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
176 to 200 of 12139 Research Studies DisplayedKeller SC, Hannum SM, Weems K
Implementing and validating a home-infusion central-line-associated bloodstream infection surveillance definition.
Researchers tested the validity of a home-infusion central-line-associated bloodstream infection (CLABSI) surveillance definition and the feasibility and acceptability of its implementation. Their study was conducted in large home-infusion agencies in a CLABSI prevention collaborative in 14 states and the District of Columbia and included semistructured interviews with staff performing home-infusion CLABSI surveillance. The results showed that the home-infusion CLABSI surveillance definition was valid and would be feasible to implement.
AHRQ-funded; HS027819.
Citation: Keller SC, Hannum SM, Weems K .
Implementing and validating a home-infusion central-line-associated bloodstream infection surveillance definition.
Infect Control Hosp Epidemiol 2023 Nov; 44(11):1748-59. doi: 10.1017/ice.2023.70..
Keywords: Home Healthcare, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs)
Vasan A, Kyle MA, Venkataramani AS
Inequities in time spent coordinating care for children and youth with special health care needs.
The purpose of this cross-sectional study was to examine sociodemographic inequities in time spent coordinating care for children and youth with special health care needs (CYSHCN) and examine the relationship between time spent coordinating care and forgone medical care. The study utilized 2018-2020 data from the National Survey of Children's Health, which included 102,740 children across all 50 states. The researchers characterized the time spent coordinating care for children with less complex special health care needs (SHCN) (managed through medications) and more complex SHCN (resulting in functional limitations or requiring specialized therapies). Race-, ethnicity-, income-, and insurance-based differences in time spent coordinating care among CYSHCN were examined, and multivariable logistic regression was utilized to explore the relationship between time spent coordinating care and forgone medical care. The study found that over 40% of caregivers of children with more complex SHCN reported spending time coordinating their children's care each week. CYSHCN whose caregivers spent 5 hours per week or more on care coordination were disproportionately Hispanic, low-income, and publicly insured or uninsured. Increased time spent coordinating care was related with an increasing probability of forgone medical care.
AHRQ-funded; HS028555.
Citation: Vasan A, Kyle MA, Venkataramani AS .
Inequities in time spent coordinating care for children and youth with special health care needs.
Acad Pediatr 2023 Nov-Dec; 23(8):1526-34. doi: 10.1016/j.acap.2023.03.002..
Keywords: Children/Adolescents, Care Coordination, Vulnerable Populations, Disparities
Ross SM, Wang A, Anthony L
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
The purpose of this study was to research the effects of interventions for blood pressure in small- and medium-sized practices. The researchers utilized retrospective analysis on data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016-2018 as part of the Agency for Healthcare Research and Quality's EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. The study included 38 H3 practices which met inclusion criteria and researchers assigned each practice to an implementer group (high or low) based on the number of interventions implemented. Practices in the high-implementer group implemented an average of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had better improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were better for the high-implementer group.
AHRQ-funded; HS000078; HS000084; HS023921.
Citation: Ross SM, Wang A, Anthony L .
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
J Hum Hypertens 2023 Nov; 37(11):1007-14. doi: 10.1038/s41371-023-00813-1..
Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Improvement
Heintzman J, Springer R, Marino M
Latino adolescent-mother language concordance, neighborhood deprivation, and vaccinations in community health centers.
Researchers examined the association between adolescent-mother language concordance and neighborhood social deprivation with adolescent vaccination completion in order to understand social/family factors related to Latino adolescent vaccination. They used a multistate, EHR-based dataset of community health center patients to compare three Latino groups; their sample included over 56,000 adolescent-mother dyads. Their findings indicated that English-preferring adolescents with Spanish-preferring mothers had the highest completion rates. The researchers concluded that future studies could attempt to understand what advantage this language dyad may have in adolescent vaccination completion.
AHRQ-funded; HS025962.
