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
51 to 75 of 119 Research Studies DisplayedSharma H, Konetzka RT, Smieliauskas F
The relationship between reported staffing and expenditures in nursing homes.
AHRQ-funded; HS024967.
Citation: Sharma H, Konetzka RT, Smieliauskas F .
The relationship between reported staffing and expenditures in nursing homes.
Med Care Res Rev 2019 Dec 1;76(6):758-83. doi: 10.1177/1077558717739214..
Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Provider Performance, Medicare
Sheetz KH, Dimick JB, Englesbe MJ
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
In 2013 the Centers for Medicare and Medicaid Services announced that it would begin levying penalties against hospitals with the highest rates of hospital-acquired conditions through the Hospital-Acquired Condition Reduction Program. This study evaluates whether the program has been successful in improving patient safety or not. The investigators concluded that the program did not improve patient safety in Michigan beyond existing trends.
AHRQ-funded; HS000053; HS026244.
Citation: Sheetz KH, Dimick JB, Englesbe MJ .
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
Health Aff 2019 Nov;38(11):1858-65. doi: 10.1377/hlthaff.2018.05504..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Provider Performance, Quality Improvement, Quality of Care, Infectious Diseases, Payment
White CM, Coleman CI, Jackman K
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
This paper analyzed ways to enhance usability of AHRQ’s Evidence-based Practice Center (EPC) reports. The reports are often lengthy and difficult for users to navigate. A quality measure index was created to allow health systems to more efficiently access relevant information. A test was created where two tables were embedded in an EPC report. The first identified quality measures covered by the report descriptively. The second contained page numbers in the executive summary which hyperlinked to those pages with the quality measures. An exercise with two health system-targeted scenarios was then created. The participants were timed how long it took to find answers to scenario questions and gave feedback. It was found that it took 63.4% less time to find quality measure information with the hyperlinked indexing tables than without. The participants felt that the tables were easy to use and more user friendly to health systems.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002.
Citation: White CM, Coleman CI, Jackman K .
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002..
Keywords: Implementation, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Outcomes Research, Provider Performance, Quality Measures, Quality Improvement, Quality of Care
Parchman ML, Anderson ML, Dorr DA
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Researchers conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. They concluded that, although they found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation.
AHRQ-funded; HS023908.
Citation: Parchman ML, Anderson ML, Dorr DA .
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S40-s49. doi: 10.1370/afm.2407..
Keywords: Cardiovascular Conditions, Primary Care, Quality Improvement, Provider Performance, Quality Measures, Quality of Care, Risk, Evidence-Based Practice, Patient-Centered Healthcare, Chronic Conditions
Barbash IJ, Davis B, Kahn JM
National performance on the Medicare SEP-1 sepsis quality measure.
Researchers characterized national performance on the sepsis measure known as SEP-1. They found that the majority of eligible hospitals reported SEP-1 data, and overall bundle compliance was highly variable. Further, SEP-1 performance was associated with structural hospital characteristics and performance on other measures of hospital quality, providing preliminary support for SEP-1 performance as a marker of timely hospital sepsis care.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Davis B, Kahn JM .
National performance on the Medicare SEP-1 sepsis quality measure.
Crit Care Med 2019 Aug;47(8):1026-32. doi: 10.1097/ccm.0000000000003613..
Keywords: Sepsis, Quality Indicators (QIs), Quality Measures, Quality of Care, Hospitals, Provider Performance
Li Y, Cen X, Cai X
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
This study examined the association between the use of “Nursing Home Compare” performance indicators and improved patient safety culture in nursing homes. A survey was conducted in 2017 using AHRQ’s Survey on Patient Safety Culture for Nursing Homes which collects data on 12 core domains of safety culture scores. Out of 2254 nursing homes sampled, there was a response rate of 36%. It was found that for every 10 percentage points increase in overall positive response rate for safety culture, there was an association with 0.56 fewer health care deficiencies, 0.74 fewer substantiated complaints, reduced fines by $2285.20, and 20% increased odds of being designed as 4-star or 5-star.
AHRQ-funded; HS024923.
Citation: Li Y, Cen X, Cai X .
Perceived patient safety culture in nursing homes associated with "Nursing Home Compare" performance indicators.
Med Care 2019 Aug;57(8):641-47. doi: 10.1097/mlr.0000000000001142..
Keywords: Surveys on Patient Safety Culture, Patient Safety, Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
AHRQ-funded; HS018718.
Citation: Perraillon MC, Brauner DJ, Konetzka RT .
