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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
1 to 25 of 30 Research Studies DisplayedChase AM, Forehand CC, Keats KR
Evaluation of critical care pharmacist evening services at an academic medical center.
This study’s purpose was to investigate the number of interventions, type of interventions, and associated cost savings with the addition of 1 board certified critical care clinical pharmacist to evening shift. Over a 12-week period, a prospective collection and characterization of 1 evening shift critical care pharmacist’s clinical interventions was conducted. Interventions were collected and categorized daily from 1 pm to 11 pm Monday through Friday. The authors collected a total of 510 interventions with an average of 9.8 interventions accepted per day. The highest proportion of interventions occurred in the medical intensive care unit, and the most common interventions included transitions of care, medication dose adjustment, and antibiotic de-escalation. They calculated an estimated cost avoidance of $66,537.80 for an average of $1279.57 saved per day. Additionally, 4.1% of interventions were considered high yield interventions upon independent review by 2 pharmacists.
AHRQ-funded; HS029009; HS028485.
Citation: Chase AM, Forehand CC, Keats KR .
Evaluation of critical care pharmacist evening services at an academic medical center.
Hosp Pharm 2024 Apr; 59(2):228-33. doi: 10.1177/00185787231207996..
Keywords: Provider: Pharmacist, Medication, Critical Care
Ducharme-Crevier L, Furlong-Dillard J, Jung P
Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU).
This study examined the safety of using primary nasal tracheal intubation (TI) in the pediatric intensive care unit (PICU), which is a minority of all TI procedures. The authors evaluated the association between TI route and safety outcomes in a prospectively collected quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from 2013 to 2020. The primary outcome was severe desaturation and/or severe adverse TI-associated events (TIAEs), using NEAR4KIDS definitions. A total of 22,741 TIs were reported from 60 PICUs, with the majority (96.2%) oral and 3.8% nasal. Infants were represented in higher proportion in the nasal TI than the oral TI (75.9%, vs 46.2%), as well as children with cardiac conditions (46.9% vs. 14.4%). Severe desaturation or severe TIAE occurred in 23.7% of nasal and 22.5% of oral TI. With propensity score (PS) matching, the prevalence of severe desaturation and or severe adverse TIAEs was 23.6% of nasal vs. 19.8% of oral TI (absolute difference 3.8%). First attempt success rate was 72.1% of nasal TI versus 69.2% of oral TI. With PS matching, the overall success rate was not different between two groups (nasal 72.2% vs. oral 71.5%).
AHRQ-funded; HS024511.
Citation: Ducharme-Crevier L, Furlong-Dillard J, Jung P .
Safety of primary nasotracheal intubation in the pediatric intensive care unit (PICU).
Intensive Care Med Paediatr Neonatal 2024; 2(1):7. doi: 10.1007/s44253-024-00035-4..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Patient Safety, Critical Care
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
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
Loi MV, Lee JH, Huh JW
Ketamine use in the intubation of critically ill children with neurological indications: a multicenter retrospective analysis.
This study examined use of ketamine in children undergoing tubal intubation (TI) for a primary neurological indication. The authors conducted a retrospective observational cohort study of critically ill children undergoing TI for neurological indications in 53 international pediatric intensive care units and emergency departments. They screened all intubations from 2014 to 2020 entered into the multicenter National Emergency Airway Registry for Children (NEAR4KIDS) registry database. Of 21,562 TIs, 2,073 were performed for a primary neurological indication, including 190 for traumatic brain injury/trauma. Patients received ketamine in 495 TIs (23.9%), which increased from 10% in 2014 to 41% in 2020. Criteria for ketamine use includes a coindication of respiratory failure, difficult airway history, and use of vagolytic agents, apneic oxygenation, and video laryngoscopy. Composite adverse outcomes were reported in 289 (13.9%) TIs and were more common in the ketamine group (17.0% vs. 13.0%). After adjusting for location, patient age and co-diagnoses, the presence of respiratory failure and shock, difficult airway history, provider demographics, intubating device, and the use of apneic oxygenation, vagolytic agents, and neuromuscular blockade, ketamine use was not significantly associated with increased composite adverse outcomes. This paucity of association remained even when only neurotrauma intubations were considered (10.6% vs. 7.7%).
