Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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In 2006, the Institute of Medicine (IOM) advanced the concept of "coordinated, regionalized, and accountable emergency care systems" to address significant problems with the delivery of emergency medical care in the United States. Achieving this vision requires the thoughtful implementation of well-aligned, system-level structures and processes that enhance access to emergency care and improve patient outcomes at a sustainable cost. Currently, the delivery of emergency medical care is supported by numerous administrative systems, including economic; reimbursement; legal and regulatory structures; licensure, credentialing, and accreditation processes; medicolegal systems; and quality reporting mechanisms. ⋯ This article identifies significant administrative challenges to integrating networks of emergency care in four specific areas: reimbursement, medical-legal, quality reporting mechanisms, and regulatory aspects. The authors propose a research agenda for indentifying optimal approaches that support consistent access to quality emergency care with improved outcomes for patients, at a sustainable cost. Researching administrative challenges will involve careful examination of the numerous natural experiments in the recent past and will be crucial to understand the impact as we embark on a new era of health reform.
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The ideal emergency care system delivers the right care to the right patient at the right time and yields appropriate patient outcomes at a sustainable overall cost. Transforming the current system of emergency care into the Institute of Medicine's vision of a coordinated, regionalized, and accountable emergency care system requires careful consideration of administrative challenges and barriers. Left unaddressed, certain processes, systems, and structures may prevent integration efforts or threaten long-term viability.
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Patient-centered care is defined by the Institute of Medicine (IOM) as care that is responsive to individual patient needs and values and that guides the treatment decisions. This article is a result of a breakout session of the 2010 Academic Emergency Medicine (AEM) consensus conference and describes the process of developing consensus-based recommendations for providing patient-centered emergency care. ⋯ Four consensus-based recommendations were developed on the following themes: enhancing communication and patient advocacy in emergency departments (EDs), facilitating care coordination after discharge, defining metrics for patient-centered care, and placing the locus of control of medical information into patients' hands. The set of research priorities based on these recommendations was created to promote research and advance knowledge in this dimension of clinical care.
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regionalization of stroke care, including diversion to stroke centers, requires that emergency medical services (EMS) systems accurately identify acute stroke patients. A barrier to evaluating and improving EMS stroke patient identification is the inability to link EMS data with hospital data for individual patients. We sought to create and validate a linkage of the North Carolina EMS Data System (NC-EMS-DS) with data contained in the North Carolina Stroke Care Collaborative (NCSCC) Registry. ⋯ linking EMS records electronically to a stroke registry is feasible and leads to a large number of valid matches. This small validation is limited by EMS data quality. Matching may improve with better EMS documentation and standardized facility documentation.