National Healthcare Quality and Disparities Report
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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
26 to 50 of 12214 Research Studies DisplayedBarwise AK, Curtis S, Diedrich DA
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
The objectives of this planned qualitative study were to use machine learning predictive analytics to identify patients with language barriers and complex medical needs in order to prioritize them for in-person interpreters. The authors conducted semi-structured interviews with clinicians, interpreters, and staff involved in caring for patients or organizing interpreters to understand perceived risks and benefits of artificial intelligence (AI) in this domain. Perceived risks included concerns about transparency, accuracy, redundancy, privacy, stigmatization among patients, alert fatigue, and supply-demand issues; perceived benefits included increased awareness of in-person interpreters, improved standard of care, and prioritization for interpreter utilization. They concluded that the use of AI to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
AHRQ-funded; HS028475.
Citation: Barwise AK, Curtis S, Diedrich DA .
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
J Am Med Inform Assoc 2024 Feb 16; 31(3):611-21. doi: 10.1093/jamia/ocad224.
Keywords: Health Information Technology (HIT), Disparities, Communication, Clinician-Patient Communication
Iglesia EGA, Kwan M, Virkud YV
Management of food allergies and food-related anaphylaxis.
This paper discusses the management of IgE-mediated food-protein allergies that may cause anaphylaxis and death in addition to the allergic response to the food-carbohydrate galactose-α-1,3-galactose (alpha-gal) in mammalian meat. In the United States, 9 foods account for more than 90% of IgE-mediated food allergies: crustacean shellfish, dairy, peanut, tree nuts, fin fish, egg, wheat, soy, and sesame. Peanut allergies are the leading food-related cause of fatal and near-fatal anaphylaxis in the US, followed by tree nuts and shellfish. The estimated fatality rate from anaphylaxis is estimated to be 0.04 per million per year. Alpha-gal syndrome has been rising with a seroprevalence of 20% to 31% in the southeastern US. While avoidance of the culprit food is the main management strategy, if there is exposure use of the self-injectable epinephrine pen is the first-line treatment for food-related anaphylaxis. The FDA has just approved an oral immunotherapy product for treatment of peanut allergy, with other immunotherapies currently in development to desensitive one or more foods.
AHRQ-funded; HS026395.
Citation: Iglesia EGA, Kwan M, Virkud YV .
Management of food allergies and food-related anaphylaxis.
JAMA 2024 Feb 13; 331(6):510-21. doi: 10.1001/jama.2023.26857.
Keywords: Care Management
Semere W, Karter AJ, Lyles CR
Care partner engagement in secure messaging between patients with diabetes and their clinicians: cohort study.
This study based on a previous cohort study investigated secure messaging (SM) use among older diabetes patients, exploring the impact of care partners. Analyzing data from a large healthcare system's patient portal, proxy users, mainly older and with lower education, showed higher SM engagement. They initiated SM sooner, had more exchanges, yet didn't bridge existing disparities. Proxy involvement may enhance patient-clinician communication in diabetes care, warranting further research on its impact on clinical outcomes.
AHRQ-funded; HS027844.
Citation: Semere W, Karter AJ, Lyles CR .
Care partner engagement in secure messaging between patients with diabetes and their clinicians: cohort study.
JMIR Diabetes 2024 Feb 9; 9:e49491. doi: 10.2196/49491.
Keywords: Diabetes, Patient and Family Engagement, Clinician-Patient Communication
Kerlikowske K, Zhu W, Su YR
Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
This study compared using supplemental magnetic resonance imaging (MRI) with or without mammography to inform discussions about supplemental MRI in women with dense breasts. The authors evaluated 52, 237 women aged 40-79 years who underwent 2611 screening MRIs alone and 6518 supplemental MRI plus mammography pairs propensity score-matched to 65, 810 screening mammograms. They estimated rates per 1000 examinations of interval, advanced, and screen-detected early-stage invasive cancers and false-positive recall and biopsy recommendation by breast density (nondense = almost entirely fatty or scattered fibroglandular densities; dense = heterogeneously/extremely dense) adjusting for registry, examination year, age, race and ethnicity, family history of breast cancer, and prior breast biopsy. Screen-detected early-stage cancer rates were statistically higher for MRI plus mammography vs mammography for nondense (9.3 vs 2.9) and dense (7.5 vs 3.5) breasts and for MRI vs MRI plus mammography for dense breasts (19.2 vs 7.5). Interval rates were not statistically different for MRI plus mammography vs mammography for nondense (0.8 vs 0.5) or dense breasts (1.5 vs 1.4), nor were advanced cancer rates. MRI plus mammography had statistically higher false-positive recall and biopsy recommendation rates than mammography alone.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Zhu W, Su YR .
Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
J Natl Cancer Inst 2024 Feb 8; 116(2):249-57. doi: 10.1093/jnci/djad201.
Keywords: Imaging, Cancer
Hernandez SE, Solomon D, Moon J
Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions.
Researchers described their fluoroquinolone restriction for the prevention of Clostridioides difficile infection (FIRST) trial, a multisite clinical study which used an electronic health record-based best-practice alert to optimize the use of fluoroquinolone antibiotics in acute care settings. Their goals were to describe the roles and responsibilities of clinical implementation coordinators within antibiotic stewardship teams and to identify facilitators and barriers coordinators experienced within the implementation process. The researchers conducted directed content analysis of semistructured interviews, implementation diaries, and check-in meetings. Their results indicated that clinical implementation coordinators facilitated the implementation process via their roles and responsibilities and acted as strategic partners in the improvement of adoption and sustainability of a fluoroquinolone preauthorization protocol.
AHRQ-funded; HS026226.
Citation: Hernandez SE, Solomon D, Moon J .
Understanding clinical implementation coordinators' experiences in deploying evidence-based interventions.
Am J Health Syst Pharm 2024 Feb 8; 81(4):120-28. doi: 10.1093/ajhp/zxad272.
Keywords: Evidence-Based Practice, Implementation, COVID-19
Anderson KE, Wu RJ, Darden M
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
To discover whether Medicare Advantage enrollees have a lower utilization of elective surgical procedures such as inpatient hip and knee total joint arthroplasty (TJA), which have usually been covered by traditional Medicare without restrictions, researchers conducted a cross-sectional study comparing traditional Medicare claims and Medicare Advantage encounter records for enrollees aged 65-85. Their results showed a lower incidence of TJA in Medicare Advantage enrollees. The interval from initial diagnosis to contact with an orthopedic surgeon and to the surgical procedure were shorter among traditional enrollees.
AHRQ-funded; HS000029.
Citation: Anderson KE, Wu RJ, Darden M .
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
J Bone Joint Surg Am 2024 Feb 7; 106(3):198-205. doi: 10.2106/jbjs.23.00507..
Keywords: Medicare, Orthopedics, Surgery
Paglino E, Lundberg DJ, Wrigley-Field E
Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths.
The authors indicate that in the United States, excess deaths reported to non-COVID-19 natural causes may represent unrecognized COVID-19 deaths, deaths caused by interruptions in health care during the pandemic, and/or deaths from the socioeconomic impacts of the pandemic. The researchers created a Bayesian hierarchical model to produce monthly estimates of excess natural-cause mortality for US counties over the first 30 months of the pandemic. The study found that from March 2020 through August 2022, 1,194,610 excess natural-cause deaths occurred nationally. A total of 162,886 of these excess natural-cause deaths were not reported to COVID-19. Overall, 15.8 excess deaths were reported to non-COVID-19 natural causes for every 100 reported COVID-19 deaths. This number was higher in nonmetropolitan counties, the West, and the South. In comparison, reported COVID-19 death counts were greater than estimates of excess natural-cause deaths in metropolitan counties in the New England and Middle Atlantic states. Increases in reported COVID-19 deaths were temporally associated with increases in excess deaths reported to non-COVID-19 natural causes in the same and/or previous month.
AHRQ-funded; HS013853.
Citation: Paglino E, Lundberg DJ, Wrigley-Field E .
Excess natural-cause mortality in US counties and its association with reported COVID-19 deaths.
Proc Natl Acad Sci U S A 2024 Feb 6; 121(6):e2313661121. doi: 10.1073/pnas.2313661121..
Keywords: COVID-19, Mortality
Dayao JKO, Duffy CEL, Cristiano AM
Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system.
The objective of this study was to evaluate the feasibility, implementation, and effectiveness of the Exercise is Medicine (EIM) initiative. Researchers used a combination of the Practical Robust Implementation and Sustainability Model (PRISM) and the Learning Evaluation model to implement EIM; data was collected from the EHR, including Physical Activity Vital Sign (PAVS) scores, and also from qualitative surveys and interviews with the patients, clinicians, and staff of 5 primary care clinics within a large academic health system. The results indicated that EIM is feasible for routine primary care practice within a large academic health system. The researchers concluded that EIM is a model to emulate to help primary care providers address healthy lifestyle behaviors more efficiently.
