National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (417)
- Adverse Drug Events (ADE) (321)
- Adverse Events (737)
- Alcohol Use (61)
- Ambulatory Care and Surgery (204)
- Antibiotics (248)
- Antimicrobial Stewardship (157)
- Anxiety (48)
- Arthritis (130)
- Asthma (122)
- Autism (31)
- Back Health and Pain (58)
- Behavioral Health (699)
- Blood Clots (62)
- Blood Pressure (132)
- Blood Thinners (79)
- Brain Injury (64)
- Breast Feeding (18)
- Burnout (64)
- Cancer (788)
- Cancer: Breast Cancer (197)
- Cancer: Cervical Cancer (21)
- Cancer: Colorectal Cancer (116)
- Cancer: Lung Cancer (83)
- Cancer: Ovarian Cancer (9)
- Cancer: Prostate Cancer (108)
- Cancer: Skin Cancer (15)
- Cardiovascular Conditions (711)
- Care Coordination (104)
- Caregiving (223)
- Care Management (225)
- Case Study (101)
- Catheter-Associated Urinary Tract Infection (CAUTI) (55)
- Centers for Education and Research on Therapeutics (CERTs) (12)
- Central Line-Associated Bloodstream Infections (CLABSI) (61)
- Children's Health Insurance Program (CHIP) (40)
- Children/Adolescents (1542)
- Chronic Conditions (700)
- Clinical Decision Support (CDS) (199)
- Clinician-Patient Communication (281)
- Clostridium difficile Infections (55)
- Colonoscopy (37)
- Communication (383)
- Community-Acquired Infections (59)
- Community-Based Practice (150)
- Community Partnerships (18)
- Comparative Effectiveness (463)
- Complementary and Alternative Medicine (23)
- Comprehensive Unit-based Safety Program (CUSP) (9)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (85)
- COVID-19 (312)
- Critical Care (220)
- Cultural Competence (64)
- Data (174)
- Decision Making (583)
- Dementia (102)
- Dental and Oral Health (66)
- Depression (237)
- Diabetes (369)
- Diagnostic Safety and Quality (545)
- Dialysis (24)
- Digestive Disease and Health (111)
- Disabilities (73)
- Disparities (449)
- Domestic Violence (30)
- Ear Infections (5)
- Education (30)
- Education: Academic (26)
- Education: Continuing Medical Education (159)
- Education: Curriculum (23)
- Education: Patient and Caregiver (231)
- Elderly (944)
- Electronic Health Records (EHRs) (729)
- Electronic Prescribing (E-Prescribing) (26)
- Emergency Department (559)
- Emergency Medical Services (EMS) (163)
- Emergency Preparedness (26)
- Evidence-Based Practice (932)
- Eye Disease and Health (36)
- Falls (85)
- Family Health and History (71)
- Genetics (96)
- Guidelines (364)
- Healthcare-Associated Infections (HAIs) (420)
- Healthcare Cost and Utilization Project (HCUP) (368)
- Healthcare Costs (787)
- Healthcare Delivery (547)
- Healthcare Utilization (384)
- Health Information Exchange (HIE) (51)
- Health Information Technology (HIT) (1425)
- Health Insurance (434)
- Health Literacy (126)
- Health Promotion (78)
- Health Services Research (HSR) (327)
- Health Status (132)
- Health Systems (104)
- Heart Disease and Health (452)
- Hepatitis (41)
- Home Healthcare (141)
- Hospital Discharge (220)
- Hospitalization (534)
- Hospital Readmissions (323)
- Hospitals (757)
- Human Immunodeficiency Virus (HIV) (255)
- Imaging (245)
- Implementation (191)
- Infectious Diseases (260)
- Influenza (41)
- Injuries and Wounds (207)
- Inpatient Care (221)
- Intensive Care Unit (ICU) (267)
- Kidney Disease and Health (199)
- Labor and Delivery (106)
- Learning Health Systems (47)
- Lifestyle Changes (134)
- Long-Term Care (226)
- Low-Income (171)
- Maternal Care (182)
- Medicaid (359)
- Medical Devices (71)
- Medical Errors (205)
- Medical Expenditure Panel Survey (MEPS) (189)
- Medical Liability (26)
- Medicare (573)
- Medication (1681)
- Medication: Safety (231)
- Men's Health (54)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (73)
- Mortality (397)
- Neonatal Intensive Care Unit (NICU) (43)
- Neurological Disorders (197)
- Newborns/Infants (258)
- Nursing (113)
- Nursing Homes (326)
- Nutrition (135)
- Obesity (250)
- Obesity: Weight Management (105)
- Opioids (303)
- Organizational Change (73)
- Orthopedics (106)
- Osteoporosis (30)
- Outcomes (798)
- Pain (208)
- Palliative Care (138)
- Patient-Centered Healthcare (456)
- Patient-Centered Outcomes Research (1033)
- Patient Adherence/Compliance (229)
- Patient and Family Engagement (275)
- Patient Experience (258)
- Patient Safety (1293)
- Patient Self-Management (140)
- Payment (200)
- Pneumonia (82)
- Policy (431)
- Practice-Based Research Network (PBRN) (16)
- Practice Improvement (34)
- Practice Patterns (305)
- Pregnancy (289)
- Pressure Ulcers (28)
- Prevention (794)
- Primary Care (718)
