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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 32 Research Studies DisplayedInterrante JD, Tuttle MS, Admon LK
Severe maternal morbidity and mortality risk at the intersection of rurality, race and ethnicity, and Medicaid.
Using maternal discharge records from childbirth hospitalizations in the HCUP National Inpatient Sample, 2007-15, researchers examined differences in rates of severe maternal morbidity and mortality by rural or urban geography, race and ethnicity, and clinical factors among Medicaid-funded births and privately insured hospital births. The highest rate of severe maternal morbidity and mortality occurred among rural Indigenous Medicaid-funded births; births among Black rural and urban residents and among Hispanic urban residents also experienced elevated rates. The researchers concluded that heightened rates of severe maternal morbidity and mortality among Medicaid-funded births indicate an opportunity for state and federal policy responses to address the maternal health challenges faced by Medicaid beneficiaries, including Black, Indigenous, and rural residents
AHRQ-funded; HS027640.
Citation: Interrante JD, Tuttle MS, Admon LK .
Severe maternal morbidity and mortality risk at the intersection of rurality, race and ethnicity, and Medicaid.
Womens Health Issues 2022 Nov-Dec;32(6):540-49. doi: 10.1016/j.whi.2022.05.003..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Women, Pregnancy, Mortality, Risk, Racial and Ethnic Minorities, Medicaid
Admon LK, Ford ND, Ko JY
Trends and distribution of in-hospital mortality among pregnant and postpartum individuals by pregnancy period.
The purpose of this study was to examine long-term trends in inpatient death rates among pregnant and postpartum individuals and proportion of deaths by pregnancy period (antenatal, delivery, and postpartum). The researchers examined patterns of inpatient mortality during pregnancy-associated hospitalizations utilizing data from the National Inpatient Sample for 1994 to 2015 and 2017 to 2019. The study found that between 1994 and 2015, among 84,181,338 hospitalizations an estimated 12,654 inpatient deaths occurred among pregnant and postpartum individuals with a mean age of 29.37. Inpatient deaths during delivery hospitalizations decreased from 10.6 deaths per 100 000 delivery hospitalizations to 4.7 deaths per 100 000 delivery hospitalizations between 1994 to 1995 and 2014 to 2015. The rate of inpatient deaths in antenatal and postpartum periods remained unchanged between 1994 to 1995 and 2014 to 2015. The researchers concluded that resources directed toward improving quality of care at obstetric delivery have been associated with decreased rates of severe morbidity and may be associated with decreased mortality, but additional efforts need to be directed toward antenatal and postpartum hospitalizations.
AHRQ-funded; HS027640.
Citation: Admon LK, Ford ND, Ko JY .
Trends and distribution of in-hospital mortality among pregnant and postpartum individuals by pregnancy period.
JAMA Netw Open 2022 Jul;5(7):e2224614. doi: 10.1001/jamanetworkopen.2022.24614..
Keywords: Healthcare Cost and Utilization Project (HCUP), Maternal Care, Mortality, Pregnancy, Women, Hospitals
Ingraham NE, King S, Proper J
Morbidity and mortality trends of pancreatitis: an observational study.
The authors assessed temporal trends of incidence, complications, management, and outcomes for acute pancreatitis in hospitalized patients at the national level. Using HCUP data, they found that the incidence of pancreatitis, from 2008 to 2015, has increased whereas inpatient mortality has decreased.
AHRQ-funded; HS026732.
Citation: Ingraham NE, King S, Proper J .
Morbidity and mortality trends of pancreatitis: an observational study.
Surg Infect 2021 Dec;22(10):1021-30. doi: 10.1089/sur.2020.473..
Keywords: Healthcare Cost and Utilization Project (HCUP), Digestive Disease and Health, Mortality
Brauer DG, Wu N, Keller MR
Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database.
This study investigates patient-level and hospital-level variables associated with the mortality difference at referral centers and, postoperatively, outside hospitals, in patients undergoing hepatopancreatobiliary (HPB) and gastric oncologic surgeries. Using HCUP data, findings showed that, for readmissions following HPB and gastric oncologic surgery, travel distance and timing were major determinants of care fragmentation. However, these variables were not associated with mortality, nor was annual hospital surgical volume after risk-adjustment.
AHRQ-funded; HS019455.
Citation: Brauer DG, Wu N, Keller MR .
Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database.
J Am Coll Surg 2021 Jun;232(6):921-32. doi: 10.1016/j.jamcollsurg.2021.03.017..
Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer, Surgery, Hospital Readmissions, Mortality
Salazar AS, Keller MR, Olsen MA
Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: a cohort study.
Cryptococcosis is one of the most common life-threatening opportunistic mycoses worldwide. Insidious presentation and slow onset of symptoms make it difficult to recognize, complicating the diagnostic process. Delays in diagnosis may lead to increased mortality. In this study, the investigators aimed to determine the frequency of missed opportunities for diagnosis of cryptococcosis and its effects on mortality.
AHRQ-funded; HS019455.
Citation: Salazar AS, Keller MR, Olsen MA .
Potential missed opportunities for diagnosis of cryptococcosis and the association with mortality: a cohort study.
EClinicalMedicine 2020 Oct 7;27:100563. doi: 10.1016/j.eclinm.2020.100563..
Keywords: Healthcare Cost and Utilization Project (HCUP), Diagnostic Safety and Quality, Mortality
Philip JL, Yang DY, Wang X
Effect of transfer status on outcomes of emergency general surgery patients.
This study looked at outcomes of transferred (TRAN) versus directly admitted (DA) emergency general surgery (EGS) patients. Patients with a diagnosis of EGS were identified from the 2008-2011 Nationwide Inpatient Sample (NIS). Outcomes included were in-hospital mortality and morbidity. They identified 274,145 TRAN and 10,456,100 DA encounters. Morbidity and mortality were both higher in TRAN patients than DA. TRAN patients were more likely to have greater comorbidity scores, have Medicare insurance, and reside in an area with a lesser median household income compared to DA patients. Morbidity among TRAN patients were primarily due urinary-, gastrointestinal-, and pulmonary-related complications. Median stay and median cost at the hospital were greater for TRAN patients.
AHRQ-funded; HS025224; HS022694.
Citation: Philip JL, Yang DY, Wang X .
Effect of transfer status on outcomes of emergency general surgery patients.
Surgery 2020 Aug;168(2):280-86. doi: 10.1016/j.surg.2020.01.005..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Transitions of Care, Mortality, Outcomes, Healthcare Costs, Hospitals
Chovatiya R, Silverberg JI. R, Silverberg R
Inpatient morbidity and mortality of measles in the United States.
This study examined measles hospitalizations from 2002-2006 using the Nationwide Inpatient Sample to assess complications and mortality. There were 1,018 measles hospitalizations during that time period. Measles and comorbidities were defined using ICD-9-CM or ICD-10-CM codes. Measles were associated with higher odds of gastrointestinal, hematologic, infection, neurologic, ophthalmologic, pulmonary and renal complications, with the strongest association observed with encephalitis. Thirty-four deaths were recorded with higher inpatient mortality for measles patients than those without measles.
AHRQ-funded; HS023011.
Citation: Chovatiya R, Silverberg JI. R, Silverberg R .
Inpatient morbidity and mortality of measles in the United States.
PLoS One 2020 Apr 28;15(4):e0231329. doi: 10.1371/journal.pone.0231329..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Mortality
Dworsky JQ, Childers CP, Gornbein J
Hospital experience predicts outcomes after high-risk geriatric surgery.
This study examined if there an association between a hospital’s annual volume of high-risk geriatric surgery and their risk of inpatient mortality, postoperative length of stay, and discharge to nursing facility. Using the 2014 National Inpatient Sample, older adults were identified who had undergone high-risk geriatric surgery. There were an estimated 514,950 hospital encounters at 3,115 hospitals undergoing surgery. A higher proportion of high-risk geriatric surgery patients was associated with decreased mortality and shorter postoperative length of stay. Higher volume hospitals were not associated with mortality but was associated with longer length of stay and decreased discharge to nursing facilities.
AHRQ-funded; HS000046; HS025079.
Citation: Dworsky JQ, Childers CP, Gornbein J .
Hospital experience predicts outcomes after high-risk geriatric surgery.
Surgery 2020 Feb;167(2):468-74. doi: 10.1016/j.surg.2019.07.026..
Keywords: Healthcare Cost and Utilization Project (HCUP), Elderly, Surgery, Risk, Hospitals, Outcomes, Mortality
Tignanelli CJ, Sheetz KH, Petersen A
Utilization of intensive care unit nutrition consultation is associated with reduced mortality.
The aim of this project was to investigate the prevalence of nutrition consultation (NC) in U.S. intensive care units (ICUs) and to examine its association with patient outcomes. Data from the Healthcare Cost and Utilization Project's state inpatient databases was utilized from 2010 - 2014. A multilevel logistic regression model was used to evaluate the relationship between NC and clinical outcomes. The investigators concluded that rates of NC were low in critically ill patients.
