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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 5 of 5 Research Studies DisplayedSchnipper JL, Raffel KE, Keniston A
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
This paper describes the protocol for a study that will build surveillance for hospital diagnostic errors into usual care, benchmark diagnostic performance across sites, pilot test interventions, and evaluate the program's impact on diagnostic error rates. The authors will test achieving diagnostic excellence through prevention and teamwork (ADEPT), a multicenter, real-world quality and safety program utilizing interrupted time-series techniques to evaluate outcomes. They will use a randomly sampled population of medical patients hospitalized at 16 US hospitals who died, were transferred to intensive care, or had a rapid response during the hospitalization. There will be surveillance for diagnostic errors on 10 events per month per site using a previously established two-person adjudication process. With guidance from national experts in quality and safety, study sites will report and benchmark diagnostic error rates, share lessons regarding underlying causes, and design, implement, and pilot test interventions using both Safety I and Safety II approaches aimed at patients, providers, and health systems. The primary outcome sought after will be the number of diagnostic errors per patient, using segmented multivariable regression to evaluate change in y-intercept and change in slope after initiation of the program.
AHRQ-funded; HS029366.
Citation: Schnipper JL, Raffel KE, Keniston A .
Achieving diagnostic excellence through prevention and teamwork (ADEPT) study protocol: a multicenter, prospective quality and safety program to improve diagnostic processes in medical inpatients.
J Hosp Med 2023 Dec; 18(12):1072-81. doi: 10.1002/jhm.13230..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality of Care, Hospitals, Inpatient Care
O'Leary KJ, Johnson JK, Williams MV
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
The objective of this pragmatic controlled trial was to evaluate the effect of interventions to redesign hospital care delivery on teamwork and patient outcomes. Survey participants were healthcare professionals and hospitalized medical patients in medical units at four U.S. hospitals. The results showed that the median teamwork climate score was higher after the intervention among nurses, but that interventions to redesign care for hospitalized patients were not associated with improved patient outcomes.
AHRQ-funded; HS02564.
Citation: O'Leary KJ, Johnson JK, Williams MV .
Effect of complementary interventions to redesign care on teamwork and quality for hospitalized medical patients: a pragmatic controlled trial.
Ann Intern Med 2023 Nov; 176(11):1456-64. doi: 10.7326/m23-0953..
Keywords: Teams, Inpatient Care, Hospitals, Quality of Care, Outcomes
Lefrak L, Schaffer KE, Bohnert J
Blood culture procedures and practices in the neonatal intensive care unit: a survey of a large multicenter collaborative in California.
The objective of this Web-based survey was to describe variation in bedside and laboratory-level blood culture practices in neonatal intensive care units (NICUs). Participants were 28 NICUs in an antimicrobial stewardship quality improvement program in the California Perinatal Quality Care Collaborative. Results showed that recommended practices for blood culturing were not routinely performed. Most NICUs did not have a procedural competency, did not document sample volume, did not receive a culture contamination report, and/or did not require reporting to the provider if less than 1 mL of blood was drawn. Skin asepsis procedure varied across NICUs.
AHRQ-funded; HS026168.
Citation: Lefrak L, Schaffer KE, Bohnert J .
Blood culture procedures and practices in the neonatal intensive care unit: a survey of a large multicenter collaborative in California.
Infect Control Hosp Epidemiol 2023 Oct; 44(10):1576=81. doi: 10.1017/ice.2023.33..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Inpatient Care, Quality of Care
Smith K, Padmanabhan P, Chen A
The impacts of the 340B Program on health care quality for low-income patients.
This study’s objective was to assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients. HCUP State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and the American Hospital Association Annual Survey were all used to extract inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data was linked on hospital 340B eligibility and participation. The authors did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality, 30-day readmission rates, or other measures. Among insured and non-Medicaid patients, they found discontinuities for acute myocardial infarction and postoperative sepsis mortality.
AHRQ-funded; HS026980.
Citation: Smith K, Padmanabhan P, Chen A .
The impacts of the 340B Program on health care quality for low-income patients.
Health Serv Res 2023 Oct; 58(5):1089-97. doi: 10.1111/1475-6773.14204..
Keywords: Low-Income, Hospitals, Vulnerable Populations, Medicaid, Uninsured, Inpatient Care, Quality of Care
Auerbach AD, Astik GJ, O'Leary KJ
Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19.
During the COVID-19 pandemic, clinicians were required to address a disease with continuously changing traits while simultaneously complying with changes in care (e.g., physical distancing) that could contribute to diagnostic errors (DEs). The purpose of this study was to examine the frequency of DEs and their causes in patients hospitalized under investigation (PUI) for COVID-19. The researchers randomly selected up to 8 cases per site per month for evaluation, with each case evaluated by two clinicians to determine whether a DE occurred, and whether any diagnostic process faults took place. The study found that wo hundred and fifty-seven patient charts were evaluated, of which 14% contained a DE. Patients with and without DE were statistically similar in socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. The most common diagnostic process issues contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination. Diagnostic process issues related with COVID-19 policies and procedures were not related with DE risk. 35.9% of patients with errors and 5.4% of patients overall suffered harm or death due to diagnostic error.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Astik GJ, O'Leary KJ .
Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19.
J Gen Intern Med 2023 Jun; 38(8):1902-10. doi: 10.1007/s11606-023-08176-6..
Keywords: COVID-19, Diagnostic Safety and Quality, Hospitals, Inpatient Care, Quality of Care