing Research 2001, 50: 233-241. PMID: 11480532, DOI: 10.1097/00006199-200107000-00007.Peer-Reviewed Original ResearchConceptsAcute coronary syndromeOlder patientsYounger patientsChest symptomsSymptom predictorsTypical symptomsCoronary syndromeRegional cardiac referral centerCardiac referral centerInitiation of treatmentLogistic regression analysisPositive predictorArm painReferral centerPatient ageAtypical symptomsEmergency departmentAppropriate triageBorderline associationSymptom presentPatient decisionGreater oddsPatientsSignificant negative predictorPatient's presence
1999
Gender differences in symptom presentation associated with coronary heart disease
Milner K, Funk M, Richards S, Wilmes R, Vaccarino V, Krumholz H. Gender differences in symptom presentation associated with coronary heart disease. The American Journal Of Cardiology 1999, 84: 396-399. PMID: 10468075, DOI: 10.1016/s0002-9149(99)00322-7.Peer-Reviewed Original ResearchConceptsCoronary heart diseaseNon-chest pain symptomsChest painEmergency departmentPain symptomsUnadjusted analysesHeart diseaseSymptom presentationYale-New Haven HospitalSubgroup of patientsNurse data collectorsGender differencesMidback painProspective studyPainNauseaVomitingSymptomsPatientsWomenDyspneaSignificant gender differencesMenDiseaseIndigestion
1997
A collaborative project in Connecticut to improve the care of patients with acute myocardial infarction.
Meehan TP, Radford MJ, Vaccarino LV, Gottlieb LD, McGovern-Hughes B, Herman MV, Revkin JH, Therrien ML, Petrillo MK, Krumholz HM. A collaborative project in Connecticut to improve the care of patients with acute myocardial infarction. Connecticut Medicine 1997, 61: 147-55. PMID: 9097486.Peer-Reviewed Original ResearchConceptsConnecticut Peer Review OrganizationPeer review organizationsCare of patientsAcute myocardial infarction careChart abstraction toolUse of thrombolyticsAcute myocardial infarctionMyocardial infarction careStaff education sessionsNon-Medicare patientsBeta blockersAtrial fibrillationAppropriate medicationEmergency departmentMyocardial infarctionQI interventionsLocal hospitalImprovement interventionsEducation sessionsHospitalQI planPatientsIndividual hospitalsQI activitiesQI project
1996
A Collaborative Project in Connecticut to Improve the Care of Patients with Acute Myocardial Infarction
Meehan T, Radford M, Vaccarino L, Gottlieb L, McGovern-Hughes B, Herman M, Revkin J, Therrien M, Petrillo M, Krumholz H. A Collaborative Project in Connecticut to Improve the Care of Patients with Acute Myocardial Infarction. The Joint Commission Journal On Quality And Patient Safety 1996, 22: 751-761. PMID: 8937949, DOI: 10.1016/s1070-3241(16)30280-2.Peer-Reviewed Original ResearchConceptsConnecticut Peer Review OrganizationPeer review organizationsCare of patientsAcute myocardial infarction careChart abstraction toolUse of thrombolyticsAcute myocardial infarctionMyocardial infarction careStaff education sessionsNon-Medicare patientsBeta blockersAtrial fibrillationAppropriate medicationEmergency departmentMyocardial infarctionQI interventionsLocal hospitalImprovement interventionsEducation sessionsHospitalQI planPatientsIndividual hospitalsQI activitiesQI project