AHRQ-funded; HS026517.
Citation: Dayao JKO, Duffy CEL, Cristiano AM .
Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system.
Fam Med Community Health 2024 Feb 2; 12(1):e002608. doi: 10.1136/fmch-2023-002608..
Keywords: Primary Care, Lifestyle Changes, Health Promotion, Implementation
Gladen KM, Tellez D, Napolitano N
Adverse tracheal intubation events in critically ill underweight and obese children: retrospective study of the National Emergency Airway for Children Registry (2013-2020).
This retrospective cohort study’s aim was to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. The National Emergency Airway for Children registry dataset of 2013-2020 was used to identify 24,342 critically ill children who underwent TI between 2013 and 2020. Underweight was most common in infants (34%); and obesity was most common in children older than 8 years old (15.1%). The underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients. TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; and obesity: aOR, 1.22).
AHRQ-funded; HS024511.
Citation: Gladen KM, Tellez D, Napolitano N .
Adverse tracheal intubation events in critically ill underweight and obese children: retrospective study of the National Emergency Airway for Children Registry (2013-2020).
Pediatr Crit Care Med 2024 Feb; 25(2):147-58. doi: 10.1097/pcc.0000000000003387..
Keywords: Children/Adolescents, Critical Care
Sleath B, Beznos B, Carpenter DM
African American patient-provider communication about glaucoma vision quality-of-life.
A study was conducted to examine African American patient-provider communication about glaucoma-related quality-of-life. Patients completed a vision quality-of-life assessment to examine patient-provider characteristics, patient demographics, and socio-demographics. The study determined that patients with worse literacy, more severe glaucoma, or depression are likely to have a lower vision quality-of-life.
AHRQ-funded; HS025370.
Citation: Sleath B, Beznos B, Carpenter DM .
African American patient-provider communication about glaucoma vision quality-of-life.
Eye 2024 Feb; 38(2):343-48. doi: 10.1038/s41433-023-02693-8..
Keywords: Eye Disease and Health, Racial and Ethnic Minorities, Clinician-Patient Communication, Communication, Quality of Life
Hogg-Graham R, Benitez JA, Lacy ME
Association between community social vulnerability and preventable hospitalizations.
The purpose of this study was to explore the relationship between variations in social vulnerability and preventable hospitalization rates. The researchers analyzed county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). The study found that preventable hospitalizations were 40% greater in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations.
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Benitez JA, Lacy ME .
Association between community social vulnerability and preventable hospitalizations.
Med Care Res Rev 2024 Feb; 81(1):31-38. doi: 10.1177/10775587231197248..
Keywords: Hospitalization, Social Determinants of Health
Carroll AR, Hall M, Noelke C
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
This study examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. Exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children, which measures at 21.02 hospitalizations per 1000. Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased, from 26.56 per 1000 in very low COI areas to 14.76 per 1000 in very high COI areas (incidence rate ratio 1.8). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in the study.
AHRQ-funded; HS026122.
Citation: Carroll AR, Hall M, Noelke C .
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
J Hosp Med 2024 Feb; 19(2):120-25. doi: 10.1002/jhm.13252..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitalization, Social Determinants of Health
Auty SG, Daw JR, Admon LK
Comparing approaches to identify live births using the Transformed Medicaid Statistical Information System.
The objective of this study was to evaluate the performance of five approaches to identifying live births using Transformed Medicaid Statistical Information System Analytic Files (TAF). The approaches each used a different combination of diagnosis and procedure, revenue, and place of service codes to identify live births. The findings showed that Approach 4 achieved the best match of birth counts relative to CDC birth record data; Approaches 1 and 3 resulted in overcounts of births and Approaches 2 and 5 resulted in undercounts. The authors concluded that including claims from both inpatient and other services files, and excluding codes unrelated to the delivery episode, improved accuracy of live birth identification in the TAF data.
AHRQ-funded; HS028754; HS027640.
Citation: Auty SG, Daw JR, Admon LK .
Comparing approaches to identify live births using the Transformed Medicaid Statistical Information System.
Health Serv Res 2024 Feb; 59(1):e14233. doi: 10.1111/1475-6773.14233..
