Development of a Novel Emergency Department Quality Measure to Reduce Very Low-Risk Syncope Hospitalizations - 12/05/22
, Alexander T. Janke, MD b, Adrian D. Haimovich, MD, PhD b, Arjun K. Venkatesh, MD, MBA b, Michelle P. Lin, MD, MS c, Keith E. Kocher, MD, MPH d, Marie-Joe Nemnom, MSc e, Venkatesh Thiruganasambandamoorthy, MBBS, MSc fAbstract |
Study objective |
Emergency department (ED) evaluations for syncope are common, representing 1.3 million annual US visits and $2 billion in related hospitalizations. Despite evidence supporting risk stratification and outpatient management, variation in syncope hospitalization rates persist. We sought to develop a new quality measure for very low-risk adult ED patients with syncope that could be applied to administrative data.
Methods |
We developed this quality measure in 2 phases. First, we used an existing prospective, observational ED patient data set to identify a very low-risk cohort with unexplained syncope using 2 variables: age less than 50 years and no history of heart disease. We then applied this to the 2019 Nationwide Emergency Department Sample (NEDS) to assess its potential effect, assessing for hospital-level factors associated with hospitalization variation.
Results |
Of the 8,647 adult patients in the prospective cohort, 3,292 (38%) patients fulfilled these 2 criteria: age less than 50 years and no history of heart disease. Of these, 15 (0.46%) suffered serious adverse events within 30 days. In the NEDS, there were an estimated 566,031 patients meeting these 2 criteria, of whom 15,507 (2.7%; 95% confidence interval [CI] 2.48% to 3.00%) were hospitalized. We found substantial variation in the hospitalization rates for this very low-risk cohort, with a median rate of 1.7% (range 0% to 100%; interquartile range 0% to 3.9%). Factors associated with increased hospitalization rates included a yearly ED volume of more than 80,000 (odds ratio [OR] 3.14; 95% CI 2.02 to 4.89) and metropolitan teaching status (OR 1.5; 95% CI 1.24 to 1.81).
Conclusion |
In summary, our novel syncope quality measure can assess variation in low-value hospitalizations for unexplained syncope. The application of this measure could improve the value of syncope care.
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| Please see page 510 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: MP, ML and AV were responsible for the study concept and design. AJ and VT were responsible for data acquisition. AJ, AH, VT and MN analyzed and interpreted the data. MP and AJ drafted the manuscript. All authors contributed critical revisions of the manuscript for important intellectual content. MN offered statistical expertise. KK and AV provided study supervision. MP takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). Dr. Probst is currently supported by an R01 grant from the NIH/NHLBI (R01HL149680). Drs. Janke and Haimovich are supported by the Emergency Medicine Foundation (EMF). Dr. Lin is supported by a K23 grant from NIH/NHLBI (K23HL143042). Dr. Venkatesh also receives support from the Centers for Medicare and Medicaid Services for the development of hospital and health system quality measures and ratings systems. He is also supported by the Agency for Healthcare Research and Quality (2R01HS022882-02) to study health system value and hospital admissions. Dr. Kocher reports a grant from Blue Cross Blue Shield of Michigan and Blue Care Network to support the Michigan Emergency Department Improvement Collaborative, a quality improvement network, outside the submitted work. Dr. Thiruganasambandamoorthy has received grant funding for syncope research from the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, and the Networks for Centres of Excellence - Cardiac Arrhythmia Network of Canada. |
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Vol 79 - N° 6
P. 509-517 - juin 2022 Retour au numéro
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