Oregon
A Multi-State Evaluation of Emergency Department Pediatric Readiness: Guideline Update and Association with Quality, Outcomes, and Cost
Oregon Health and Science University
Principal Investigator: Craig D. Newgard, MD, MPH
The National Pediatric Readiness Project (NPRP) launched in 2012 to ensure ideal pediatric emergency care by implementing standardized guidelines for EDs and measuring their improvement. However, the ability of EDs to adopt and implement these guidelines, the impact on health outcomes, and the associated costs have not yet been evaluated. To address this gap, the investigators will evaluate two multistate cohorts of children presenting to EDs combined with national survey data to evaluate the impact of ED Pediatric Readiness in 13 states (1,504 EDs) and (separately) trauma systems in 44 states (639 trauma centers). The project will focus on two high-risk subgroups within these cohorts that are likely to be particularly sensitive to ED readiness: seriously injured children (Injury Severity Score >= 16) and critically ill non-injured children.
Objectives
- Measure pediatric emergency care guideline uptake and the associated health outcomes of children over an 8-year period
- Assess the improvements in pediatric health outcomes that would result from children receiving emergency care at high-readiness EDs within 30 minutes from their homes
- Determine costs associated with various levels of readiness for both hospitals and patients
Health outcomes to be assessed include mortality, preventable complications, and costs for both patients and hospitals.
Published research
- Newgard CD, Lin A, Goldhaber-Fiebert JD, Remick KE, Gausche-Hill M, Burd RS, Malveau S, Cook JNB, Jenkins PC, Ames SG, Mann NC, Glass NE, Hewes HA, Fallat M, Salvi A, Carr BG, McConnell KJ, Stephens CQ, Ford R, Auerbach MA, Babcock S, Kuppermann N. State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved. JAMA Netw Open. 2024 Nov 4;7(11):e2442154. doi: 10.1001/jamanetworkopen.2024.42154. PubMed PMID: 39485354; PubMed Central PMCID: PMC11530936.
- Weyant C, Lin A, Newgard CD, Kuppermann N, Gausche-Hill M, Remick KE, Hewes HA, Burd RS, Mann NC, Ames SG, Carr BG, Malveau S, McConnell KJ, Cook JNB, Goldhaber-Fiebert JD. Cost-Effectiveness And Health Impact Of Increasing Emergency Department Pediatric Readiness In The US. Health Aff (Millwood). 2024 Oct;43(10):1370-1378. doi: 10.1377/hlthaff.2023.01489. PubMed PMID: 39374456.
- Newgard CD, Rakshe S, Salvi A, Lin A, Cook JNB, Gausche-Hill M, Kuppermann N, Goldhaber-Fiebert JD, Burd RS, Malveau S, Jenkins PC, Stephens CQ, Glass NE, Hewes H, Mann NC, Ames SG, Fallat M, Jensen AR, Ford RL, Child A, Carr B, Lang K, Buchwalder K, Remick KE. Changes in Emergency Department Pediatric Readiness and Mortality. JAMA Netw Open. 2024 Jul 1;7(7):e2422107. doi: 10.1001/jamanetworkopen.2024.22107. PubMed PMID: 39037816; PubMed Central PMCID: PMC11265139.
- Ames SG, Salvi A, Lin A, Malveau S, Mann NC, Jenkins PC, Hansen M, Papa L, Schmitz S, Sabogal C, Newgard CD. Timing and causes of death to 1 year among children presenting to emergency departments. Acad Emerg Med. 2024 Jun;31(6):555-563. doi: 10.1111/acem.14875. Epub 2024 Mar 18. PubMed PMID: 38499441; PubMed Central PMCID: PMC11168880.
- Jenkins PC, Lin A, Ames SG, Newgard CD, Lang B, Winslow JE, Marin JR, Cook JNB, Goldhaber-Fiebert JD, Papa L, Zonfrillo MR, Hansen M, Wall SP, Malveau S, Kuppermann N. Emergency Department Pediatric Readiness and Disparities in Mortality Based on Race and Ethnicity. JAMA Netw Open. 2023 Sep 5;6(9):e2332160. doi: 10.1001/jamanetworkopen.2023.32160. PubMed PMID: 37669053; PubMed Central PMCID: PMC10481245.
- Newgard CD, Babcock SR, Song X, Remick KE, Gausche-Hill M, Lin A, Malveau S, Mann NC, Nathens AB, Cook JNB, Jenkins PC, Burd RS, Hewes HA, Glass NE, Jensen AR, Fallat ME, Ames SG, Salvi A, McConnell KJ, Ford R, Auerbach M, Bailey J, Riddick TA, Xin H, Kuppermann N. Emergency Department Pediatric Readiness Among US Trauma Centers: A Machine Learning Analysis of Components Associated With Survival. Ann Surg. 2023 Sep 1;278(3):e580-e588. doi: 10.1097/SLA.0000000000005741. Epub 2022 Nov 1. PubMed PMID: 36538639; PubMed Central PMCID: PMC10149578.
- Newgard CD, Smith M, Lin A, McConnell KJ, Remick KE, Burd RS, Marin JR, Mann NC, Gausche-Hill M, Hewes HA, Child A, Lang B, Foster AA, Maughan B, Goldhaber-Fiebert JD. The cost of emergency care for children across differing levels of emergency department pediatric readiness. Health Aff Sch. 2023 Jul;1(1):qxad015. doi: 10.1093/haschl/qxad015. eCollection 2023 Jul. PubMed PMID: 38756836; PubMed Central PMCID: PMC10986251.
- Remick K, Smith M, Newgard CD, Lin A, Hewes H, Jensen AR, Glass N, Ford R, Ames S, Cook J, Malveau S, Dai M, Auerbach M, Jenkins P, Gausche-Hill M, Fallat M, Kuppermann N, Mann NC. Impact of individual components of emergency department pediatric readiness on pediatric mortality in US trauma centers. J Trauma Acute Care Surg. 2023 Mar 1;94(3):417-424. doi: 10.1097/TA.0000000000003779. Epub 2022 Sep 1. PubMed PMID: 36045493; PubMed Central PMCID: PMC9974586.
- Newgard CD, Lin A, Malveau S, Cook JNB, Smith M, Kuppermann N, Remick KE, Gausche-Hill M, Goldhaber-Fiebert J, Burd RS, Hewes HA, Salvi A, Xin H, Ames SG, Jenkins PC, Marin J, Hansen M, Glass NE, Nathens AB, McConnell KJ, Dai M, Carr B, Ford R, Yanez D, Babcock SR, Lang B, Mann NC. Emergency Department Pediatric Readiness and Short-term and Long-term Mortality Among Children Receiving Emergency Care. JAMA Netw Open. 2023 Jan 3;6(1):e2250941. doi: 10.1001/jamanetworkopen.2022.50941. PubMed PMID: 36637819; PubMed Central PMCID: PMC9857584.
- Newgard CD, Malveau S, Mann NC, Hansen M, Lang B, Lin A, Carr BG, Berry C, Buchwalder K, Lerner EB, Hewes HA, Kusin S, Dai M, Wei R. A Geospatial Evaluation of 9-1-1 Ambulance Transports for Children and Emergency Department Pediatric Readiness. Prehosp Emerg Care. 2023;27(2):252-262. doi: 10.1080/10903127.2022.2064020. Epub 2022 May 13. PubMed PMID: 35394855; PubMed Central PMCID: PMC9681031.