Citation: Heintzman J, Springer R, Marino M .
Latino adolescent-mother language concordance, neighborhood deprivation, and vaccinations in community health centers.
Matern Child Health J 2023 Nov; 27(11):2026-37. doi: 10.1007/s10995-023-03742-0..
Keywords: Racial and Ethnic Minorities, Community-Based Practice, Vaccination, Children/Adolescents, Vulnerable Populations, Social Determinants of Health
Shear K, Rice H, Garabedian PM
Management of fall risk among older adults in diverse primary care settings.
The purpose of this study was to describe how urban and rural primary care staff and older adults manage fall risk and factors relevant to the application of computerized clinical decision support (CCDS). METHODS: Interviews, contextual inquiries, and workflow observations were analyzed. The study found that participants valued fall prevention and described similar approaches. Variations in available resources existed between rural and urban locations. Participants wanted evidence-based guidance incorporated into workflows to bridge gaps in skills.
AHRQ-funded; HS027557.
Citation: Shear K, Rice H, Garabedian PM .
Management of fall risk among older adults in diverse primary care settings.
J Appl Gerontol 2023 Nov; 42(11):2219-32. doi: 10.1177/07334648231185757..
Keywords: Falls, Elderly, Primary Care, Rural Health, Rural/Inner-City Residents
Henke RM, Fingar KR, Liang L
AHRQ Author: Liang L, Jiang HJ
Medicare Advantage in rural areas: implications for hospital sustainability.
This study examined the association between Medicare Advantage penetration levels in rural areas and hospital financial distress and closure. This retrospective study followed rural general acute hospitals open from 2008-2019 or until closure using HCUP State Inpatient Databases for 14 states. Medicare Advantage penetration at rural hospitals grew from 6.5% in 2008 to 20.6% in 2019. A 1-percentage point increase in hospital penetration was associated with an increase in financial stability of 0.04 units on the Altman Z score and a 4% reduction in risk of closure (HR, 0.96).
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation: Henke RM, Fingar KR, Liang L .
Medicare Advantage in rural areas: implications for hospital sustainability.
Am J Manag Care 2023 Nov; 29(11):594-600. doi: 10.37765/ajmc.2023.89455..
Keywords: Medicare, Rural Health, Rural/Inner-City Residents, Hospitals
Bridges NC, Taber R, Foulds AL
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
This study’s purpose was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide medications for opioid use disorder (MOUD) in rural Pennsylvania. The authors interviewed patients and providers who were involved in the Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project, which facilitated adoption of MOUD in rural primary care clinics. The study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. The interviews were coded by the study team. Themes from the qualitative interviews were organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. Patients and providers agreed on many barriers (such as lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health while providers focused on their professional roles, responsibilities, and operations within the primary care setting.
AHRQ-funded; HS025072.
Citation: Bridges NC, Taber R, Foulds AL .
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
J Subst Use Addict Treat 2023 Nov; 154:209133. doi: 10.1016/j.josat.2023.209133..
Keywords: Rural Health, Rural/Inner-City Residents, Opioids, Medication, Substance Abuse, Behavioral Health, Primary Care
Michelson KA, Bachur RG, Cruz AT
Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
The objectives of this study were to derive a method of automated identification of delayed diagnosis of two serious pediatric conditions in the emergency department (ED). Subjects were patients under the age of 21 who had two EDs encounters within 7 days, the second resulting in a diagnosis of new-onset diabetic ketoacidosis (DKA) or sepsis. The results showed that delayed diagnosis was present in 89 % of DKA patients seen twice within 7 days. 17 % of sepsis patients were deemed to have delayed diagnosis; the authors noted that many children with sepsis delayed diagnosis may be identified using the proposed approach with low specificity, indicating a need for manual case review. The fewer days between ED encounters was the most important characteristic associated with delayed diagnosis.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Cruz AT .