- Primary Care: Models of Care (86)
- Provider (299)
- Provider: Clinician (67)
- Provider: Health Personnel (91)
- Provider: Nurse (112)
- Provider: Pharmacist (98)
- Provider: Physician (237)
- Provider: Physician Assistant (1)
- Provider Performance (199)
- Public Health (182)
- Public Reporting (40)
- Quality Improvement (551)
- Quality Indicators (QIs) (138)
- Quality Measures (227)
- Quality of Care (990)
- Quality of Life (199)
- Racial and Ethnic Minorities (749)
- Registries (146)
- Rehabilitation (61)
- Research Methodologies (418)
- Respiratory Conditions (367)
- Risk (756)
- Rural/Inner-City Residents (23)
- Rural Health (133)
- Screening (457)
- Sepsis (140)
- Sex Factors (67)
- Sexual Health (126)
- Sickle Cell Disease (49)
- Simulation (48)
- Skin Conditions (121)
- Sleep Problems (70)
- Social Determinants of Health (355)
- Social Media (46)
- Social Stigma (52)
- Stress (71)
- Stroke (162)
- Substance Abuse (299)
- Surgery (1110)
- Surveys on Patient Safety Culture (13)
- System Design (15)
- Teams (137)
- TeamSTEPPS (17)
- Telehealth (256)
- Tobacco Use (83)
- Tobacco Use: Smoking Cessation (22)
- Tools & Toolkits (49)
- Training (143)
- Transitions of Care (192)
- Transplantation (141)
- Trauma (104)
- Treatments (185)
- U.S. Preventive Services Task Force (USPSTF) (217)
- Uninsured (80)
- Urban Health (92)
- Urinary Tract Infection (UTI) (70)
- Vaccination (158)
- Vitamins and Supplements (10)
- Vulnerable Populations (229)
- Web-Based (84)
- Women (545)
- Workflow (66)
- Workforce (89)
- Young Adults (85)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
201 to 225 of 12139 Research Studies DisplayedReed KG, Sun Z, Yabes JG
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
The purpose of this study was to evaluate variations among patients who do and do not visit Commission on Cancer (CoC) accredited facilities. The researchers utilized Pennsylvania Cancer Registry data linked to facility records for 87,472 patients diagnosed with cancer between 2018 and 2019. The study found that patients in the most advantaged Area Deprivation Index quartiles were more likely to visit CoC facilities compared with other quartiles. Urban patients were more likely than rural to be seen at a CoC facility as were Hispanic patients and non-Hispanic Black patients compared with White patients.
AHRQ-funded; HS027396.
Citation: Reed KG, Sun Z, Yabes JG .
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
JNCI Cancer Spectr 2023 Oct 31; 7(6). doi: 10.1093/jncics/pkad080..
Keywords: Cancer, Health Information Technology (HIT), Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents
Lovero KL, Kemp CG, Wagenaar BH
Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review.
The authors conducted a systematic literature review on the use of Expert Recommendations for Implementing Change (ERIC) project strategies for health intervention implementation in low- and middle-income countries (LMICs) in order to identify gaps and to inform future research. The results indicated that ERIC usage in LMICs is rapidly growing, but its application has not been consistently used to test strategy effectiveness. The authors recommended that future LMICs research test strategies need to be better specified, so they may be compared across contexts and their impact on outcomes evaluated.
AHRQ-funded; HS025632.
Citation: Lovero KL, Kemp CG, Wagenaar BH .
Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review.
Implement Sci 2023 Oct 30; 18(1):56. doi: 10.1186/s13012-023-01310-2..
Keywords: Implementation, Evidence-Based Practice
Boxley C, Fujimoto M, Ratwani RM
A text mining approach to categorize patient safety event reports by medication error type.
This study examined whether natural language processing can be used to better categorize medication related patient safety event reports. A total of 3,861 medication related patient safety event reports that were previously annotated using a consolidated medication error taxonomy were used to develop three models using the following algorithms: (1) logistic regression, (2) elastic net, and (3) XGBoost. The models were tested and performance was analyzed. The authors found the XGBoost model performed best across all medication error categories. 'Wrong Drug', 'Wrong Dosage Form or Technique or Route', and 'Improper Dose/Dose Omission' categories performed best across the three models. In addition, they identified five words most closely associated with each medication error category and which medication error categories were most likely to co-occur.
