CONSENUS CONFERENCE PAPER ADMINISTRATIVE DATA RESEARCH Advancing the Use of Administrative Data for Emergency Department Imaging Research Damon R. Kuehl Tiffany D. Jackson Carl Berdahl Rakesh D. Mistry Neha P. Raukar Mythreyi Bhargavan Arjun K. Venkatesh Linda F. McCaig Brendan G. Carr Jeremiah D. Schuur Keith E. Kocher All authors are members of the planning group for the breakout session, “Using Administrative Data for Emergency Imaging Research,” at the 2015 Academic Emergency Medicine Consensus Conference, “Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization.” CONSENUS CONFERENCE PAPER ADMINISTRATIVE DATA RESEARCH ABSTRACT Administrative data have been critical to describe patterns of use, cost, and appropriateness of imaging in emergency care. Administrative data encompass a range of source material that have been collected primarily for a non-research use: documenting clinical care (e.g., medical records), or administering care or financial transactions (e.g., insurance claims). These data excel when used in large scale descriptive studies, which have documented the rise and expanded role of diagnostic imaging in the emergency department (ED). Yet as researchers and policymakers seek to improve the value of imaging in emergency care, traditional approaches with administrative data are limited. This article summarizes the discussions of the breakout session on use of administrative data for emergency imaging research at the May 2015 Academic Emergency Medicine Consensus Conference, “Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization.” We describe the areas where administrative data have been applied to research evaluating the use of diagnostic imaging in the ED, the common sources for these data, and the strengths and limitations of administrative data. Next, we examine the future role of administrative data in answering key research questions in an evolving health system increasingly focused on measuring appropriateness, ensuring quality, and improving value for health spending. Finally, we consider how to move administrative data from a focus on descriptive studies to explanatory research exploring causal relationships. CONSENUS CONFERENCE PAPER ADMINISTRATIVE DATA RESEARCH INTRODUCTION Administrative data refers to data derived from a variety of preexisting sources, including documentation of clinical encounters (e.g., electronic health records), datasets from clinical care administrative systems (e.g., radiology or pharmacy information systems), hospital billing data or insurance claims, or intentional aggregations of these sources into large datasets designed for research applications. Because these data are created predominantly for financial and management purposes rather than research, they are of varying degrees of accuracy and completeness, and often lack important clinical granularity, such as vital signs. Nevertheless, their power is derived from the generally large sample sizes available, ability to describe the delivery of care over time and geography, and relatively low cost to acquire and analyze. Over the last two decades, administrative data have documented the growth and variation in the use of diagnostic imaging in the emergency department (ED).1–6 Imaging has become integral to the functioning of the contemporary ED as emergency providers are increasingly asked to provide rapid diagnosis and make hospitalization decisions for our health system. As a result, the ED is a major consumer of these services with sometimes unclear impact on downstream outcomes and cost of care.7 Within the context of an increasingly value driven health care system, ED diagnostic imaging research utilizing administrative data provides several future avenues of inquiry. Key questions include examining how imaging appropriateness and value should be determined, exploring how to move from descriptive studies of imaging use to CONSENUS CONFERENCE PAPER ADMINISTRATIVE DATA RESEARCH explanatory research investigating causal relationships, enriching existing or developing new administrative datasets to improve the yield of such research, determining which populations should be of highest priority for study, and aligning these endeavors with national priorities of reducing cost, improving health, and bettering the patient experience of care? CONSENUS CONFERENCE PAPER ADMINISTRATIVE DATA RESEARCH REFERENCES 1. Feng, L. B., Pines, J. M., Yusuf, H. R. & Grosse, S. D. U.S. trends in computed tomography use and diagnoses in emergency department visits by patients with symptoms suggestive of pulmonary embolism, 2001-2009. Acad. Emerg. Med. Off. J. Soc. Acad. Emerg. Med. 20, 1033–1040 (2013). 2. Kocher, K. E. et al. 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