Multicenter evaluation of a method to identify delayed diagnosis of diabetic ketoacidosis and sepsis in administrative data.
Diagnosis 2023 Nov; 10(4):383-89. doi: 10.1515/dx-2023-0019..
Keywords: Diabetes, Diagnostic Safety and Quality, Sepsis
McLoone M, McNamara M, Jennings MA
Observing sources of system resilience using in situ alarm simulations.
The authors conducted in situ simulations of a hypoxemic-event alarm in medical/surgical and intensive care units at a tertiary care pediatric hospital to identify sources of resilience in alarm systems. They collected data on response timing, made observations of the environment, and conducted postsimulation debrief interviews. Four primary means of successful alarm responses were mapped to domains of the Systems Engineering Initiative for Patient Safety framework to guide future alarm system design and improvement.
AHRQ-funded; HS026620; HS028682.
Citation: McLoone M, McNamara M, Jennings MA .
Observing sources of system resilience using in situ alarm simulations.
J Hosp Med 2023 Nov; 18(11):994-98. doi: 10.1002/jhm.13217..
Keywords: Patient Safety, Hospitals
Kieren MQ, Kelly MM, Garcia MA
Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis.
The objective of this study was to describe the process of identifying and reporting inpatient safety concerns from the perspective of parents of children with medical complexity (CMC). Researchers conducted a secondary analysis of qualitative data from semi-structured interviews with English and Spanish-speaking parents of CMC at two tertiary children's hospitals. The parents described a multi-step process of reporting their safety concerns and a spectrum of staff response and validation. The researchers concluded that their findings could inform family-centered interventions that support safety concern reporting in the inpatient setting.
AHRQ-funded; HS025781.
Citation: Kieren MQ, Kelly MM, Garcia MA .
Parent experiences with the process of sharing inpatient safety concerns for children with medical complexity: a qualitative analysis.
Acad Pediatr 2023 Nov-Dec; 23(8):1535-41. doi: 10.1016/j.acap.2023.06.008..
Keywords: Children/Adolescents, Patient Safety, Inpatient Care, Chronic Conditions
Williams M, Coppin JD, Bender M
Predictors of Clinical Nurse Leader implementation success across a national sample of settings: a Bayesian multilevel modeling analysis.
The aim of this study was to examine and compare patterns of empirical correspondence to the Clinical Nurse Leader (CNL) Practice Model and predict their influence on implementation success. The researchers conducted a secondary analysis of a 2015 national-level study with clinicians and administrators involved with CNL initiatives in their health system. A total of 920 participants responded, with 59% providing success scores. The variability around success score across CNL Practice Model element ratings was largest at the component level compared to either the domain level or the item level. The components most predictive of implementation success were (a) consensus CNL model can close gaps, (b) organization level implementation strategy, and (c) alignment of empirical CNL microsystem level structuring to the model's conceptualization.
AHRQ-funded; HS027181.
Citation: Williams M, Coppin JD, Bender M .
Predictors of Clinical Nurse Leader implementation success across a national sample of settings: a Bayesian multilevel modeling analysis.
J Nurs Scholarsh 2023 Nov; 55(6):1238-47. doi: 10.1111/jnu.12926..
Keywords: Nursing, Healthcare Delivery, Provider: Nurse
Plummer N, Guardado R, Ngassa Y
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
This cross-sectional study evaluated the frequency of racial/ethnic differences in the self-report of mental illness and psychiatric medication use at jail entry. The authors used data from the "Offender Management System," the administrative database used by the jail containing data on people who are incarcerated, and COREMR, the electronic medical record (EMR) used in the Middlesex Jail & House of Correction, located in Billerica, MA. They evaluated two primary outcomes: (1) self-reported mental illness history and (2) self-reported use of psychiatric medication, with the primary indicator of interest as race/ethnicity. At intake over half (57%) in the sample self-reported a history of mental illness, with 20% reporting the use of psychiatric medications. Among people who self-reported a history of mental illness, non-White inmates all had decreased odds of reporting psychiatric medication. Only 20% reported receiving medications in the community prior to incarceration.
