Acute Care Health Services Research Unit

Mahshid Abir, MD, MSc

• 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

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

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

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.

Evaluating Ambulatory-Care Sensitive Emergency Department Visits and

Hospitalizations at the University of Michigan Health System

Mahshid Abir, MD, MScJason Goldstick, PhD

Tim Peterson, MD, MBA

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)

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

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

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

Next steps

• Further characterize ACSC ED visits and hospitalizations

• Evaluate barriers to improved management of ACSC in the ambulatory setting and potential related strategies