Defining The State of Emergency Care Research. Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians

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1 Defining The State of Emergency Care Research Robert W. Neumar MD, PhD Chair, Research Committee American College of Emergency Physicians

2 Future of Emergency Care Series Hospital-Based Emergency Care At the Breaking Point Committee on the Future of Emergency Care in the United States Health System 2006

3 Recommendations 8.2: The Secretary of the Department of Health and Human Services (DHHS) should conduct a study to examine the gaps and opportunities in emergency and trauma care research, and recommend a strategy for the optimal organization and funding of the research effort. 8.2a: This study should include consideration of training of new investigators, development of multi-center research networks, funding of General Clinical Translational Clinical Research Science Centers (CTSCs) (GCRCs) that specifically include an emergency and trauma care component, involvement of emergency and trauma care researchers in the grant review and research advisory processes, and improved research coordination through a dedicated center or institute. 8.2b: Congress and federal agencies involved in emergency and trauma care research (including the Department of Transportation, the Department of Health and Human Services, the Department of land Security, and Department of Defense) should implement the study s recommendations.

4 To understand the scope and nature of NIH supported research and training that underpin emergency care, the NIH is conducting a targeted internal review of its current research portfolio as it relates to the key scientific questions that need to be addressed to improve emergency medical care. This will include research in pediatric emergency care, pre-hospital acute care, and research training opportunities.

5 Annual NIH Funding for NIH Funding to Departments of Emergency Medicine Departments of Emergency Medicine $28,000,000 $24,000,000 $20,000,000 $16,000,000 % of Total NIH Budget 0.03% 0.03% 0.03% 0.06% 0.09% $12,000,000 $8,000,000 $4,000,000 $ Year

6 QuickTime and a TIFF (LZW) decompressor are needed to see this picture.

7 QuickTime and a TIFF (LZW) decompressor are needed to see this picture.

8 Defining The State of Emergency Care Research Patients Presentations and Diseases Places Practioners Timing Summary

9 Defining The State of Emergency Care Research Patients Presentations and Diseases Places Practioners Timing Summary

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13 Number and Distribution of Ambulatory Care Vists 2005 (Num bers in Millions) All ED ED % All visits 1,169, ,323 10% Patient age A ll ED ED % < 1 39,717 3,745 9% ,181 9,253 14% ,260 11,500 11% ,683 18,682 19% ,656 33,232 13% ,564 22,182 7% ,334 6,756 5% ,938 9,974 7%

14 Number and Distribution of Ambulatory Care Vists 2005 A ll ED ED % A ll visits 1,169, ,323 10% Patient Race A ll ED ED % W hite 984,419 86,149 9% Black or African Am erican 134,917 25,223 19% Asian 37,618 2,173 6% Native Hawaiian or O therp ac ific I s lander 4, % Am erican Indian or Alaska Na tive 4, % Two or more races reported 3, % Patient Ethnicity A ll ED ED % Hispanic o r Latino 130,064 16,872 13% Not-Hispanic or Latino 1,039,269 98,451 9% Patient Sex A ll ED ED % Male 677,744 62,109 9% Fem ale 491,589 53,213 11%

15 Number and Distribution of Ambulatory Care Vists 2005 (Numbers in Millions) All ED ED % All visits 1,169, ,323 10% Payer Status A ll ED ED % Private insurance 692,542 45,999 7% Me dicare 266,062 19,184 7% Me dicareandmedicaid 24,674 23,140 94% Me dicaid/schip 167,413 28,661 17% No insura nce 69,288 19,267 28% Self-pa y 62,875 18,426 29% No charge/charity 7,153 1,227 17% W orker scom pensation 128,611 1,977 2% Other 29,411 2,732 9% Unk nown or blank 58,462 27,462 47%

16 Defining The State of Emergency Care Research Patients Presentations and Diseases Places Practioners Timing Summary

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18 Table 9. Emergency department visits principal reasons for visit: United States, 2005

19 Table 11. ED visits by primary ED diagnosis groups: United States, 2005

20 Table 11. ED visits by hospital discharge diagnosis: United States, 2005

21 Projected NIH Expenditures Biotechnology 9,794,000,000 2 Clinical R esearch 8,688,000,000 3 Prevention 6,739,000,000 4 Ca ncer 5,654,000,000 5 Ge netics 4,865,000,000 6 Neurosciences 4,823,000,000 7 Brain Disorders 4,671,000,000 8 Pediatric 3,188,000,000 9 Behavioral a nd Social Science 3,057,000, Infectious Diseases 3,045,000, Clinical Trials 2,958,000, HIV/AIDS 1/ 2,913,000, He alth Disparities 2,732,000, Aging 2,461,000, Minority Hea lth 2,393,000, Ca rdiovascular 2,361,000, He art Disease 2,111,000, Mental Hea lth 1,849,000, Em erging Infectious Disease s 1,815,000, Biodefense 1,748,000, Substance Abuse 1,522,000, Bioengineering 1,478,000, Vaccine Relate d 1,341,000, Im m uniza tion 1,324,000, Digestive Disease s 1,231,000,000

