Trends in Emergency Care Provided by Non-Physician Providers and Physicians: 2009-2021.

Objectives: We describe the types of emergency department (ED) visits managed by non-physician providers (NPPs), including physician assistants and nurse practitioners, and emergency medicine (EM) physicians, assessing shifts in care patterns over time.

Methods: We used data from the National Hospital Ambulatory Medical Care Survey collected from 2009 to 2021. We classified visits by provider type: physician only, physician with resident, physician with NPP, and NPP only.

Emergency Physician Employer Market Share and Concentration by Ownership Type.

Study Objective: With rapid consolidation and corporatization of the emergency physician workforce over recent years, little is known about the current state of the emergency physician market. We characterized employer group market share by ownership structure and market concentration by ownership across geographies.

Methods: We selected hospitals from the Centers for Medicare and Medicaid Services (CMS) Hospital General Information Dataset (2021).

Development and Pilot Testing of an Artificial Intelligence and Care Coach Intervention for Cognitively Impaired Older Adults.

Background: Care transitions from the emergency department (ED) to community settings are particularly challenging for persons living with cognitive impairment (PLWCI) and their caregivers. The chaotic ED environment and limited post-discharge support contribute to poor outcomes and high caregiver burden. This study aimed to develop and pilot test an intervention integrating artificial intelligence (AI) technology and care coaching to enhance post-ED support among PLWCI and their caregivers.

Emergency department visits among rural and urban older adults: disparities in ambulatory and emergency care sensitive conditions.

Background: Older adults in rural geographies may be uniquely vulnerable to difficulty accessing outpatient care, and therefore more reliant on emergency department (ED) care. We compared ED utilization for ambulatory care sensitive conditions (ACSCs) and emergency care sensitive conditions (ECSCs) among rural and urban Medicare beneficiaries.

Methods: We conducted a pooled cross-sectional analysis of 2016-2020 Medicare Current Beneficiary Survey data, assessing ED visitation rates for ACSCs and ECSCs.

Development and Validation of an Administrative Claims Measure of Emergency Medical Services (EMS) Triage Quality for Mobile Integrated Health Interventions.

Objectives: In general, Medicare pays for emergency ground ambulance services when a patient is transported to the nearest emergency department (ED) or other select facilities. As state and local agencies strive to provide high quality person-centered emergency care in locations outside the ED, there is a need for a reliable and valid prehospital quality measure to ensure patient safety. The Centers for Medicare and Medicaid Innovation Center's Emergency Triage, Treat and Transport (ET3) Model created a unique opportunity to develop a quality measure for ambulance organizations to measure safe and effective prehospital care.

Patient Volume Requirements: Evaluation of the 2025 ACGME Proposal for Emergency Medicine Residency Programs.

Objectives: The 2025 ACGME proposed that all EM residency programs must be 4 years and achieve a minimum of 3000 patients per resident. We characterize the current residency program patient volume per resident based on the proposed requirements. Secondarily, we describe the number of programs that meet the proposed visit volume requirement and the estimated impact of the 4-year length mandate.

Detection and differentiation of undiagnosed dementia in the emergency department: A pilot referral pathway.

Introduction: Cognitive impairment (CI) is under-recognized by emergency department (ED) clinicians, and processes for cognitive screening and outpatient referrals are limited.

Methods: This pilot study tested the feasibility of ED clinicians referring older adult patients identified through CI screening and direct clinician referral for outpatient cognitive evaluation. Telephone interviews and chart reviews were conducted on 100 patients about their emergency care, cognitive function, and referral status.

Development and validation of the Patient-Reported Outcome Measure-Older adult care Transitions from the Emergency Department (PROM-OTED) tool.

Background: Care transitions from the emergency department (ED) to the community represent a critical period that can significantly impact clinical outcomes of older adults, yet there is a lack of standardized tools to measure patient-reported experiences and outcomes during this transition. Our objective was to develop and validate the Patient-Reported Outcome Measure-Older adult care Transitions in the ED (PROM-OTED) tool to measure care transition outcomes within 4-10 days after ED discharge.

Methods: Older adults (65+ years) discharged from four EDs were enrolled between November 2021 and April 2024 in a multiphase process: qualitative interviews, item generation, member checking, cognitive debriefing, technical expert panel review, and psychometric evaluation and validation.

