National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (10)
- Antibiotics (2)
- Cardiovascular Conditions (3)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Complementary and Alternative Medicine (1)
- Elderly (4)
- Emergency Department (1)
- Evidence-Based Practice (2)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (5)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Health Information Technology (HIT) (1)
- Heart Disease and Health (3)
- Hospitalization (1)
- Hospitals (3)
- Imaging (1)
- Infectious Diseases (1)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Medical Errors (2)
- Medication (8)
- Medication: Safety (3)
- Mortality (1)
- Nursing Homes (3)
- Opioids (3)
- Outcomes (3)
- Pain (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (2)
- (-) Patient Safety (23)
- (-) Practice Patterns (23)
- Prevention (2)
- Primary Care (1)
- Provider: Health Personnel (1)
- Provider: Physician (1)
- Quality Improvement (1)
- Respiratory Conditions (1)
- Risk (1)
- Shared Decision Making (2)
- Surgery (1)
- Tools & Toolkits (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 23 of 23 Research Studies DisplayedVu K, Zhou J, Everhart A
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
Variation in de-adoption of ineffective or unsafe treatments is not well-understood. In this study the investigators examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning. The investigators found that physician specialty had a dominant role in prescribing decision, and specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.
AHRQ-funded; HS025164.
Citation: Vu K, Zhou J, Everhart A .
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
BMC Nephrol 2021 Aug 21;22(1):284. doi: 10.1186/s12882-021-02491-y..
Keywords: Evidence-Based Practice, Medication: Safety, Medication, Patient Safety, Practice Patterns, Provider: Physician
Worsham CM, Woo J, Jena AB
Adverse events and emergency department opioid prescriptions in adolescents.
Understanding the risks associated with opioid prescription in adolescents is critical for informing opioid policy, but the risks are challenging to quantify given the lack of randomized trial data. Using a regression discontinuity design, the investigators exploited a discontinuous increase in opioid prescribing in the emergency department (ED) when adolescents transitioned from "child" to "adult" at age eighteen to estimate the effect of an ED opioid prescription on subsequent opioid-related adverse events.
AHRQ-funded; HS026753.
Citation: Worsham CM, Woo J, Jena AB .
Adverse events and emergency department opioid prescriptions in adolescents.
Health Aff 2021 Jun;40(6):970-78. doi: 10.1377/hlthaff.2020.01762..
Keywords: Children/Adolescents, Emergency Department, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Practice Patterns
Navis A, George MC, Nmashie A
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
This study assessed the use of the Safer Opioid Prescribing Evaluation Tool (SOPET) which was designed to improve the implementation of the 2016 Centers for Disease Control Guidelines on the prescription of opioids for chronic pain. Four raters with varying levels of clinical experience were trained to use the SOPET and then used it to evaluate 21 baseline patient scenarios. Inter-rater reliability was measured using intraclass correlation coefficient (ICC) estimates and their 95% confidence intervals for the total SOPET score based on a mean-rating absolute-agreement, two-way random-effects model. Inter-rater reliability was found to be good for the three physician raters (0.92, 0.97, and 0.99). However, inter-rater reliability for the non-physician rater was lower (0.67).
AHRQ-funded; HS025641.
Citation: Navis A, George MC, Nmashie A .
Validation of the Safer Opioid Prescribing Evaluation Tool (SOPET) for assessing adherence to the Centers for Disease Control opioid prescribing guidelines.
Pain Med 2020 Dec 25;21(12):3655-59. doi: 10.1093/pm/pnaa138..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Guidelines, Practice Patterns, Pain, Chronic Conditions, Evidence-Based Practice
Angraal S, Nuti SV, Masoudi FA
Digoxin use and associated adverse events among older adults.
The authors describe national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over the past two decades. They found that, while digoxin prescriptions have decreased, the drug is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. They concluded that these findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
AHRQ-funded; HS025164; HS025402; HS025517.
