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  • Coordinated Care May Address Emergency Department Use by Adults With Disabilities

    Working-age adults with disabilities account for a disproportionately high amount of annual emergency department visits, reports a comparison study from National Institutes of Health (NIH) researchers.

    The NIH study analyzed pooled data from the Medical Expenditure Panel Survey. Researchers found access to regular medical care, health profile complexity, and disability status contributed to people with disabilities' use of the emergency department.

    Despite representing 17% of the working age US population, the study found that adults with disabilities accounted for 39.2% of total emergency department visits. Those with a severely limiting disability visited an urgent care department more often than their peers and were more likely to visit the emergency department more than 4 times per year.

    Emergency visits also were associated with poor access to primary medical care, which was more prevalent among adults with disabilities.

    "We want to understand what takes people to the emergency department to learn if their care could be better managed in other ways," said Elizabeth Rasch, PhD, chief of the Epidemiology and Biostatistics Section in the NIH Clinical Center's Rehabilitation Medicine Department. "While many of those visits may be necessary, it is likely that some could be avoided through better information sharing among all of the health care providers who see a particular individual."

    The authors make recommendations for providers and policymakers to offset some of the need for emergency care by individuals with disabilities. Prevention and chronic condition management programs tailored for the functional limitations and service needs of people with disabilities may help avoid a crisis situation that would call for an urgent care visit, the report noted. The authors also endorsed wider adoption of coordinated care systems for people with disabilities that provide case management, integration of psychosocial care, and 24/7 access to medical assistance, among other services.

    Free full text of the study is available online in Health Services Research.  

    Physical therapists (PTs) are increasingly being asked to provide evaluation and management of patients in the emergency department. As part of the emergency department team, PTs have the opportunity to collaborate in the care of patients with a wide range of acute and chronic problems coming from the neuromusculoskeletal, cardiovascular/pulmonary and integumentary systems. PTs in this setting also serve a critical role in screening for appropriateness of care, consultation with other practitioners, and in the direct care of patients. For more information about this expanding area of practice, visit APTA's Physical Therapist Practice in the Emergency Department webpage, which includes a toolkit designed to help PTs initiate the development of a PT practice in an emergency department.   

    Reducing Health Disparities

    A new infographic roadmap from the Robert Wood Johnson Foundation (RWJF) illustrates a 6-step framework that integrates reducing disparities into all health care quality improvement efforts. The framework is designed to be flexible: organizations can get on the road where appropriate. Its goal is to support a thoughtful and comprehensive approach to achieving equity, even though the causes of disparities may vary across regions or patient populations.

    The roadmap draws upon lessons learned from RWJF's Finding Answers' 33 grantee projects and 11 systematic reviews of the disparities-reduction literature.

    Copying Information in EHRs Common Among ICU Physicians

    Copying and pasting old, potentially out-of-date information into patients' electronic health records (EHR) is common among physicians in the intensive care unit (ICU), according to a Reuters Health article based on a study that examined 2,068 electronic patient progress reports created by 62 residents and 11 attending physicians in a Cleveland hospital ICU.

    Using plagiarism-detection software, the researchers analyzed 5 months' worth of progress notes for 135 patients. They found that 82% of residents' notes and 74% of attending physicians' notes included 20% or more copied and pasted material from the patients' records.

    In their report, published in Critical Care Medicine, the authors did not examine what motivated physicians and residents to copy and paste, or whether the shortcut affected patient care, says Reuters.

    Nothing about a patient—length of stay, sex, age, race or ethnicity, what brought them into the ICU or how severely ill they were—affected how often a physician copied information into the medical record.

    Although residents' notes more often included copied material, attending physicians tended to copy more material between notes. They also tended to copy more of their own assessments from other notes.

    Experts suggested that copying information signifies a shift in how physicians use notes—away from being a means of communication among fellow health care providers and toward being a barrage of data to document billing, the article says.

    Supreme Court Declines to Hear Challenge to Stem Cell Policy

    The Supreme Court will not hear a challenge to President Obama's policy of expanding government-funded research using embryonic stem cells that scientists say may offer hope for new treatments for spinal injuries and Parkinson disease, reports the Los Angeles Times

    The court's action brings an end to a lawsuit that threatened to end all funding for such research. 

    A federal judge in Washington in 2010 ordered the National Institutes of Health (NIH) to halt funding of the research, citing a long-standing congressional ban on spending for research in which "human embryos are destroyed."

    But an appeals court overturned that order and ruled last year that the ban applied only to research that destroyed human embryos so as to obtain stem cells.

    President George W. Bush in 2001 had allowed limited research on several stem cell lines that were already in existence. Upon taking office in 2009, President Obama went further and said NIH could conduct "scientifically worthy human stem cell research to the extent permitted by law." Under guidelines issued by NIH, researchers can used stem line cells derived from donated frozen embryos that are no longer needed for fertility treatments, says the article.

    Two researchers who work with adult stem lines brought the lawsuit to the high court. They were represented by several groups, including the Law of Life Project, whose general counsel called human stem cell research "an ethical tragedy as well as a waste of the taxpayer's money," the Times says.