AHRQ-funded; HS022464, HS024511.
Citation: Loi MV, Lee JH, Huh JW .
Ketamine use in the intubation of critically ill children with neurological indications: a multicenter retrospective analysis.
Neurocrit Care 2024 Feb; 40(1):205-14. doi: 10.1007/s12028-023-01734-0.
Keywords: Children/Adolescents, Critical Care, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Sick-Samuels AC, Koontz DW, Xie A
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
A survey of medical professionals from 16 different academic pediatric hospitals was conducted from May 2021-January 2022. The goal of the survey was to examine respiratory culture practices, drivers, and barriers in mechanically ventilated patients. The study concluded that respiratory culture practices were inconsistent.
AHRQ-funded; HS028634.
Citation: Sick-Samuels AC, Koontz DW, Xie A .
A survey of PICU clinician practices and perceptions regarding respiratory cultures in the evaluation of ventilator-associated infections in the BrighT STAR Collaborative.
Pediatr Crit Care Med 2024 Jan; 25(1):e20-e30. doi: 10.1097/pcc.0000000000003379..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Critical Care, Healthcare-Associated Infections (HAIs)
Qureshi N, Kroger J, Zangwill KM
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
The purpose of this study was to assess clinician perceptions towards the value and implementation of antibiotic stewardship (AS) in neonatal intensive care units (NICU). The researchers conducted a mixed-methods study of AS perceptions utilizing surveys and interviews in 30 California NICUs before and after a multicenter collaborative (Optimizing Antibiotic Use in California NICUs [OASCN]). The study found that pre-OASCN, 24% of respondents believed there was "a lot of" or "some" inappropriate prescribing, often driven by fear of a bad outcome or hesitation to change existing practices. Clinicians reported statistically significant increases in AS importance, perceived AS activity, and more openness to change after OASCN.
AHRQ-funded; HS026168.
Citation: Qureshi N, Kroger J, Zangwill KM .
Changes in perceptions of antibiotic stewardship among neonatal intensive care unit providers over the course of a learning collaborative: a prospective, multisite, mixed-methods evaluation.
J Perinatol 2024 Jan; 44(1):62-70. doi: 10.1038/s41372-023-01823-0..
Keywords: Antibiotics, Antimicrobial Stewardship, Newborns/Infants, Intensive Care Unit (ICU), Critical Care
Admon AJ, Seymour CW, Gershengorn HB
Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism.
The researchers examined the relationship between intensive care unit (ICU) use for patients with pulmonary embolism (PE) and cost, mortality, readmission, and procedure use in 263 hospitals. They found wide variations in ICU admission rates for acute PE without a detectable impact on mortality, cost, or readmission.
AHRQ-funded; HS020672
Citation: Admon AJ, Seymour CW, Gershengorn HB .
Hospital-level variation in ICU admission and critical care procedures for patients hospitalized for pulmonary embolism.
Chest. 2014 Dec;146(6):1452-61. doi: 10.1378/chest.14-0059..
Keywords: Blood Clots, Care Management, Critical Care, Healthcare Delivery, Intensive Care Unit (ICU)
Berner ES, Burkhardt JH, Panjamapirom A
Cost implications of human and automated follow-up in ambulatory care.
This study tracked costs associated with using nurse-initiated telephone calls or interactive voice response (IVR) over the first two years of followup for a practice assumed to have 4800 acute care patient visits per year. For the first two years, costs were approximately the same but, in subsequent years, IVR followup is approximately $9000 per year less expensive than nurse followup.
AHRQ-funded; HS017060
Citation: Berner ES, Burkhardt JH, Panjamapirom A .
Cost implications of human and automated follow-up in ambulatory care.
Am J Manag Care. 2014 Nov;20(11 Spec No. 17):SP531-40..
Keywords: Healthcare Costs, Primary Care, Quality of Care, Critical Care
Balamuth F, Weiss SL, Neuman MI
Pediatric severe sepsis in U.S. children's hospitals.
The objective of this study was to compare epidemiological trends in the prevalence, resource utilization, and mortality of pediatric patients with severe sepsis and septic shock. The researchers found that the prevalence of severe sepsis/septic shock has increased in the studied U.S. children’s hospitals between 2004 and 2012, whereas resource utilization and mortality have decreased over that time period.