Citation: Angraal S, Nuti SV, Masoudi FA .
Digoxin use and associated adverse events among older adults.
Am J Med 2019 Oct;132(10):1191-98. doi: 10.1016/j.amjmed.2019.04.022.
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Keywords: Medication, Elderly, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Practice Patterns
Chopra V, Kaatz S, Swaminathan L
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
This study examined complication rates from placement of midline vascular catheters. They have become more common in use recently. Complications were analyzed using medical records from hospitalized patients in 12 hospitals from January 2017 to February 2018. Most midline catheters were placed in general ward settings for difficult intravenous access. About half were removed within 5 days of insertion. Major or minor complications occurred in 10.3% of midlines with minor complications accounting for 71% of all adverse events. These minor complications included dislodgement, leaking, and infiltration. Major complications included occlusion, upper-extremity DVT and BSI. Use of midlines and outcomes varied widely across hospitals.
AHRQ-funded; HS025891.
Citation: Chopra V, Kaatz S, Swaminathan L .
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
BMJ Qual Saf 2019 Sep;28(9):714-20. doi: 10.1136/bmjqs-2018-008554..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Infectious Diseases, Adverse Events, Practice Patterns, Outcomes, Hospitals
Rogal SS, Beste LA, Youk A
Characteristics of opioid prescriptions to veterans with cirrhosis.
The goal of this study was to assess time trends in the prescribing of opioids and factors associated with patients with cirrhosis receiving opioids. National Veterans Health Administration data was used to assess characteristics of cirrhosis patients and their prescriptions for opioids.
AHRQ-funded; HS019461.
Citation: Rogal SS, Beste LA, Youk A .
Characteristics of opioid prescriptions to veterans with cirrhosis.
Clin Gastroenterol Hepatol 2019 May;17(6):1165-74.e3. doi: 10.1016/j.cgh.2018.10.021..
Keywords: Medication, Medication: Safety, Opioids, Patient Safety, Practice Patterns
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
This editorial viewpoint discusses structured approaches that emphasize the four critical time points (‘Moments’) in the process of antibiotic prescribing, and which may improve antibiotic decisionmaking by clinicians and communication about antibiotic decisions among health care practitioners. AHRQ’s Safety Program for Improving Antibiotic Use is highlighted, since it features the training of clinicians to incorporate the ‘4 moments’ of antibiotic decisionmaking into their thought processes when prescribing antibiotics. The 4 moments are described and an example provided for each. The authors conclude that an organized approach such as the 4 moments of antibiotic decisionmaking could be helpful if it is used every time antibiotic therapy is considered.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
JAMA 2019 Jan;321(2):139-40. doi: 10.1001/jama.2018.19509..
Keywords: Antibiotics, Shared Decision Making, Medication, Patient Safety, Practice Patterns
Pulia M, Kern M, Schwei RJ
Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis.
The objective of this study was to characterize antibiotic therapy for nursing home (NH) residents and compare appropriateness based on setting of prescription initiation. The study concluded that antibiotics initiated out-of-facility for NH residents constituted a small but not trivial percent of all prescriptions and inappropriate use was high in these settings.
AHRQ-funded; HS024342; HS022465.
Citation: Pulia M, Kern M, Schwei RJ .
Comparing appropriateness of antibiotics for nursing home residents by setting of prescription initiation: a cross-sectional analysis.
Antimicrob Resist Infect Control 2018 Jun 14;7:74. doi: 10.1186/s13756-018-0364-7..
Keywords: Elderly, Nursing Homes, Patient Safety, Practice Patterns
Spatz ES, Wang Y, Beckman AL
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
This study examined the use of traditional Chinese medicine (TCM) in patients admitted for acute myocardial infarction (AMI) in China during the first 24 hours of hospitalization. The data came from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction. A chart review was done of randomly sampled patients in 2001, 2006 and 2011 in 162 Western medicine hospitals across China. Nearly all (99%) hospitals used some form of TCM, with Salvia miltiorrhiza being the most commonly prescribed. This TCM treatment (and others) was used intravenously and use has increased over the span of the study, despite lack of evidence of benefit or harm.
