Emergency Department as Community Microcosm, Data Hub: Q&A with Jeremy Brown
Aug 8, 2013, 12:49 PM
The National Institutes of Health’s Office of Emergency Care Research (OECR), established in 2012, will now be under the leadership of Jeremy Brown, MD. Brown was recently appointed as the first permanent director of OECR, which is housed in NIH’s National Institute of General Medical Sciences.
Before joining NIH, Brown was an associate professor of emergency medicine and chief of the clinical research section in the Department of Emergency Medicine at The George Washington University. Additionally, he served as an attending physician in the emergency department of the Washington, D.C., VA Medical Center. According to the acting director of the National Institute of General Medical Sciences, Judith H. Greenberg, PhD, “Brown brings an impressive mix of clinical expertise, research experience, management abilities and communication skills to this important new position.”
Brown’s research has included how to introduce routine HIV screening—a public health intervention—in hospital emergency departments. Previous studies have found these screenings to be cost-effective and frequently welcomed by patients. Brown says that this is just one of the many ways in which steps could be taken in the emergency room setting to help improve the data available to assist public health efforts across the country. By using emergency departments (EDs)as sites for collecting data on the status of the public’s health, more targeted efforts for prevention can be implemented.
NewPublicHealth spoke with Dr. Brown on the evidence that shows support for the collaboration between emergency departments and efforts to improve public health, as well as his new role and what he sees for the future of emergency departments.
NewPublicHealth: How is the transition into this new position going so far and how are you pulling from previous experiences to help with new challenges in this position?
Jeremy Brown: This is the beginning of my fourth week here; it is a new program and a new project really for both me as its first permanent director and for the NIH as well. They’ve never had an office that has addressed this particular part of our nation’s health and I think it’s going to be a learning experience on both sides.
So far, I’ve been really struck by the extremely warm reception that I’ve had from people within the institutes and centers with whom I’ve had meetings. Currently, my agenda is really to meet with as many people as possible within NIH whose work touches on emergency medicine and other time sensitive medical issues.
In terms of the latter, I started a brand new HIV screening project from scratch at GW, it hadn’t been done there previously and it really had only been done in a couple of places in the U.S. before. That required the marshaling of a lot of different aspects of both the hospital, the nursing staff, and emergency physicians to get that up and running.
NPH: What other public health initiatives do you think EDs can take the lead on to improve public health?
Brown: The role of EDs in public health is one that ED physicians grapple with. On the one hand, it’s the only point of contact with the medical provider for many people, even those with insurance…and so it makes sense to use the opportunity to address a much wider range of medical issues than those which brought the patient in.
On the other hand, EDs, as we all know, are very busy places where the wait for services can sometimes be long, and so the question is does it make sense to delay the care of another patient because the ED is addressing a public health issue? And this actually has been a point of lively discussion in the emergency medicine community. In fact, the question of what public health interventions, or more precisely, what preventative care needs are most appropriately addressed in the ED has been carefully examined by the Society for Academic Emergency Medicine which looked at the issue from the only way it should be looked at, namely from an evidenced-based position.
In a paper published in 2000, they examined 17 preventative care interventions with possible applicability to the emergency department, and of those 17, they found five for which there was enough evidence to support offering them in the emergency department and those five are HIV screening in certain populations, hypertension screening, adult pneumococcal vaccinations the referral of children without a primary care doctor to continuing care, and smoking cessation counseling.
NPH: How can emergency department data be used to help improve public health overall?
Brown: This is a really key point, and I think the other issue is to emphasize that smart decisions about public health issues need to be based on good data. We have pretty good data, for instance, from the National Hospital Ambulatory Medical Care Survey, which is coordinated by the Centers for Disease Control and Prevention and already collects data about ED visits across the U.S. each year using close to 400 hospital EDs as collection sites. They evaluate the data to come up with a national estimate of both the number of ED visits and the specific kind of visits that are going on. The statistic we have on 10 million ED visits each year for abdominal pain, for example, comes from this important healthcare survey.
But with the penetration of the electronic medical record into health systems generally and into EDs, in particular, the possibility of collecting data in real time about ED visits is truly phenomenal. But, of course, the data that exists can only be collected when computer platforms are able to speak to each other and when there is both the IT support and the financial support to collect the data. This is not a cheap undertaking, but it is one that is vitally important to the future of our nation’s health.
NPH: Do you think, overall, as we get all of this massive data and public health and healthcare find new and more data-informed ways to work together, that there will be a revolution in these kinds of partnerships?
Brown: Well, I’m actually a little bit skeptical of the big changes that might come along through data. But there is no doubt that there have been some advances using data such as what people are now calling smart policing where police are sent on patrol based on geospatial software combined with use of crime statistics so that patrols are happening in the areas of highest crime rates. I think the equivalent is very attainable for public health issues and the emergency department is a vital ally in this fight.
NPH: What else do you think public health practitioners can learn from the ED?
Brown: I think one of the key messages I would give is to really think a hospital's emergency department as a microcosm and as a laboratory of the community’s health and health needs.
This commentary originally appeared on the RWJF New Public Health blog.