Nursing home response to Nursing Home Compare: the provider perspective.
Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165..
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement
Ahluwalia SC, Damberg CL, Haas A
How are medical groups identified as high-performing? The effect of different approaches to classification of performance.
The researchers examined how different classification approaches influence which providers are designated as "high-performers.” They found that classification of medical groups as high performing is sensitive to the domains of performance included, the classification approach, and the choice of threshold. They further suggest that the absence of a consistently applied approach to identifying high performers impedes efforts to reliably compare, select and reward high-performing providers.
AHRQ-funded; HS024067.
Citation: Ahluwalia SC, Damberg CL, Haas A .
How are medical groups identified as high-performing? The effect of different approaches to classification of performance.
BMC Health Serv Res 2019 Jul 18;19(1):500. doi: 10.1186/s12913-019-4293-9..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Provider Performance, Quality of Care, Quality Measures
Sankaran R, Sukul D, Nuliyalu U
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
This study evaluated the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and changes in clinical outcomes. Out of the total of 724 hospitals were penalized in fiscal year 2015, 708 were included in the study. The majority of the penalized hospitals were large teaching institutions and have a greater share of low-income patients than non-penalized hospitals. After penalization, there was a non-significant change in hospital acquired conditions, 30-day readmission rates, and 30-day mortality. This might mean that disparities in care could be exacerbated.
AHRQ-funded; HS026244.
Citation: Sankaran R, Sukul D, Nuliyalu U .
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
BMJ 2019 Jul 3;366:l4109. doi: 10.1136/bmj.l4109..
Keywords: Health Insurance, Healthcare-Associated Infections (HAIs), Hospitals, Medicare, Patient Safety, Provider Performance, Payment, Quality of Care, Quality Indicators (QIs)
Chen PG, Harrison MI, Bergofsky LR
AHRQ Author: Harrison MI, Bergofsky LR
Use of internal performance measurement to guide improvement within medical groups.
The purpose of this study was to investigate how medical groups use measures of quality, cost, and patient experience of care for performance improvement. Through interviews, findings showed that strategies for using internal measurement for quality improvement included taking a gradual, iterative approach and setting clear goals with high priority, finding workable approaches to data sharing, and fostering engagement by focusing on actionable measures. Measurement was also used to check accuracy of external performance reports, clarify and manage conflicting external measurement requirements, and prepare for anticipated external measurement requirements. Most respondents did not report a need to assess costs of internal measurement or the capacity to do so.
AHRQ-authored; AHRQ-funded; 233201500026I.
Citation: Chen PG, Harrison MI, Bergofsky LR .
Use of internal performance measurement to guide improvement within medical groups.
Jt Comm J Qual Patient Saf 2019 Jul;45(7):487-94. doi: 10.1016/j.jcjq.2019.02.009..
Keywords: Quality Measures, Quality Improvement, Provider Performance, Patient Experience, Quality of Care
Sheetz KH, Ibrahim AM, Nathan H
Variation in surgical outcomes across networks of the highest-rated US hospitals.
This longitudinal analysis of 87 hospitals in 1 of 16 networks who were affiliated with the US News & World Report Honor Roll hospitals discusses variation in surgical outcomes compared with their network affiliates. Data was used from Medicare beneficiaries who underwent colectomy, coronary artery bypass graft, or hip replacement between 2005 and 2014. Thirty-day postoperative complications, mortality, failure to rescue and readmissions were compared. Outcomes were not consistently better at Honor Roll hospitals compared with their network affiliates. Honor Roll hospitals had lower failure to rescue rates but higher complication rates.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Nathan H .
Variation in surgical outcomes across networks of the highest-rated US hospitals.
JAMA Surg 2019 Jun;154(6):510-15. doi: 10.1001/jamasurg.2019.0090..
Keywords: Surgery, Outcomes, Provider Performance, Hospitals, Quality of Care
Campbell KH, Illuzzi JL, Lee HC
Optimal maternal and neonatal outcomes and associated hospital characteristics.
The goal of this study was to examine hospital variation in both maternal and neonatal morbidities and to identify institutional characteristics associated with hospital performance in a combined measure of maternal and neonatal outcomes. The authors found that hospitals with low maternal morbidity rates may not have low neonatal morbidity rates and vice versa, highlighting the importance of assessing joint maternal-newborn outcomes in order to fully characterize a hospital's obstetrical performance.
AHRQ-funded; HS023801.
Citation: Campbell KH, Illuzzi JL, Lee HC .