AHRQ-funded; HS026008.
Citation: Plummer N, Guardado R, Ngassa Y .
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
Adm Policy Ment Health 2023 Nov; 50(6):966-75. doi: 10.1007/s10488-023-01297-4..
Keywords: Racial and Ethnic Minorities, Behavioral Health, Vulnerable Populations
Beck AF, Wymer L, Pinzer E
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
This study’s goal as to determine whether housing renovations affect the prevalence of asthma in an underresourced community. Between 2010 and 2012, the Fay Apartments (~800 units) in Cincinnati, Ohio, were renovated to "green building" standards and renamed the Villages at Roll Hill. Asthma prevalence among 7-year-olds was determined by accessing Ohio Medicaid data for the years 2013 to 2021. Average prevalence of asthma among 7-year-olds averaged 12.7% in the first 6 years after the renovations (2013-2018). But in postrenovation years 7-9 (2019-221), average prevalence of asthma had dropped to 5.9%.
AHRQ-funded; HS027996.
Citation: Beck AF, Wymer L, Pinzer E .
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
J Allergy Clin Immunol Glob 2023 Nov; 2(4):1-4. doi: 10.1016/j.jacig.2023.100143..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Vulnerable Populations, Social Determinants of Health
Keith A, Jenkins TC, O'Leary S
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
The objective of the planned study described in this article will be to evaluate two low-cost interventions to increase guideline-concordant antibiotic durations in children with acute otitis media (AOM). The authors will explore differences in implementation effectiveness by patient population, clinician type, clinical setting, and organization as well as by intervention type. They will also conduct formative qualitative interviews with clinicians and administrators and focus groups with the parents of patients. The results of the study will provide a framework for healthcare systems to address the problem of excessive durations of therapy for AOM and to inform national antibiotic stewardship policy development.
AHRQ-funded; HS029153.
Citation: Keith A, Jenkins TC, O'Leary S .
Reducing length of antibiotics for children with ear infections: protocol for a cluster-randomized trial in the USA.
J Comp Eff Res 2023 Nov; 12(11):e230088. doi: 10.57264/cer-2023-0088..
Keywords: Children/Adolescents, Antibiotics, Medication, Ear Infections
Thompson MP, Hou H, Stewart JW
Relationship between community-level distress and cardiac rehabilitation participation, facility access, and clinical outcomes after inpatient coronary revascularization.
The purpose of this retrospective cohort study was to assess the association between community-level distress and cardiac rehabilitation (CR) participation, access to CR facilities, and clinical outcomes. The study included a 100% sample of Medicare beneficiaries undergoing inpatient coronary revascularization between July 2016 and December 2018. Community-level distress was defined by the researchers as using the Distressed Community Index quintile at the beneficiary zip code level, with the first and fifth quintiles representing prosperous and distressed communities, respectively. The study found that any CR use was lower for beneficiaries in distressed compared with prosperous communities (26.0% versus 46.1%), which was significant after multivariable adjustment. 23.7% of beneficiaries had a CR facility within their zip code, which increased from 16.3% in prosperous communities to 26.6% in distressed communities. Any CR utilization was related with absolute reductions in mortality, all-cause hospitalization, and acute myocardial infarction hospitalization, which were comparable across each Distressed Community Index quintiles.
AHRQ-funded; HS027830.
Citation: Thompson MP, Hou H, Stewart JW .
Relationship between community-level distress and cardiac rehabilitation participation, facility access, and clinical outcomes after inpatient coronary revascularization.