Keywords: Medicaid, Research Methodologies
Auerbach AD, Lee TM, Hubbard CC
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
The objective of this retrospective cohort study was to determine the prevalence, underlying causes, and harms of diagnostic errors in hospitalized adults who were transferred to an intensive care unit or who died. Data was taken from 29 academic medical centers in the U.S. in a random sample of adults hospitalized with general medical conditions. Errors were found to have contributed to temporary harm, permanent harm, or death in nearly 18% of patients; among patients who died, diagnostic error was judged to have contributed to death in 6.6% of cases. The researchers noted that problems with choosing and interpreting tests and the processes involved with clinician assessment were a high priority for improvement efforts.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Lee TM, Hubbard CC .
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
JAMA Intern Med 2024 Feb; 184(2):164-73. doi: 10.1001/jamainternmed.2023.7347..
Keywords: Diagnostic Safety and Quality, Medical Errors, Hospitals, Inpatient Care, Quality of Care, Patient Safety, Adverse Events
Beznos B, Sayner R, Carpenter DM
Do African American patients with glaucoma ask their eye providers the questions they have?
The objective of this randomized controlled trial was to test the effectiveness of a pre-visit video/glaucoma question prompt-list to increase question-asking during medical visits. Participants were adult African American patients with glaucoma and a history of non-adherence to glaucoma medications, The questions that patients checked on the question prompt list were described, and how often the same checked questions were asked during medical visits noted. The findings indicated that although patients with glaucoma had questions about glaucoma and their medications, few asked all their questions during visits. The researchers concluded that future research should focus on ways to improve question asking using a question prompt list.
AHRQ-funded; HS025370.
Citation: Beznos B, Sayner R, Carpenter DM .
Do African American patients with glaucoma ask their eye providers the questions they have?
Eye 2024 Feb; 38(2):279-83. doi: 10.1038/s41433-023-02674-x..
Keywords: Racial and Ethnic Minorities, Eye Disease and Health, Clinician-Patient Communication, Communication
Mattioli DD, Thomas GW, Long S
Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation skill.
This study evaluated best methods to assess surgical wire navigation skill, which can be objectively evaluated by analysis of intraoperative fluoroscopic image sequences. Prior work suggests that such image-based behavior analysis of operating room (OR) performance can predict performer experience level and agree with expert opinion (the current standard) on the quality of a final implant construct. Objective image-based evaluations were compared to expert assessments for entire technical OR performances. The relationship of three key variables were studied: (1) objective image-based criteria, (2) expert opinions, and (3) performing surgeon experience level. The authors used a paired-comparison survey of seven experts, based upon eight OR fluoroscopic wire navigation image sequences, which showed that the experts' preferences are best explained by objective metrics that reflect psychomotor and decision-making behaviors which are counter-productive to successful implant placement, like image count and behavior tally. One such behavior, adjustments away from goal, uniquely correlated well with all three key variables: a fluoroscopic image-based analysis composite score, expert consensus, and performer experience. The results confirmed that experts view less efficient technical behavior as indicative of lesser technical proficiency.
AHRQ-funded; HS022077; HS025353.
Citation: Mattioli DD, Thomas GW, Long S .
Fluoroscopic image-based behavior analysis can objectively explain subjective expert assessment of wire navigation skill.
J Orthop Res 2024 Feb; 42(2):404-14. doi: 10.1002/jor.25685..
Keywords: Surgery, Orthopedics
Post B, Hollenbeck BK, Norton EC
Hospital-physician integration and clinical volume in traditional Medicare.
The purpose of this study was to test the effect of hospital-physician integration on primary care physicians' (PCP) clinical volume in traditional Medicare. The researchers identified 70,000 PCPs, some of whom remained non-integrated and some who became hospital-integrated during this study period. An event study design was utilized to identify the effect of integration on key measures of physicians' clinical volume, including the number of claims, work-relative value units (RVUs), professional revenue generated, number of patients treated, and facility fee revenue generated. The study found that per-physician clinical volume declined by statistically and economically significant margins. Relative to the comparison group who remained non-integrated, work RVUs fell by 7%; the number of patients treated fell by 4%; and claims volume among PCPs who became hospital-integrated fell by over 15%.
AHRQ-funded; HS027044; HS025707.
Citation: Post B, Hollenbeck BK, Norton EC .
Hospital-physician integration and clinical volume in traditional Medicare.
