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Research interest nonetheless expanded considerably through the 1980s and 1990s, as investigators began exploring DSIP's broader neuroendocrine roles, including its interactions with the HPA axis, circadian timing systems, and stress-response pathways, establishing the compound as a multifunctional regulatory neuropeptide whose biological significance extends well beyond its original sleep-focused characterization

JAMA Internal Medicine 2011, 171: 941-954

As explained in the CY 2026 OPPS/ASC proposed rule (90 FR 33770), although data element feasibility testing was performed at only one REH, the measure was also tested at some rural hospital EDs with similar characteristics of pre-conversion REHs