Circ Cardiovasc Qual Outcomes 2023 Nov; 16(11):e010148. doi: 10.1161/circoutcomes.123.010148..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Outcomes
Chen VW, Chidi AP, Dong Y
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
This study’s goal was to compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. The study cohort included 697,566 patients treated at 104 Veterans’ Affairs hospitals across 24 quarters with a mean age of 60.9 years and 91.4% male. These patients underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters). Outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]. Of 274 hospital quarters detected with observed to expected ratios, 72.6% were concurrently detected by at least 1 CUSUM signal vs 42.7% by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49).
AHRQ-funded; HS013853.
Citation: Chen VW, Chidi AP, Dong Y .
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
JAMA Surg 2023 Nov; 158(11):1176-83. doi: 10.1001/jamasurg.2023.3673..
Keywords: Quality Improvement, Surgery, Hospitals, Patient Safety, Mortality, Quality of Care
Woods-Hill CZ, Koontz DW, Colantuoni EA
Sustainability of the Bright STAR diagnostic stewardship program to reduce blood culture rates among critically ill children.
From 2017 to2020, 14 pediatric intensive care units (PICUs) participated in the Bright STAR (Testing Stewardship for Antibiotic Reduction) QI collaborative to reduce unnecessary blood cultures for PICU patients. The collaborative project found that 4 sites demonstrated a 33% decrease in blood culture rates and a 13% decrease in broad spectrum antibiotic use. The purpose of this current study was to assess whether sites sustained reduced blood culture rates after completion of the formal project. The study found that all sites had lower blood culture rates during the sustainability period when compared with the pre-implementation period. The blood culture rate increased 8% during the sustainability period compared with the postimplementation period but was 27% lower than during the pre-implementation period.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Koontz DW, Colantuoni EA .
Sustainability of the Bright STAR diagnostic stewardship program to reduce blood culture rates among critically ill children.
JAMA Pediatr 2023 Nov; 177(11):1234-37. doi: 10.1001/jamapediatrics.2023.3229..
Keywords: Children/Adolescents, Critical Care, Quality Improvement, Diagnostic Safety and Quality, Quality of Care
Wu L, Chang C, Lo K
Telephone-based social health screening by pharmacists in the nonadherent Medicare population.
The study examined social health needs among Medicare patients and pharmacist-led screening's impact on medication adherence and healthcare use. Using a predictive algorithm, higher-risk patients were identified. Patients accepting referrals had better statin adherence, while those declining had more hospital stays and fewer primary care visits. The findings suggest pharmacist interventions can improve medication adherence without worsening healthcare use or plan membership.
AHRQ-funded; HS027343.
Citation: Wu L, Chang C, Lo K .
Telephone-based social health screening by pharmacists in the nonadherent Medicare population.
J Manag Care Spec Pharm 2023 Nov; 29(11):1184-92. doi: 10.18553/jmcp.2023.29.11.1184..
Keywords: Provider: Pharmacist, Patient Adherence/Compliance, Social Determinants of Health, Medication
Bernard DM, Selden TM, Fang Z
AHRQ Author: Bernard
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
This AHRQ-authored paper examined the joint distribution of three financial problems related to healthcare: high out-of-pocket burdens, medical debt, and financial barriers to needed care. The authors applied relatively strict definitions of financial problems to data from the 2018-2019 MEPS and found that 27% of nonsenior adults lived in families with at least one of the three financial strains assessed. The percentage of participants who faced more broadly defined financial problems was 45.5%. This prevalence varied across sociodemographic characteristics, families' health care needs, insurance coverage, and financial resources.
AHRQ-authored.
Citation: Bernard DM, Selden TM, Fang Z .
The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care.
Health Aff 2023 Nov; 42(11):1517-26. doi: 10.1377/hlthaff.2023.00604..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Access to Care, Health Insurance
Godfrey CM, Shipe ME, Welty VF
The thoracic research evaluation and treatment 2.0 model: a lung cancer prediction model for indeterminate nodules referred for specialist evaluation.