AHRQ-funded; HS023000.
Citation: Spatz ES, Wang Y, Beckman AL .
Traditional Chinese medicine for acute myocardial infarction in western medicine hospitals in China.
Circ Cardiovasc Qual Outcomes 2018 Mar;11(3):e004190. doi: 10.1161/circoutcomes.117.004190..
Keywords: Adverse Events, Cardiovascular Conditions, Complementary and Alternative Medicine, Heart Disease and Health, Hospitals, Mortality, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Practice Patterns, Risk
Paje D, Conlon A, Kaatz S
Patterns and predictors of short-term peripherally inserted central catheter use: a multicenter prospective cohort study.
The goal of this study was to identify patient, provider, and device characteristics and the clinical outcomes associated with short-term peripherally inserted central catheters (PICCs). Trained abstractors collected data from the medical records of adults that received PICCs during hospitalization; patients were prospectively followed until PICC removal, death, or 70 days after insertion. Complications associated with short-term use were assessed. Major complications included venous thromboembolism or central line associated bloodstream infection. Common minor complications were catheter occlusion and tip migration.
AHRQ-funded; HS022835.
Citation: Paje D, Conlon A, Kaatz S .
Patterns and predictors of short-term peripherally inserted central catheter use: a multicenter prospective cohort study.
J Hosp Med 2018 Feb;13(2):76-82. doi: 10.12788/jhm.2847..
Keywords: Adverse Events, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety, Practice Patterns
McElligott M, Welham G, Pop-Vicas A
Antibiotic stewardship in nursing facilities.
The authors review the determinants of antibiotic prescribing in nursing facilities, strategies to improve antibiotic prescribing in this setting, current status of ASPs in nursing facilities, and steps that facilities can take to enhance existing ASP structure and process.
AHRQ-funded; HS022465.
Citation: McElligott M, Welham G, Pop-Vicas A .
Antibiotic stewardship in nursing facilities.
Antibiotics, Elderly, Nursing Homes, Patient Safety, Provider Practice Patterns.
Keywords: Antibiotics, Elderly, Nursing Homes, Patient Safety, Practice Patterns
Zullo AR, Dore DD, Gutman R
Metformin safety warnings and diabetes drug prescribing patterns for older nursing home residents.
Diabetes mellitus is common in US nursing homes (NHs), and the mainstay treatment, metformin, has US Food and Drug Administration (FDA) boxed warnings indicating safety concerns in those with advanced age, heart failure, or renal disease. The researchers quantified the determinants of initiating sulfonylureas over metformin with the aim of understanding the impact of FDA-labeled boxed warnings in older NH residents.
AHRQ-funded; HS022998.
Citation: Zullo AR, Dore DD, Gutman R .
Metformin safety warnings and diabetes drug prescribing patterns for older nursing home residents.
J Am Med Dir Assoc 2017 Oct;18(10):879-84.e7. doi: 10.1016/j.jamda.2017.05.020..
Keywords: Elderly, Medication, Nursing Homes, Patient Safety, Practice Patterns
Amin AP, Bach RG, Caruso ML
Association of variation in contrast volume with acute kidney injury in patients undergoing percutaneous coronary intervention.
The purpose of this study was to examine the national variation in acute kidney injury (AKI) incidence and contrast use among US physicians and the variation's association with patients' risk of developing AKI after percutaneous coronary intervention (PCI). This cross-sectional study used the American College of Cardiology National Cardiovascular Data Registry (NCDR) CathPCI Registry to identify in-hospital care for percutaneous coronary intervention (PCI) in the United States.
AHRQ-funded; HS022481.
Citation: Amin AP, Bach RG, Caruso ML .
Association of variation in contrast volume with acute kidney injury in patients undergoing percutaneous coronary intervention.