Clinical Practice Patterns of the Emergency Physician Workforce Before and After Attrition.

Study Objective: Practice patterns of the emergency physician workforce have garnered increasing attention in recent years. Our objective was to assess the clinical service volume preceding and settings practiced following emergency physician workforce attrition.

Methods: We performed a repeated cross-sectional analysis using 2013-2021 Medicare data.

Workforce Attrition Among Emergency Medicine Non-Physician Practitioners.

Study Objective: Non-physician practitioners, including nurse practitioners and physician assistants, increasingly practice in emergency departments, especially in rural areas, where they help mitigate physician shortages. However, little is known about non-physician practitioner durability and demographic trends in emergency departments. Our objective was to examine attrition rates and ages among non-physician practitioners in emergency medicine.

Why do we need quality measures in emergency medicine?

Quality measures increasingly influence the delivery and reimbursement of care provided in emergency departments. While emergency physicians are accustomed to using quality measures to improve care delivery, payors, including the Centers for Medicare and Medicaid Services (CMS), are increasingly adjusting reimbursement to measure performance as a means to bend the cost curve and improve the value of healthcare services. The American College of Emergency Physicians Quality and Patient Safety Committee presents this whitepaper to guide practicing emergency physicians through the policy context of implementing measures in emergency care and understanding its impact reimbursement.

"What Matters" in the Emergency Department: A Prospective Analysis of Older Adults' Concerns and Desired Outcomes.

Objective: To describe "What Matters" to older adults seeking emergency department (ED) care and to identify patient characteristics associated with meeting desired outcomes.

Background: As part of the 4Ms framework, identifying "What Matters" has been captured across healthcare settings, yet limited attention has been directed to older adults in the ED.

Methods: We performed a secondary analysis of a multicenter prospective observational study.

Inclusion of Veterans Health Administration hospitals in Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.

Background/objective: The Centers for Medicare & Medicaid Services (CMS) Overall Hospital Quality Star Rating, established in 2016, is a summary of publicly available quality information for acute care hospitals. In July 2023, Veterans Health Administration (VHA) hospitals became eligible to receive a CMS Overall Hospital Quality Star Rating for the first time. Our objective was to compare performance in quality ratings among VHA and non-VHA hospitals.

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative study.

Background: Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample.

Methods: Using Medicare Current Beneficiary Survey data, we conducted a pooled cross-sectional analysis of Medicare beneficiaries aged 65+ years with a date of death between July 1, 2015 and December 31, 2021.

Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta-analysis.

Introduction: Older adults are at high risk of adverse health outcomes in the post-emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribute to these outcomes. To identify discharge comprehension gaps amenable to future interventions, we utilize meta-analysis to determine patient comprehension across five domains of discharge instructions: diagnosis, medications, self-care, routine follow-up, and return precautions.

Total and Out-of-Pocket Costs Surrounding Emergency Department Care Among Older Adults Enrolled in Traditional Medicare and Medicare Advantage.

Study Objective: We sought to quantify differences in total and out-of-pocket health care costs associated with treat-and-release emergency department (ED) visits among older adults with traditional Medicare and Medicare Advantage.

Methods: We conducted a repeated cross-sectional analysis of treat-and-release ED visits using 2015 to 2020 data from the Medicare Current Beneficiary Survey. We measured total and out-of-pocket health care spending during 3 time periods: the 30 days prior to the ED visit, the treat-and-release ED visit itself, and the 30 days after the ED visit.

Nursing Home to Emergency Care Transition Form Has Limited Uptake But Improves Documentation.

Critical information gaps exist in nursing home-to-emergency department (NH-ED) transfer documentation. Standardization of forms may address these gaps. In a single state, a Continuity of Care Acute Care Transfer (CoC) Form was standardized and mandated to be used for all NH-ED transfers.

Estimating the size and scope of the academic emergency physician workforce.

Background: Academic emergency medicine (EM) is foundational to the EM specialty through the development of new knowledge and clinical training of resident physicians. Despite recent increased attention to the future of the EM workforce, no evaluations have specifically characterized the U.S.