In this research study the authors updated and expanded the Thoracic Research Evaluation and Treatment (TREAT) model into a more generalized, robust approach for lung cancer prediction in patients referred for specialty evaluation to improve lung cancer prediction accuracy. Clinical and radiographic data on 1401 patients with indeterminate pulmonary nodules (IPNs) from six sites were collected retrospectively and divided into groups by clinical setting: pulmonary nodule clinic (n = 374; cancer prevalence, 42%), outpatient thoracic surgery clinic (n = 553; cancer prevalence, 73%), or inpatient surgical resection (n = 474; cancer prevalence, 90%). The new prediction model was developed using a missing data-driven pattern submodel approach and compared with the original TREAT, Mayo Clinic, Herder, and Brock models. Two-thirds of patients were found to have missing data; nodule growth and fluorodeoxyglucose-PET scan avidity were missing most frequently. The TREAT version 2.0 mean area under the receiver operating characteristic curve across missingness patterns was 0.85 compared with the original TREAT (0.80), Herder (0.73), Mayo Clinic (0.72), and Brock (0.68) models with improved calibration.
AHRQ-funded; HS026122.
Citation: Godfrey CM, Shipe ME, Welty VF .
The thoracic research evaluation and treatment 2.0 model: a lung cancer prediction model for indeterminate nodules referred for specialist evaluation.
Chest 2023 Nov; 164(5):1305-14. doi: 10.1016/j.chest.2023.06.009..
Keywords: Cancer: Lung Cancer, Cancer
Mak A, Hwang R, Nace G
Trends in histrelin implantation at a pediatric tertiary care center.
This study investigated procedural outcomes and identified changing trends of utilization among patients undergoing histrelin implantation at a large pediatric tertiary care center over a 15 year period. A total of 746 patients underwent 1794 unique procedures, with 1364 placements/replacements and 430 removals. Procedures were performed in the clinic (60%), sedation unit (35%), and operating room (5%). A total of 14 patients had complications, including two patients that required early implant removal and one patient requiring antibiotics. 579 implants were placed for central precocious puberty (CPP) and 167 for gender dysphoria (GD). The cohort included 25.9% males and 74.1% females with mean age of implantation of 9.48 years. The GD cohort was comprised of 52.4% males and 47.6% females, compared to 18.3% males and 81.7% females in the CPP group. Significant difference was identified for mean age at placement by indication (CPP 8.65 years versus GD 12.34). New patient referrals and implant procedures increased significantly for patients over 14 years of age. Yearly frequency of patients receiving implants for CPP and GD increased significantly, with the proportion of GD patients increasing from 7% to 32%.
AHRQ-funded; HS026116.
Citation: Mak A, Hwang R, Nace G .
Trends in histrelin implantation at a pediatric tertiary care center.
J Surg Res 2023 Nov; 291:73-79. doi: 10.1016/j.jss.2023.05.019..
Keywords: Children/Adolescents
Opel DJ, Vo HH, Dundas N
Validation of a process for shared decision-making in pediatrics.
The purpose of this study was to explore a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves assessing whether the decision includes greater than 1 medically reasonable choice; 2) if one choice has a favorable medical benefit-burden ratio compared to other choices; and 3) parents' preferences regarding the choices; and 4) calibrating the SDM approach based on other applicable characteristics of the decision. The researchers videotaped a sample of pediatric inpatient and outpatient engagements at a United States children's hospital. Clinicians within craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine service categories were eligible for participation. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. The researchers conducted individual post-encounter interviews with clinician and parent participants used video-stimulated recall to stimulate reflection of decision-making that took place during the engagement. The study included 30 videotaped encounters and 53 interviews and discovered that clinicians' and parents' experiences of decision-making confirmed each SDM step. There were differences in the interpretation of each step and, depending on specific decisional contexts, a need for flexibility in implementing the process.
AHRQ-funded; HS026994.
Citation: Opel DJ, Vo HH, Dundas N .
Validation of a process for shared decision-making in pediatrics.