JAMA Cardiol 2017 Sep;2(9):1007-12. doi: 10.1001/jamacardio.2017.2156..
Keywords: Adverse Events, Kidney Disease and Health, Cardiovascular Conditions, Patient Safety, Heart Disease and Health, Practice Patterns
Grunwell JR, Kamat PP, Miksa M
Trend and outcomes of video laryngoscope use across PICUs.
The use of video laryngoscopy for tracheal intubation is now common for adult ICUs, but has not been quantified in pediatric ICUs (PICUs). A retrospective review was conducted of PICUs across the US and four other countries. There was a wide variability of use of video laryngoscopy across PICUs. There has been a significant increase in the use of video laryngoscopy versus direct laryngoscopy from 2011 to 2015, which has resulted in a decrease in adverse outcomes.
AHRQ-funded; HS021583; HS022464.
Citation: Grunwell JR, Kamat PP, Miksa M .
Trend and outcomes of video laryngoscope use across PICUs.
Pediatr Crit Care Med 2017 Aug;18(8):741-49. doi: 10.1097/pcc.0000000000001175..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Patient Safety, Practice Patterns, Respiratory Conditions
Lavin JM, Boss EF, Brereton J
Responses to errors and adverse events: the need for a systems approach in otolaryngology.
The authors reported otolaryngologists' reactions to errors and adverse events and determined if temporal changes in physician efforts to assume responsibility; ameliorate patients' conditions; or change personal, group-wide, or hospital practices have occurred. Members of the American Academy of Otolaryngology-Head and Neck Surgery were surveyed. The undertaking of corrective actions was reported, and these events led to changes in personal, group/departmental, and hospital practice. The authors found that efforts to change personal practice were much more common than efforts to improve systems.
AHRQ-funded; HS022932.
Citation: Lavin JM, Boss EF, Brereton J .
Responses to errors and adverse events: the need for a systems approach in otolaryngology.
Laryngoscope 2016 Sep;126(9):1999-2002. doi: 10.1002/lary.25837.
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Keywords: Adverse Events, Medical Errors, Patient Safety, Practice Patterns
Chopra V, Smith S, Swaminathan L
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
The researchers examined the use of peripherally inserted central catheters (PICCs) by conducting a prospective study at 10 hospitals through the Michigan Hospital Medicine Safety Consortium. Their multicenter study found substantial variation in PICC indications, patterns of use, and outcomes at the 10 Michigan hospitals included in the study.
AHRQ-funded; HS022835.
Citation: Chopra V, Smith S, Swaminathan L .
Variations in peripherally inserted central catheter use and outcomes in Michigan hospitals.
JAMA Intern Med 2016 Apr;176(4):548-51. doi: 10.1001/jamainternmed.2015.8402.
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Keywords: Patient Safety, Practice Patterns, Healthcare-Associated Infections (HAIs), Hospitals, Outcomes, Adverse Events
Martin BI, Lurie JD, Tosteson AN
Use of bone morphogenetic protein among patients undergoing fusion for degenerative diagnoses in the United States, 2002 to 2012.
The authors examined whether published concerns about the safety of bone morphogenetic protein (BMP) altered clinical practice. They found that use of BMP in spinal fusion surgery declined subsequent to published safety concerns and revelations of financial conflicts of interest for investigators involved in the pivotal clinical trials.
AHRQ-funded; HS021695.
Citation: Martin BI, Lurie JD, Tosteson AN .
Use of bone morphogenetic protein among patients undergoing fusion for degenerative diagnoses in the United States, 2002 to 2012.
Spine J 2015 Apr;15(4):692-9. doi: 10.1016/j.spinee.2014.12.010.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Patient Safety, Patient-Centered Outcomes Research, Practice Patterns, Surgery
White AA, Brock DM, McCotter PI
Risk managers' descriptions of programs to support second victims after adverse events.