AHRQ-funded; HS021114
Citation: Balamuth F, Weiss SL, Neuman MI .
Pediatric severe sepsis in U.S. children's hospitals.
Pediatr Crit Care Med. 2014 Nov;15(9):798-805. doi: 10.1097/pcc.0000000000000225..
Keywords: Hospitals, Children/Adolescents, Critical Care
Cooke CR, Iwashyna TJ
Sepsis mandates: improving inpatient care while advancing quality improvement.
In light of improvements in the care of the acutely ill hospitalized patients and changes in the epidemiology of hospital care, the authors recommend new quality mandates focused on sepsis. These mandates should: (1) address the reality that sepsis is frequently underdiagnosed, (2) focus on catalyzing and aggregating local efforts for quality improvements, and (3) plan for a phased implementation, improving measures in select sites prior to national roll-out.
AHRQ-funded; HS020672
Citation: Cooke CR, Iwashyna TJ .
Sepsis mandates: improving inpatient care while advancing quality improvement.
JAMA. 2014 Oct 8;312(14):1397-8. doi: 10.1001/jama.2014.11350..
Keywords: Quality of Care, Hospitalization, Inpatient Care, Critical Care, Sepsis
Ramnath VR, Khazeni N
Centralized monitoring and virtual consultant models of tele-ICU care: a side-by-side review.
This side-by-side review directly compares the Centralized Monitoring and Virtual Consultant tele-ICU Models. The Centralized Monitoring tele-ICU Model showed improved mortality and/or length of stay and staff acceptance, particularly in rural or specific patient populations, but with high costs and unclear savings. The Virtual Consultant Model could not be adequately evaluated for effects on clinical outcomes or staff acceptance given minimal data; however, it can be both portable and implemented at a lower cost profile. Improved compliance with clinical practice guidelines was seen in both models. Further study is recommended.
AHRQ-funded; HS019816.
Citation: Ramnath VR, Khazeni N .
Centralized monitoring and virtual consultant models of tele-ICU care: a side-by-side review.
Telemed J E Health 2014 Oct;20(10):962-71. doi: 10.1089/tmj.2014.0024.
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Keywords: Critical Care, Comparative Effectiveness, Quality of Care, Intensive Care Unit (ICU), Telehealth
Ramnath VR, Ho L, Maggio LA
Centralized monitoring and virtual consultant models of tele-ICU care: a systematic review.
This systematic literature review compares the Centralized Monitoring and Virtual Consultant tele-ICU Models. Compared with the Virtual Consultant tele-ICU Model, studies addressing the Centralized Monitoring Model of tele-ICU care were greater in quantity and sample size, with qualitative conclusions of clinical outcomes, staff satisfaction and workload, and financial sustainability largely consistent with past systematic reviews.
AHRQ-funded; HS019816.
Citation: Ramnath VR, Ho L, Maggio LA .
Centralized monitoring and virtual consultant models of tele-ICU care: a systematic review.
Telemed J E Health 2014 Oct;20(10):936-61. doi: 10.1089/tmj.2013.0352.
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Keywords: Critical Care, Comparative Effectiveness, Quality of Care, Intensive Care Unit (ICU), Telehealth
Patrick SW, Kawai AT, Kleinman K
Health care-associated infections among critically ill children in the US, 2007-2012.
The researchers examined trends in central line-associated blood stream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP) incidence rates between 2007 and 2012 based on standardized surveillance data from pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) in the United States. They found that incidence rates of CLABSIs and VAPs decreased among critically ill neonates and children during this period.
AHRQ-funded; HS018414.
Citation: Patrick SW, Kawai AT, Kleinman K .
Health care-associated infections among critically ill children in the US, 2007-2012.
Pediatrics 2014 Oct;134(4):705-12. doi: 10.1542/peds.2014-0613..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Urinary Tract Infection (UTI), Critical Care, Children/Adolescents, Healthcare-Associated Infections (HAIs)
Bakullari A, Metersky ML, Wang Y
Racial and ethnic disparities in healthcare-associated infections in the United States, 2009-2011.