AHRQ-funded; HS026379.
Citation: Tignanelli CJ, Sheetz KH, Petersen A .
Utilization of intensive care unit nutrition consultation is associated with reduced mortality.
JPEN J Parenter Enteral Nutr 2020 Feb;44(2):213-19. doi: 10.1002/jpen.1534..
Keywords: Healthcare Cost and Utilization Project (HCUP), Intensive Care Unit (ICU), Nutrition, Patient-Centered Outcomes Research, Outcomes, Critical Care, Mortality
Law AC, Stevens JP, Walkey AJ
National trends in timing of death among patients with septic shock, 1994-2014.
Investigators sought to assess trends in the timing of mortality among patients with septic shock. Using HCUP data, they found that septic shock 48-hour, 3-14-day, and greater than 14-day mortality declined markedly over two decades; in contrast, patients with acute respiratory failure only experienced marked decreases in greater than 14-day in-hospital mortality rates.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Walkey AJ .
National trends in timing of death among patients with septic shock, 1994-2014.
Crit Care Med 2019 Nov;47(11):1493-96. doi: 10.1097/ccm.0000000000003956..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sepsis, Mortality, Hospitals
Kahn JM, Davis BS, Yabes JG
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
The purpose of this study was to evaluate the association between New York State sepsis regulations and the outcomes of patients hospitalized with sepsis. Results showed that, in New York State, mandated protocolized sepsis care was associated with a greater decrease in sepsis mortality compared with sepsis mortality in control states (Florida, Maryland, Massachusetts, and New Jersey) that did not implement sepsis regulations. The authors add that, because baseline mortality rates differ between New York and the comparison states, it is uncertain whether these findings will be generalizable to other states.
AHRQ-funded; HS025146.
Citation: Kahn JM, Davis BS, Yabes JG .
Association between state-mandated protocolized sepsis care and in-hospital mortality among adults with sepsis.
JAMA 2019 Jul 16;322(3):240-50. doi: 10.1001/jama.2019.9021..
Keywords: Guidelines, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Mortality, Outcomes, Policy, Sepsis
Daniel VT, Rushing AP, Ingraham AM
Association between operating room access and mortality for life-threatening general surgery emergencies.
Few diseases truly require emergency surgery today. In this study, the authors investigated the relationship between access to operating room (OR) and outcomes for patients with life-threatening emergency general surgery (LT-EGS) diseases at US hospitals. The investigators concluded that round-the-clock availability of personnel, specifically emergency general surgeons and recovery room nurses, is associated with decreased mortality.
AHRQ-funded; HS022694.
Citation: Daniel VT, Rushing AP, Ingraham AM .
Association between operating room access and mortality for life-threatening general surgery emergencies.
J Trauma Acute Care Surg 2019 Jul;87(1):35-42. doi: 10.1097/ta.0000000000002267..
Keywords: Access to Care, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Surgery
Goldstein E, MacFadden DR, Karaca Z
AHRQ Author: Karaca Z Steiner CA
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Researchers studied the relation between the prevalence of resistance to various antibiotics in different bacteria and rates of sepsis-related outcomes. They found that, among the different combinations of antibiotics/bacteria, prevalence of resistance to fluoroquinolones in E. coli had the strongest association with septicemia hospitalization rates for individuals aged over 50 years, and with sepsis mortality rates for individuals aged 18-84 years. They also found a number of positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization/sepsis mortality rates in adults.
AHRQ-authored.
Citation: Goldstein E, MacFadden DR, Karaca Z .
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Int J Antimicrob Agents 2019 Jul;54(1):23-34. doi: 10.1016/j.ijantimicag.2019.03.004..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare Cost and Utilization Project (HCUP), Hospitals, Hospitalization, Medication, Mortality, Sepsis
Daniel VT, Ayturk D, Ward DV
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
An association between lack of insurance and inferior outcomes has been well described for a number of surgical emergencies, yet little is known about the relationship of payor status and outcomes of patients undergoing emergent surgical repair for upper gastrointestinal (UGI) perforations. In this study, the investigators evaluated the association of payor status and in-hospital mortality for patients undergoing emergency surgery for UGI perforations in the United States.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Ward DV .
The influence of payor status on outcomes associated with surgical repair of upper gastrointestinal perforations due to peptic ulcer disease in the United States.