Acad Pediatr 2023 Nov-Dec; 23(8):1588-97. doi: 10.1016/j.acap.2023.01.007..
Keywords: Decision Making, Children/Adolescents
Shields AD, Vidosh J, Thomson BA
Validation of a simulation-based resuscitation curriculum for maternal cardiac arrest.
The purpose of this study was to evaluate the knowledge, skills, and self-efficacy of health care participants completing a simulation-based blended learning training curriculum on managing maternal medical emergencies and maternal cardiac arrest. The study included a formative assessment of the Obstetric Life Support curriculum. The training consisted of self-guided pre-course work and an instructor-led simulation course using a customized low-fidelity simulator. Eighty-five participants consented to participation in the training (out of 88 invited); 77 participants completed the training over eight sessions. The study found that at baseline, less than 50% of participants were able to achieve a passing score on the cognitive assessment. After the course, mean cognitive assessment scores improved by 13 points, from 69.4% at baseline to 82.4% after the course. The researchers observed significant improvements in participant self-efficacy, and 92.6% of participants agreed or strongly agreed that the course met its educational objectives.
AHRQ-funded; HS026169.
Citation: Shields AD, Vidosh J, Thomson BA .
Validation of a simulation-based resuscitation curriculum for maternal cardiac arrest.
Obstet Gynecol 2023 Nov 1; 142(5):1189-98. doi: 10.1097/aog.0000000000005349..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Maternal Care, Simulation, Training, Education: Continuing Medical Education, Women
Oke I, Slopen N, Hunter DG
Vision testing for adolescents in the US.
The purpose of this cross-sectional study was to characterize patterns in vision testing as a function of age among United States adolescents and identify sociodemographic factors related with vision testing. The researchers utilized data from 24,752 adolescent children (aged 12 to <18 years) from the 2018-2019 National Survey of Children's Health, a nationally representative survey of the noninstitutionalized United States pediatric population. The primary outcome of the study was the caregiver report of vision testing within the last 12 months. Vision testing in any setting within the previous year was reported by caregivers of 18,621 adolescents. Vision testing was reported to have occurred at an eye clinic in 13,323 participants, at a primary care clinic in 5,230 participants, at a school in 2,594 participants, and at a health center in 635 participants. The rate of adolescents reported to have vision tested decreased with age due to a decrease in testing in primary care and school settings. After adjusting for age and sex, there were lower odds of vision testing reported for adolescents who were uninsured vs insured, had caregivers with less than vs greater than high school education, and were from a family born outside vs inside the United States.
AHRQ-funded; HS000063.
Citation: Oke I, Slopen N, Hunter DG .
Vision testing for adolescents in the US.
JAMA Ophthalmol 2023 Nov; 141(11):1068-72. doi: 10.1001/jamaophthalmol.2023.4475..
Keywords: Children/Adolescents, Eye Disease and Health, Screening
Hose BZ, Carayon P, Hoonakker PLT
Work system barriers and facilitators of a team health information technology.
This study’s objective was to identify work design barriers and facilitators to the use of a team health IT that supports care transitions for pediatric trauma patients. The authors conducted an analysis on 36 interviews - representing 12 roles - collected from a scenario-based evaluation of T(3). They identified eight dimensions with both barriers and facilitators in all five work system elements: person (experience), task (task performance, workload/efficiency), technology (usability, specific features of T(3)), environment (space, location), and organization (communication/coordination). They concluded that designing technology that meets every role's needs is challenging; in particular, when trade-offs need to be managed, e.g., additional workload for one role or divergent perspectives regarding specific features.
AHRQ-funded; HS023837
Citation: Hose BZ, Carayon P, Hoonakker PLT .
Work system barriers and facilitators of a team health information technology.
Appl Ergon 2023 Nov; 113:104105. doi: 10.1016/j.apergo.2023.104105..
Keywords: Health Information Technology (HIT), Teams