This study examined racial and ethnic disparities in the occurrence of healthcare-associated infections (HAIs) in 79,019 Medicare patients hospitalized with acute cardiovascular disease, pneumonia, and major surgery. It found that Asian and Hispanic patients, but not non-Hispanic blacks, had significantly higher rates of HAIs than white non-Hispanic patients.
AHRQ-funded; 290201200003C
Citation: Bakullari A, Metersky ML, Wang Y .
Racial and ethnic disparities in healthcare-associated infections in the United States, 2009-2011.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S10-6. doi: 10.1086/677827..
Keywords: Healthcare-Associated Infections (HAIs), Disparities, Racial and Ethnic Minorities, Critical Care, Patient Safety
Brown SE, Rey MM, Pardo D
The allocation of intensivists' rounding time under conditions of intensive care unit capacity strain.
This single-center study of 566 patients provides the first description of how ICU physicians allocate time spent on patient rounds and how this allocation changes as ICUs become strained. Daily rounding time increased with increases in census and admissions, but less time was spent per patient, primarily affecting new admissions and nonblack follow-up patients. Neither patient age, sex, acuity, and severity of illness nor the presence of family on rounds affected the allocation of rounding time.
AHRQ-funded; HS018406
Citation: Brown SE, Rey MM, Pardo D .
The allocation of intensivists' rounding time under conditions of intensive care unit capacity strain.
Am J Respir Crit Care Med. 2014 Oct 1;190(7):831-4. doi: 10.1164/rccm.201406-1127LE..
Keywords: Intensive Care Unit (ICU), Critical Care, Care Coordination
Eckenrode S, Bakullari A, Metersky ML
The association between age, sex, and hospital-acquired infection rates: results from the 2009-2011 National Medicare Patient Safety Monitoring System.
The researchers, using six different measures of hospital-acquired infections (HAIs), analyzed data from a large national sample of patients admitted to the hospital with acute cardiovascular disease, pneumonia, and major surgery to determine to determine age- and sex-related differences in HAI rates. They found that there are no simple ways to focus HAI-prevention efforts based solely on age or sex.
AHRQ-funded; 290201200003C
Citation: Eckenrode S, Bakullari A, Metersky ML .
The association between age, sex, and hospital-acquired infection rates: results from the 2009-2011 National Medicare Patient Safety Monitoring System.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S3-9. doi: 10.1086/677831..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Medicare, Critical Care
Berner ES, Ray MN, Panjamapirom A
Exploration of an automated approach for receiving patient feedback after outpatient acute care visits.
The authors' objective was to provide post-visit feedback to physicians on patient outcomes following acute care visits. They found that many patients who do not improve as expected do not take action to further address unresolved problems. They suggested that systematic follow-up/feedback mechanisms can potentially identify and connect such patients to needed care.
AHRQ-funded; HS017060.
Citation: Berner ES, Ray MN, Panjamapirom A .
Exploration of an automated approach for receiving patient feedback after outpatient acute care visits.
J Gen Intern Med 2014 Aug;29(8):1105-12. doi: 10.1007/s11606-014-2783-3.
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Keywords: Critical Care, Emergency Medical Services (EMS), Health Information Technology (HIT), Ambulatory Care and Surgery, Cancer
Drake FT, Mottey NE, Farrokhi ET
Time to appendectomy and risk of perforation in acute appendicitis.
This study sought to determine whether there is an association between time and perforation after acute appendicitis patients arrive at the hospital. Using data on 7,505 patients treated at 52 hospitals, they found that there was no association between perforation and in-hospital time prior to surgery among adults treated with appendectomy.
AHRQ-funded; SCOAP-CERTAIN
Citation: Drake FT, Mottey NE, Farrokhi ET .
Time to appendectomy and risk of perforation in acute appendicitis.
JAMA Surg. 2014 Aug;149(8):837-44. doi: 10.1001/jamasurg.2014.77..
Keywords: Surgery, Quality of Care, Patient Safety, Critical Care
Gadzinski AJ, Dimick JB, Ye Z
Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals.
This study evaluated discharge practice patterns and use of post-acute care after surgical admissions at critical access hospitals (CAHs). It found that for each of six common surgical procedures, a greater proportion of patients was transferred to another hospital. However, the proportion of patients at CAHs using post-acute care is equal to or less than that of patients treated in non-CAHs.