Health Serv Res 2024 Feb; 59(1):e14172. doi: 10.1111/1475-6773.14172..
Keywords: Medicare, Primary Care, Healthcare Delivery, Provider: Physician
Dalal AK, Schnipper JL, Raffel K
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
This paper describes the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study, whose aim was to define the prevalence and underlying causes of diagnostic errors (DEs) in patients who die in the hospital or are transferred to the intensive care unit (ICU) after the first 48 hours. This study was conducted at 31 hospitals with more than 2500 cases reviewed using electronic health records. The authors identified some insights into key requirements into building a robust DE surveillance program by developing these steps: 1) Develop a shared understanding of what constitutes a diagnostic error; 2) Use validated tools to identify diagnostic errors and classify process failures, but respect your context; 3) Develop a standard approach to using electronic health records for case reviews; 4) Ensure reliability and consistency of the case review process; and 5) Link diagnostic error case reviews to institutional safety programs. They also developed steps to establish a diagnosis error review process at the hospital level with six processes.
AHRQ-funded; HS027369; HS026613.
Citation: Dalal AK, Schnipper JL, Raffel K .
Identifying and classifying diagnostic errors in acute care across hospitals: early lessons from the Utility of Predictive Systems in Diagnostic Errors (UPSIDE) study.
J Hosp Med 2024 Feb; 19(2):140-45. doi: 10.1002/jhm.13136..
Keywords: Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Quality of Care, Hospitals
Hoffman GJ, Alexander Nb, Ha J
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
This study’s objective was to assess whether the Medicare Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs). The authors looked at secondary data from Medicare to assess changes in 30- and 90-day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus "non-targeted" (gastrointestinal) conditions. They tested for modification by hospitals with "high-risk" before HRRP and accounted for potential upcoding. They also explored changes in 30-day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities). They identified 1.5 million (522,596 pre-HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%-20% reductions in 30- and 90-day FRI readmissions for patients with CHF (-0.42 percentage points [ppt]) and AMI (-0.35). Two years after implementation, HRRP was associated with reductions in 90-day FRI readmission for AMI (-1.27 ppt) and CHF (-0.98 ppt) patients. After HRRP's announcement, decreases were observed in home health (AMI: -2.43 ppt; CHF: -8.83 ppt; pneumonia: -1.97 ppt) and skilled nursing facility referrals (AMI: -5.95 ppt; CHF: -3.19 ppt; pneumonia: -10.27 ppt).
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Alexander Nb, Ha J .
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
Health Serv Res 2024 Feb; 59(1):e14246. doi: 10.1111/1475-6773.14246..
Keywords: Hospital Readmissions, Medicare, Falls
Fleming MD, Safaeinili N, Knox M
Organizational and community resilience for COVID-19 and beyond: leveraging a system for health and social services integration.
This case study paper examined how a preexisting initiative to align health care, public health, and social services influenced COVID-19 pandemic response. In-depth interviews were conducted with administrators and frontline staff in health care, public health, and social services in Contra Costa County, California from October 2020 to May 2021. The authors interviewed 31 informants including 14 managers in public health, health care, or social services and 17 social needs case managers who coordinated services across these sectors on behalf of patients. They identified four distinct components of the county's system alignment capabilities that supported COVID-19 response, including (1) an organizational culture of adaptability fostered through earlier system alignment efforts, which included the ability and willingness to rapidly implement new organizational processes, (2) trusting relationships among organizations based on prior, positive experiences of cross-sector collaboration, (3) capacity to monitor population health of historically marginalized community members, including information infrastructures, data analytics, and population monitoring and outreach, and (4) frontline staff with flexible skills to support health and social care who had built relationships with the highest risk community members.
AHRQ-funded; HS027648.
Citation: Fleming MD, Safaeinili N, Knox M .
Organizational and community resilience for COVID-19 and beyond: leveraging a system for health and social services integration.
Health Serv Res 2024 Feb; 59(suppl 1):e14250. doi: 10.1111/1475-6773.14250..