Optimal maternal and neonatal outcomes and associated hospital characteristics.
Birth 2019 Jun;46(2):289-99. doi: 10.1111/birt.12400.
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Keywords: Hospitals, Newborns/Infants, Outcomes, Pregnancy, Provider Performance, Quality of Care, Women
Hung DY, Harrison MI, Liang SY
AHRQ Author: Harrison MI
Contextual conditions and performance improvement in primary care.
This study examined organizational features of primary care clinics that had gone through Lean redesigns and had experienced the greatest performance improvements. They surveyed 1333 physicians and staff in 43 primary care clinics across a large primary care system. They found that clinics with prior experience with quality improvement had the highest increases in efficiency. Clinics reporting the highest levels of burnout and work stress before the redesign also made efficiency gains. Physician productivity gains was associated with a history of change, staff participation and leadership support. The greatest improvements in patient satisfaction occurred where there was the lowest stress levels with highest levels of teamwork, staff engagement and leadership support.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Harrison MI, Liang SY .
Contextual conditions and performance improvement in primary care.
Qual Manag Health Care 2019 Apr/Jun;28(2):70-77. doi: 10.1097/qmh.0000000000000198..
Keywords: Organizational Change, Healthcare Delivery, Primary Care, Provider Performance, Quality Improvement, Quality of Care, Workflow
Cefalu MS, Elliott MN, Setodji CM
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
The objective of this study was to evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. The investigators found that there were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. They concluded that hospital quality should be measured using a variety of indicators reflecting different dimensions of quality.
AHRQ-funded; HS016980; HS016978.
Citation: Cefalu MS, Elliott MN, Setodji CM .
Hospital quality indicators are not unidimensional: a reanalysis of Lieberthal and Comer.
Health Serv Res 2019 Apr;54(2):502-08. doi: 10.1111/1475-6773.13056..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Patient Experience, Provider Performance, Quality of Care, Quality Indicators (QIs), Quality Measures
Perraillon MC, Konetzka RT, He D
Consumer response to composite ratings of nursing home quality.
Health care report cards are intended to address information asymmetries and enable consumers to choose providers of better quality. This study examined whether the form of the information mattered to consumers. The investigators concluded that the form of quality reporting mattered to consumers, and that the increased use of composite ratings was likely to increase consumer response.
AHRQ-funded; HS021877; HS021861; HS000084.
Citation: Perraillon MC, Konetzka RT, He D .
Consumer response to composite ratings of nursing home quality.
Am J Health Econ 2019 Spring;5(2):165-90. doi: 10.1162/ajhe_a_00115..
Keywords: Nursing Homes, Long-Term Care, Quality of Care, Provider Performance, Quality Measures
Schlesinger MJ, Rybowski L, Shaller D
Americans' growing exposure to clinician quality information: insights and implications.
The authors of this article examined the impact of changes in the growth of consumer information seeking and the availability of patient narratives about care on consumer awareness of quality information and sociodemographic differences. Public exposure to quality information of any type doubled between 2010 and 2015, ad exposure to patient narratives and experience surveys tripled. Minority consumers were better informed than whites consistently over this period, although there were differences across subgroups regarding the types of information encountered. An education-related gradient in quality awareness also emerged. The authors conclude that public policy should respond to these emerging trends in information exposure by establishing standards for rigorous elicitation of narratives and assisting consumer learning via a combination of narratives and quantified clinician quality metrics.
AHRQ-funded; HS016978; HS016980; HS021858.
Citation: Schlesinger MJ, Rybowski L, Shaller D .
Americans' growing exposure to clinician quality information: insights and implications.
Health Aff 2019 Mar;38(3):374-82. doi: 10.1377/hlthaff.2018.05006..
Keywords: Policy, Provider Performance, Public Reporting, Quality of Care, Quality Measures
Cerully JL, Parker AM, Rybowski L
Improving patients' choice of clinician by including roll-up measures in public healthcare quality reports: an online experiment.
The purpose of this paper was to determine how presenting quality scores at different levels of aggregation affects patients' clinician choices. A simulated clinician-choice experiment with 550 panelists was employed. The results suggested that roll-ups in healthcare quality reports, alone or as a complement to drill-downs, can help patients make better decisions.
AHRQ-funded; HS016978.
Citation: Cerully JL, Parker AM, Rybowski L .
Improving patients' choice of clinician by including roll-up measures in public healthcare quality reports: an online experiment.
J Gen Intern Med 2019 Feb;34(2):243-49. doi: 10.1007/s11606-018-4725-y..