AHRQ-funded; HS018346
Citation: Gadzinski AJ, Dimick JB, Ye Z .
Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals.
JAMA Surg. 2014 Jul;149(7):671-7. doi: 10.1001/jamasurg.2013.5694..
Keywords: Surgery, Critical Care, Hospital Discharge, Quality of Care
Wehbe-Janek H, Pliego J, Sheather S
System-based interprofessional simulation-based training program increases awareness and use of rapid response teams.
The objective of this study was to develop and implement an interprofessional simulation-based training program for rapid response and cardiac arrest emergencies with emphasis on early recognition and effective communication. The researchers concluded that their study demonstrated that rapid response team underuse due to system barriers may be overcome by this type of program targeting specific needs of the institution.
AHRQ-funded; HS016634
Citation: Wehbe-Janek H, Pliego J, Sheather S .
System-based interprofessional simulation-based training program increases awareness and use of rapid response teams.
Jt Comm J Qual Patient Saf. 2014 Jun;40(6):279-87..
Keywords: Critical Care, Cardiovascular Conditions, Simulation, Training, Communication
Admon AJ, Cooke CR
Will Choosing Wisely(R) improve quality and lower costs of care for patients with critical illness?
This article reports on a campaign by the American Board of Internal Medicine to improve care and lower costs by generating a “top five” list of expensive tests or treatments without known benefits. It offers several strategies for stakeholders to increase the impact of the critical care top-five list.
AHRQ-funded; HS020672
Citation: Admon AJ, Cooke CR .
Will Choosing Wisely(R) improve quality and lower costs of care for patients with critical illness?
Ann Am Thorac Soc. 2014 Jun;11(5):823-7. doi: 10.1513/AnnalsATS.201403-093OI..
Keywords: Shared Decision Making, Critical Care, Quality of Care, Healthcare Costs
Lanspa MJ, Dickerson J, Morris AH
Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulin.
The researchers studied the association between coefficient of variation of glucose and mortality and also whether the association between glycemic variability and mortality was independent of hypoglycemia and other patient attributes. They found that blood glucose coefficient of variation was associated with 30-day mortality both in diabetic as well as in non-diabetic patients. The association was independent of hypoglycemia, blood glucose target, age, disease severity, and comorbidities.
AHRQ-funded; HS006594.
Citation: Lanspa MJ, Dickerson J, Morris AH .
Coefficient of glucose variation is independently associated with mortality in critically ill patients receiving intravenous insulin.
Crit Care 2014 Apr 30;18(2):R86. doi: 10.1186/cc13851..
Keywords: Critical Care, Mortality, Diabetes
Ballesca MA, LaGuardia JC, Le PC
An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines.
The researchers investigated the association between the use of an evidence-based, electronic order set (OS) for acute myocardial infarction (AMI) and better adherence to clinical practice guidelines among 5,789 patients hospitalized with AMI. They found that use of the electronic OS is associated with increased adherence to evidence-based therapies and lower 30-day mortality.
AHRQ-funded; HS018480
Citation: Ballesca MA, LaGuardia JC, Le PC .
An electronic order set for acute myocardial infarction is associated with improved patient outcomes through better adherence to clinical practice guidelines.
J Hosp Med 2014 Mar;9(3):155-61. doi: 10.1002/jhm.2149..
Keywords: Health Information Technology (HIT), Heart Disease and Health, Outcomes, Guidelines, Critical Care
Patel RB, Mathur MB, Gould M
Demographic and clinical predictors of mortality from highly pathogenic avian influenza A (H5N1) virus infection: CART analysis of international cases.
The researchers for this international study sought to model individuals at highest risk of mortality from HPAI N5N1 virus infection in order to inform preventive and therapeutic interventions. They found that age, health expenditure, delay from symptom onset to hospitalization and country are significant predictors of mortality.
AHRQ-funded; HS019816
Citation: Patel RB, Mathur MB, Gould M .
Demographic and clinical predictors of mortality from highly pathogenic avian influenza A (H5N1) virus infection: CART analysis of international cases.
PLoS One. 2014 Mar 25;9(3):e91630. doi: 10.1371/journal.pone.0091630..
Keywords: Influenza, Mortality, Critical Care, Hospitalization, Risk