A recent report by the Institute of Medicine's (IOM) Committee on the Future of Emergency Care characterized hospital-based emergency care in the US as """"""""at the breaking point."""""""" As a result of the mismatch between demand for emergency department (ED) services and the resources needed to provide them, many EDs in the US are struggling to provide quality emergency care to the patients who present to them. The short and long-term goals of this application are to contribute to research on the quality of ED care by identifying factors that influence patient safety, timeliness, effectiveness and efficiency of EDcare, implementing and evaluating promising interventions to improve the quality of ED care and becoming an independent investigator. To achieve these goals, my career development plan includes the following components: (1) identification of senior mentors and collaborators who will advise me;(2) acquisition of new skills through formal coursework;(3) attendance at quality of care meetings within the institution as well as national conferences;and (4) conduct of research projects that will advance my expertise in this area. There are 2 research projects proposed. The first one has two phases. Phase 1 will examine relationship among patient, provider and system factors that and the quality of ED care using a retrospective cohort design that involves review of electronic medical record data for approximately 2,500 patients who present to the ED with chest or abdominal pain during a 15 month period. In phase 2, we will use a prospective cohort design to examine the relationship between the quality of care received for 1,260 ED patients with chest or abdominal pain and patient-reported outcomes, specifically self-reported health, patient satisfaction with the ED visit and compliance with ED discharge instructions. Subjects in phase 2 will be interviewed during their index ED visit and one week later. The final project will pilot an intervention designed to improve the quality of ED care. The research environment is highly supportive of the goals of this application. I will collaborate with several quality and safety research groups within the institution. I will also work closely with members of my department to develop a proactive, quality of care surveillance program for our health system.