Am J Surg 2019 Jan;217(1):121-25. doi: 10.1016/j.amjsurg.2018.06.025..
Keywords: Adverse Events, Digestive Disease and Health, Health Insurance, Healthcare Cost and Utilization Project (HCUP), Mortality, Outcomes, Patient Safety, Surgery, Uninsured
Han RH, McKinnon A, CreveCoeur TS
Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study.
This study examined the risk factors for mortality in preterm infants with intraventricular hemorrhage (IVH). An overall inpatient mortality occurred in 10% of the cohort of 7437 preterm infants born between 2005 and 2014. Mortality risk was independently associated with a variety of factors including male sex, Asian race, lower gestational age, higher IVH grade, gastrotomy, tracheostomy, and shunt infection.
AHRQ-funded; HS019455.
Citation: Han RH, McKinnon A, CreveCoeur TS .
Predictors of mortality for preterm infants with intraventricular hemorrhage: a population-based study.
Childs Nerv Syst 2018 Nov;34(11):2203-13. Epub ahead of print. doi: 10.1007/s00381-018-3897-4..
Keywords: Healthcare Cost and Utilization Project (HCUP), Mortality, Newborns/Infants, Outcomes
Hirayama A, Goto T, Shimada YJ
Association of obesity with severity of heart failure exacerbation: a population-based study.
Researchers investigate the associations of obesity with severity of heart failure exacerbation and in-hospital mortality using population-based data from the State Inpatient Databases. Subjects were adults hospitalized for heart failure exacerbation in seven States from 2012 to 2013. The researchers found that, based on large population-based data sets of patients with heart failure exacerbation, obesity was associated with higher acute severity measures but lower in-hospital mortality.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Shimada YJ .
Association of obesity with severity of heart failure exacerbation: a population-based study.
J Am Heart Assoc 2018 Mar 15;7(6). doi: 10.1161/jaha.117.008243..
Keywords: Healthcare Cost and Utilization Project (HCUP), Obesity, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Mortality
Goto T, Hirayama A, Faridi MK
Obesity and severity of acute exacerbation of chronic obstructive pulmonary disease.
A study was done to determine if there was an increase in severity and mortality with chronic obstructive pulmonary disease (COPD) patients who were also obese. Researchers used data from 2012-2013 State Inpatient Databases data of seven U.S. states. 17% of COPD patients in the database were defined as obese. Obesity was shown to increase use of ventilation, increased hospital stays but not in-hospital mortality.
AHRQ-funded; HS023305.
Citation: Goto T, Hirayama A, Faridi MK .
Obesity and severity of acute exacerbation of chronic obstructive pulmonary disease.
Ann Am Thorac Soc 2018 Feb;15(2):184-91. doi: 10.1513/AnnalsATS.201706-485OC..
Keywords: Chronic Conditions, Respiratory Conditions, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Mortality, Obesity
Cutler E, Karaca Z, Henke R
AHRQ Author: Karaca Z, Wong HS
The effects of Medicare accountable organizations on inpatient mortality rates.
This study examined whether Medicare Accountable Care Organizations (ACOs) have improved hospital quality of care, specifically focusing on preventable inpatient mortality. The investigators concluded that, on average, Medicare ACO hospitals are not associated with improved mortality rates for the studied inpatient quality indicator conditions. They suggest that stakeholders may potentially consider providing ACOs with incentives or designing new programs for ACOs to target inpatient mortality reductions.
AHRQ-authored.
Citation: Cutler E, Karaca Z, Henke R .
The effects of Medicare accountable organizations on inpatient mortality rates.
Inquiry 2018 Jan-Dec;55:46958018800092. doi: 10.1177/0046958018800092..
Keywords: Quality of Care, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicare, Mortality
Jones JM, Fingar KR, Miller MA
AHRQ Author: Miller MA; Heslin KC
Racial disparities in sepsis-related in-hospital mortality: using a broad case capture method and multivariate controls for clinical and hospital variables, 2004-2013.
The objective of this study was to use a broad method of capturing sepsis cases to estimate 2004-2013 trends in in-hospital sepsis mortality rates by race/ethnicity. Mortality rates adjusted for patient characteristics were higher for all minority groups than for white patients. After adjusting for hospital characteristics, sepsis mortality rates in 2013 were similar for white, black, and Hispanic patients.
AHRQ-authored.
Citation: Jones JM, Fingar KR, Miller MA .
Racial disparities in sepsis-related in-hospital mortality: using a broad case capture method and multivariate controls for clinical and hospital variables, 2004-2013.