22 Defining The State of Emergency Care Research Patients Diseases Places Practioners Timing Summary

23 Emergency Care EMS Air Diagnostic Radiology Obs. Unit OR Health care facility EMS Ground Emergency Department Inpatient Cath. Lab Interv. Rad. ICU Rehab Public Setting Private Transfer Ward/Floor Managed care

24 Defining The State of Emergency Care Research Patients Diseases Places Practioners Timing Summary

25 Family Bystander Nurse Primary Care Provider Health care facility EMT Paramedic Flight Nurse EMS Air EMS Ground Emergency Care EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Diagnostic Radiology Emergency Department Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Obs. Unit Inpatient OR Cath. Lab Interv. Rad. ICU Family Nurse Primary Care Provider Rehab Med. Specialist Rehab Public Setting Private Transfer Ward/Floor Managed care

26 Defining The State of Emergency Care Research Patients Diseases Places Practioners Timing Strengths and challenges

27 Emergency Care Research Hypothesis Rapid diagnosis and early intervention in acute illness or acutely decompensated chronic illness improves patient outcomes. Neumar, Ann Emerg Med, 2007

28 Family Bystander Nurse Primary Care Provider Health care facility EMT Paramedic Flight Nurse EMS Air EMS Ground Emergency Care EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Diagnostic Radiology Emergency Department Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Obs. Unit Inpatient OR Cath. Lab Interv. Rad. ICU Family Nurse Primary Care Provider Rehab Med. Specialist Rehab Public Setting Private Transfer Ward/Floor Managed care Minutes Minutes to Hours Hours to Days Days to Months

29 Emergency Care Research Family Bystander Nurse Primary Care Provider EMT Paramedic Flight Nurse EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Family Nurse Primary Care Provider Rehab Med. Specialist EMS Air Diagnostic Radiology Obs. Unit OR Health care facility EMS Ground Emergency Department Inpatient Cath. Lab Interv. Rad. ICU Rehab Public Setting Private Transfer Ward/Floor Managed care Dx Rx O Minutes Minutes to Hours Hours to Days Days to Months

30 Emergency Care Research Family Bystander Nurse Primary Care Provider EMT Paramedic Flight Nurse EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Family Nurse Primary Care Provider Rehab Med. Specialist EMS Air Diagnostic Radiology Obs. Unit OR Health care facility EMS Ground Emergency Department Inpatient Cath. Lab Interv. Rad. ICU Rehab Public Setting Private Transfer Ward/Floor Managed care Dx Rx O Minutes Minutes to Hours Hours to Days Days to Months

31 Emergency Care Research Family Bystander Nurse Primary Care Provider EMT Paramedic Flight Nurse EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Family Nurse Primary Care Provider Rehab Med. Specialist EMS Air Diagnostic Radiology Obs. Unit OR Health care facility EMS Ground Emergency Department Inpatient Cath. Lab Interv. Rad. ICU Rehab Public Setting Private Transfer Ward/Floor Managed care Dx Rx O Minutes Minutes to Hours Hours to Days Days to Months

32 Emergency Care Research Family Bystander Nurse Primary Care Provider EMT Paramedic Flight Nurse EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Family Nurse Primary Care Provider Rehab Med. Specialist EMS Air Diagnostic Radiology Obs. Unit OR Health care facility EMS Ground Emergency Department Inpatient Cath. Lab Interv. Rad. ICU Rehab Public Setting Private Transfer Ward/Floor Managed care Dx Rx O Minutes Minutes to Hours Hours to Days Days to Months

33 Emergency Care Research Family Bystander Nurse Primary Care Provider EMT Paramedic Flight Nurse EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Family Nurse Primary Care Provider Rehab Med. Specialist EMS Air Diagnostic Radiology Obs. Unit OR Health care facility EMS Ground Emergency Department Inpatient Cath. Lab Interv. Rad. ICU Rehab Public Setting Private Transfer Ward/Floor Managed care Dx Rx O Minutes Minutes to Hours Hours to Days Days to Months

34 Emergency Care Research Family Bystander Nurse Primary Care Provider EMT Paramedic Flight Nurse EM Physician Trauma Surgeon Cosultants ED Nurse Paramedics/EMT Surgeon or Surgery Subspecialist Interventional Radiologist Cardiologist Neurologist Critical Care Specialist Hospitalist Ward and ICU Nurse PA or NP Family Nurse Primary Care Provider Rehab Med. Specialist EMS Air Diagnostic Radiology Obs. Unit OR Health care facility EMS Ground Emergency Department Inpatient Cath. Lab Interv. Rad. ICU Rehab Public Setting Private Transfer Ward/Floor Managed care Dx Rx O Minutes Minutes to Hours Hours to Days Days to Months

35 Defining The State of Emergency Care Research Patients Diseases Places Practioners Timing Strengths and challenges

36 Emergency Care Research Strengths 24/7/365 operation High acuity High volume Concentrated resources Patient access Integral part of health care system

37 Emergency Care Research Challenges Unscheduled Multiple locations and providers Time sensitive diagnosis and treatment Consent Standardized data elements Interoperable data sets Investigator training infrastructure

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