Keywords: Shared Decision Making, Quality of Care, Provider Performance
Chukmaitov A, Harless DW, Bazzoli GJ
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
This study evaluates quality performance of hospitals participating in Medicare Shared Savings and Pioneer Accountable Care Organization (ACO) programs relative to nonparticipating hospitals. The authors studied preventable hospitalizations for conditions sensitive to high-quality ambulatory care and 30-day all-cause readmissions potentially influenced by hospital care. A decrease was found in preventable hospitalizations for COPD and asthma and for diabetes complications for ACO participating hospitals, but no significant differences for preventable chronic heart failure hospitalizations and 30-day readmissions.
AHRQ-funded; HS023332.
Citation: Chukmaitov A, Harless DW, Bazzoli GJ .
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
Am J Med Qual 2019 Jan/Feb;34(1):14-22. doi: 10.1177/1062860618778786..
Keywords: Hospital Readmissions, Hospitals, Quality of Care, Provider Performance, Hospitalization
Zuckerman RB, Wu S, Chen LM
The five-star skilled nursing facility rating system and care of disadvantaged populations.
AHRQ-funded; HS000029.
Citation: Zuckerman RB, Wu S, Chen LM .
The five-star skilled nursing facility rating system and care of disadvantaged populations.
J Am Geriatr Soc 2019 Jan;67(1):108-14. doi: 10.1111/jgs.15629..
Keywords: Nursing Homes, Vulnerable Populations, Medicare, Elderly, Provider Performance, Quality of Care, Hospital Discharge, Disparities
Dowding D, Merrill J, Russell D
Using feedback intervention theory to guide clinical dashboard design.
The provision of feedback to clinicians and organizations on the quality of care they provide is thought to influence clinician and organizational behavior leading to care improvements. Clinical Dashboards use data visualization techniques to provide feedback to individuals on their performance compared to quality metrics. In this paper the authors outline a theoretical approach to the design of a clinical dashboard; Feedback Intervention Theory (FIT).
AHRQ-funded; HS023855.
Citation: Dowding D, Merrill J, Russell D .
Using feedback intervention theory to guide clinical dashboard design.
AMIA Annu Symp Proc 2018 Dec 5;2018:395-403..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider Performance, Quality of Care, Quality Improvement
Meddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Rolnick JA, Ryskina KL
The use of individual provider performance reports by US Hospitals.
In this study, the investigators examined overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. They used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles. They linked these data to AHA Annual Survey responses for all general adult and pediatric hospitals and used Multivariable logistic regression to model the odds of use as a function of hospital characteristics.
AHRQ-funded; HS022198.
Citation: Rolnick JA, Ryskina KL .
The use of individual provider performance reports by US Hospitals.
J Hosp Med 2018 Aug;13(8):562-65. doi: 10.12788/jhm.2922..
Keywords: Provider Performance, Quality of Care, Provider, Hospitals, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Brauner D, Werner RM, Shippee TP
Does Nursing Home Compare reflect patient safety in nursing homes?
In this study the investigators compared nursing homes' performance on several composite quality measures from Nursing Home Compare, the most prominent recent example of a national policy aimed at improving the quality of nursing home care, to their performance on measures of patient safety in nursing homes such as pressure sores, infections, falls, and medication errors.
AHRQ-funded; HS024967.
Citation: Brauner D, Werner RM, Shippee TP .
Does Nursing Home Compare reflect patient safety in nursing homes?
Health Aff 2018 Nov;37(11):1770-78. doi: 10.1377/hlthaff.2018.0721.
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Keywords: Quality of Care, Nursing Homes, Patient Safety, Provider Performance, Quality Measures
Fraze TK, Lewis VA, Tierney E
Quality of care improves for patients with diabetes in Medicare shared savings accountable care organizations: organizational characteristics associated with performance.
This study analyzed secondary data retrospectively to examine Medicare Shared Savings Program (MSSP) Accountable Care Organizations’ performance on diabetes metrics in the first 2 years of ACO contracts in order to determine how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes.
AHRQ-funded; HS024075.
Citation: Fraze TK, Lewis VA, Tierney E .
Quality of care improves for patients with diabetes in Medicare shared savings accountable care organizations: organizational characteristics associated with performance.
Popul Health Manag 2018 Oct;21(5):401-08. doi: 10.1089/pop.2017.0102..
Keywords: Diabetes, Quality of Care, Medicare, Provider Performance, Quality Improvement