Crit Care Med 2017 Dec;45(12):e1209-e17. doi: 10.1097/ccm.0000000000002699.
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Keywords: Disparities, Healthcare Cost and Utilization Project (HCUP), Mortality, Racial and Ethnic Minorities, Sepsis
Moore BJ, White S, Washington R
AHRQ Author: Elixhauser A
Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: the AHRQ Elixhauser Comorbidity Index.
The researchers extended the literature on comorbidity measurement by developing 2 indices, based on the Elixhauser Comorbidity measures, designed to predict 2 frequently reported health outcomes: in-hospital mortality and 30-day readmission in administrative data. The index scores performed as well as using all 29 Elixhauser comorbidity variables separately.
AHRQ-authored; AHRQ-funded.
Citation: Moore BJ, White S, Washington R .
Identifying increased risk of readmission and in-hospital mortality using hospital administrative data: the AHRQ Elixhauser Comorbidity Index.
Med Care 2017 Jul;55(7):698-705. doi: 10.1097/mlr.0000000000000735.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Mortality, Risk
Graboyes EM, Kallogjeri D, Saeed MJ
Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery.
Researchers sought to determine the frequency, risk factors, and outcomes for head and neck cancer patients experiencing postdischarge care fragmentation. They found that postdischarge care fragmentation following head and neck cancer surgery is common, as 37 percent of readmitted patients and 31 percent of patients readmitted with a treatment complication are readmitted to a hospital other than the surgical hospital.
AHRQ-funded; HS019455.
Citation: Graboyes EM, Kallogjeri D, Saeed MJ .
Postoperative care fragmentation and thirty-day unplanned readmissions after head and neck cancer surgery.
Laryngoscope 2017 Apr;127(4):868-74. doi: 10.1002/lary.26301.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer, Surgery, Hospital Readmissions, Mortality
Hines AL, Raetzman SO, Barrett ML
AHRQ Author: Moy E, Andrews RM
Managed care and inpatient mortality in adults: effect of primary payer.
This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service (FFS) plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS.
AHRQ-authored.
Citation: Hines AL, Raetzman SO, Barrett ML .
Managed care and inpatient mortality in adults: effect of primary payer.
BMC Health Serv Res 2017 Feb 8;17(1):121. doi: 10.1186/s12913-017-2062-1.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Inpatient Care, Mortality, Outcomes, Hospitalization, Medicare
Brown JR, Rezaee ME, Hisey WM
Reduced mortality associated with acute kidney injury requiring dialysis in the United States.
The researchers describe the epidemiology of dialysis-requiring acute kidney injury (AKI-D) as well as associated in-hospital mortality in the US. They found that the incidence rate of AKI-D has increased considerably in the US since 2001. However, in-hospital mortality associated with AKI-D hospital admissions has decreased significantly. AHRQ-funded; HS018443.
AHRQ-funded; HS018443.
Citation: Brown JR, Rezaee ME, Hisey WM .
Reduced mortality associated with acute kidney injury requiring dialysis in the United States.
Am J Nephrol 2016;43(4):261-70. doi: 10.1159/000445846.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Mortality, Patient Safety, Kidney Disease and Health
Jiang HJ, Reiter KL, Wang J
AHRQ Author: Jiang HJ
Measuring mortality performance: How did safety-net hospitals compare with other hospitals?
This study assessed mortality performance of safety-net hospitals (SNHs) using all-payer databases and measures for a broad range of conditions and procedures. It found small differences in risk-adjusted mortality rates between SNHs and non-SNHs only among teaching hospitals. After controlling for hospital factors, these differences were substantially reduced and remained significant only for surgical mortality rates.
AHRQ-authored.
Citation: Jiang HJ, Reiter KL, Wang J .
Measuring mortality performance: How did safety-net hospitals compare with other hospitals?
Med Care 2016 Jul;54(7):648-56. doi: 10.1097/mlr.0000000000000540.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitals, Mortality, Provider Performance
Yanamadala S, Morrison D, Curtin C
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
The authors assessed the relationship between electronic health records (EHR) adoption and patient outcomes. Their results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system. They concluded that EHRs may play a smaller role than expected in patient outcomes and overall quality of care.
AHRQ-funded; HS024096.
Citation: Yanamadala S, Morrison D, Curtin C .
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
Medicine (Baltimore) 2016 May;95(19):e3332. doi: 10.1097/md.0000000000003332.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Electronic Health Records (EHRs), Quality of Care, Mortality, Hospitals