Keywords: COVID-19, Social Determinants of Health
Patel MD, Lin P, Cheng Q
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
The purpose of this multi-site retrospective study was to assess differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, factoring in age, clinical factors, and ED operating conditions. The study assessed differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. For the study outcome, ESI levels were grouped into three categories: 1-2 (highest acuity), 3, and 4-5 (lowest acuity). The researchers analyzed patient-level data from three EDs affiliated with a large Southeastern United States health system. The study found 186,840 eligible ED visits with 56,417 from an academic ED, 69,698 from a metropolitan community ED, and 60,725 from a rural community ED. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females had a lower likelihood of being assigned ESI 1-2 compared to White males although both groups were roughly comparable in the assignment of ESI 4-5. Non-White and Hispanic females were generally least likely to be assigned ESI 1-2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant.
AHRQ-funded; HS029078.
Citation: Patel MD, Lin P, Cheng Q .
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
Am J Emerg Med 2024 Feb; 76:29-35. doi: 10.1016/j.ajem.2023.11.008..
Keywords: Emergency Department, Disparities, Racial and Ethnic Minorities
Jindal M, Barnert E, Chomilo N
AHRQ Author: Mistry KB
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
This partly AHRQ-authored paper is part of a series on Racism and Child Health in the USA, which builds on Paper 1's summary of existing disparities in health-care delivery and highlights policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improves the health of racially and ethnically minoritized children. The authors discuss current and historical policy approaches across housing, employment, health insurance, immigration, and criminal which have the potential to affect child health equity. They commented that these policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. If these policy efforts do not directly address structural racism, they will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism.
AHRQ-authored.
Citation: Jindal M, Barnert E, Chomilo N .
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
Lancet Child Adolesc Health 2024 Feb; 8(2):159-74. doi: 10.1016/s2352-4642(23)00262-6..
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Policy
Steuart R, Pan AY, Woolums A
Respiratory culture growth and 3-years lung health outcomes in children with bronchopulmonary dysplasia and tracheostomies.
The goal of this cohort study is to determine the long-term effects of pathogenic identification on respiratory cultures in children. The study included infants and children with BPD and tracheostomies. The cohort study conclusions suggest that respiratory pathogens including P. aeruginosa may not promote long-term respiratory dysfunction, but identification of P. aeruginosa may delay decannulation.
AHRQ-funded; HS025138.
Citation: Steuart R, Pan AY, Woolums A .
Respiratory culture growth and 3-years lung health outcomes in children with bronchopulmonary dysplasia and tracheostomies.
Pediatr Pulmonol 2024 Feb; 59(2):300-13. doi: 10.1002/ppul.26746..
Keywords: Children/Adolescents, Respiratory Conditions, Outcomes
Ali KJ, Goeschel CA, Eckroade MM
The TeamSTEPPS for improving diagnosis team assessment tool: scale development and psychometric evaluation.
The authors developed and evaluated the TeamSTEPPS Improving Diagnosis Team Assessment Tool (TAT), which assesses diagnostic teamwork and communication in five critical domains. The TAT was administered as a cross-sectional survey to health professionals in nine diverse US health systems. A psychometric evaluation demonstrated that the TAT was a reliable and valid instrument for assessing teamwork and communication among and across diagnostic teams. The authors concluded that TAT added a novel, evidence-based measurement tool.
AHRQ-funded; 233201500022I.
Citation: Ali KJ, Goeschel CA, Eckroade MM .
The TeamSTEPPS for improving diagnosis team assessment tool: scale development and psychometric evaluation.
Jt Comm J Qual Patient Saf 2024 Feb; 50(2):95-103. doi: 10.1016/j.jcjq.2023.08.009..
Keywords: Diagnostic Safety and Quality, Teams, TeamSTEPPS
Van Damme DM, McRae EM, Irving SY
Tracheal intubation by advanced practice registered nurses in pediatric critical care: retrospective study from the National Emergency Airway for Children Registry (2015-2019).
A study was conducted from 2015-2019 to compare the success rates of tracheal intubation (TI) administered by advanced practice registered nurses (APRNs), vs. more experienced clinicians. It also compared the rates of TI-associated events (TIAE). The study subjects were critically ill children in need of tracheal intubation. The findings indicated a lower TI success rate for APRNs when compared to more experienced clinicians. The study did not find significant differences in adverse events.
AHRQ-funded; HS024511.
Citation: Van Damme DM, McRae EM, Irving SY .
Tracheal intubation by advanced practice registered nurses in pediatric critical care: retrospective study from the National Emergency Airway for Children Registry (2015-2019).
Pediatr Crit Care Med 2024 Feb; 25(2):139-46. doi: 10.1097/pcc.0000000000003386..
Keywords: Children/Adolescents, Critical Care, Nursing