The researchers surveyed US members of the American Society for Healthcare Risk Management about the presence, features, and perceived efficacy of their organization’s provider support program. The majority reported that their organization had a support program, but features varied widely and there are substantial opportunities to improve services.
AHRQ-funded; HS019531.
Citation: White AA, Brock DM, McCotter PI .
Risk managers' descriptions of programs to support second victims after adverse events.
J Healthc Risk Manag 2015;34(4):30-40. doi: 10.1002/jhrm.21169..
Keywords: Adverse Events, Patient Safety, Medical Errors, Practice Patterns
Kruger JF, Chen AH, Rybkin A
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
The authors examined outpatient clinician attitudes towards considering radiation exposure when ordering CT scans and clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry. They found that displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging.
AHRQ-funded; HS018090.
Citation: Kruger JF, Chen AH, Rybkin A .
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
BMJ Qual Saf 2014 Nov;23(11):893-901. doi: 10.1136/bmjqs-2013-002773.
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Keywords: Shared Decision Making, Provider: Health Personnel, Imaging, Patient Safety, Practice Patterns
Fakih MG, Krein SL, Edson B
AHRQ Author: Battles JB
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
The "On the CUSP: Stop CAUTI" initiative represents the single largest national effort to mitigate urinary catheter risk. The program brings together key organizations to assist hospitals by providing education and coaching support. Continuity is secured by integrating the process into the health care worker's daily routine activities.
AHRQ-authored; AHRQ-funded; 290201000025I; 29032001T.
Citation: Fakih MG, Krein SL, Edson B .
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
Am J Infect Control 2014 Oct;42(10 Suppl):S223-9. doi: 10.1016/j.ajic.2014.03.355.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Prevention, Practice Patterns
Fakih MG, Krein SL, Edson B
AHRQ Author: Battles JB
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
This article discusses catheter-associated urinary tract infection (CAUTI) prevention efforts, describes the national collaboration between different organizations, briefly reviews the technical and socio-adaptive components of the program, and specifically describes an approach to engaging health care workers as an essential part of CAUTI prevention and averting patient harm.
AHRQ-authored; AHRQ-funded; 290201000025I; 29032001T
Citation: Fakih MG, Krein SL, Edson B .
Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.
Am J Infect Control. 2014 Oct;42(10 Suppl):S223-9. doi: 10.1016/j.ajic.2014.03.355..
Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Prevention, Practice Patterns, Quality Improvement
Armstrong EP, Wang SM, Hines LE
Prescriber perceptions of a near real-time fax alert program for potential drug-drug interactions.
The purpose of this study was to determine whether prescribers thought that near real-time fax alerts for potential drug-drug interactions (PDDIs) were a good way to communicate with them. The researchers found that physician perceptions of the value of the fax alerts were dependent on which combination of drugs was involved.
AHRQ-funded; HS017001
Citation: Armstrong EP, Wang SM, Hines LE .
Prescriber perceptions of a near real-time fax alert program for potential drug-drug interactions.
J Manag Care Spec Pharm. 2014 May;20(5):494-500a..
Keywords: Adverse Drug Events (ADE), Health Information Technology (HIT), Medication, Patient Safety, Practice Patterns
Pohl JM, Nath R, Zheng K
Use of a comprehensive patient safety tool in primary care practices.
This article describes experiences with the use of the Physician Practice Patient Safety Assessment tool in six safety net practices—three of which were primary care nurse-managed health centers and three were physician-led federally qualified health centers. The authors concluded that this tool has enormous relevance for primary care settings, especially those preparing themselves for patient-centered medical home status and meaningful use.
AHRQ-funded; HS017191.
Citation: Pohl JM, Nath R, Zheng K .
Use of a comprehensive patient safety tool in primary care practices.
J Am Assoc Nurse Pract 2013 Aug;25(8):415-8. doi: 10.1111/1745-7599.12021..
Keywords: Patient Safety, Primary Care, Patient-Centered Healthcare, Practice Patterns, Tools & Toolkits