AHRQ-funded; HS026481.
Citation: Boxley C, Fujimoto M, Ratwani RM .
A text mining approach to categorize patient safety event reports by medication error type.
Sci Rep 2023 Oct 26; 13(1):18354. doi: 10.1038/s41598-023-45152-w..
Keywords: Health Information Technology (HIT), Patient Safety, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events
Ganguli I, Mackwood MB, Yang CW
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
The objective of this retrospective cohort study was to characterize racial differences in receipt of low-value care among older Medicare beneficiaries overall and within U.S. health systems. Medicare fee-for-service administrative data was used for Black and White Medicare patients who were at least 65 as of 2016. Findings showed that, of the 40 low value services examined, Black patients had a higher adjusted receipt of 9 services and lower receipt of 20 services than White patients. Differences were generally small and largely due to differential care within health systems, but the authors concluded that their findings suggested potential factors that researchers, policymakers, and health system leaders might investigate to improve health care quality and equity.
AHRQ-funded; HS024930.
Citation: Ganguli I, Mackwood MB, Yang CW .
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
BMJ 2023 Oct 25; 383:e074908. doi: 10.1136/bmj-2023-074908..
Keywords: Elderly, Racial and Ethnic Minorities, Medicare, Health Systems
Ranusch A, Lin YJ, Dorsch MP
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
The objective of this study was to examine how individual authority of clinical pharmacists and anticoagulation nurses is affected by the implementation success of an electronic health record (EHR) direct oral anticoagulant (DOAC) Dashboard for safe DOAC medication prescribing. Researchers conducted semistructured interviews with pharmacists and nurses after the implementation of the EHR DOAC Dashboard at three clinical sites. Results showed that a high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard; conversely, a lack of individual authority was associated with key barriers to effective use. The researchers concluded that increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard.
AHRQ-funded; HS026874.
Citation: Ranusch A, Lin YJ, Dorsch MP .
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
JMIR Hum Factors 2023 Oct 24; 10:e49025. doi: 10.2196/49025..
Keywords: Medication, Provider: Pharmacist, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Blood Thinners
Routh D, Simmons R, Sanders J
Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review.
The purpose of this study was to conduct a systematic review of policy and practice recommendations to improve contraceptive care to reproductive-aged, incarcerated individuals in the US. The researchers used the Joanna Briggs Institute methodology, framed within the National Implementation Research Network's (NIRN) Exploration stage. Sources included MedLine, ProQuest, PSYCInfo, PubMed, SCOPUS, Social Science Citation Index, and Web of Science, as well as the reference sections of included materials. A total of 45 materials met the inclusion criteria. The researchers identified seven themes: 1. policy changes needed for care implementation; 2. the need for contraceptive care in carceral systems; 3. Barriers from justice agencies regarding the provision of contraceptive care; 4. policy barriers to access to contraceptives; 5. funding strategies to improve care; 6. patient preferences for contraceptive care delivery; and 7. healthcare provider knowledge about contraceptive care. The seven themes highlighted the need for contraceptive care provision to incarcerated individuals, as well as gaps, barriers, and facilitators of current contraceptive care provision for this population.
AHRQ-funded; HS027220.
Citation: Routh D, Simmons R, Sanders J .
Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review.
Health Justice 2023 Oct 20; 11(1):43. doi: 10.1186/s40352-023-00243-8..
Keywords: Sexual Health, Vulnerable Populations
Kim B, Cruden G, Crable EL
A structured approach to applying systems analysis methods for examining implementation mechanisms.
This article delineated a structured approach to applying systems analysis methods to examining implementation mechanisms. This approach included steps for selecting, tailoring, and evaluating an implementation strategy. The authors illustrated the approach by using an example case, then discussed the strengths and limitations of this approach, when each step might be appropriate. They suggested work that might extend systems analysis methods to the implementation mechanisms research.
AHRQ-funded; HS025632.
Citation: Kim B, Cruden G, Crable EL .
A structured approach to applying systems analysis methods for examining implementation mechanisms.
Implement Sci Commun 2023 Oct 19; 4(1):127. doi: 10.1186/s43058-023-00504-5..
Keywords: Implementation, Evidence-Based Practice, Health Systems
Song J, Min SH, Chae S
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
The purpose of this study was to characterize risk factor patterns documented in home health care (HHC) clinical notes and explore their relationships with hospitalizations or emergency department (ED) visits. The researchers analyzed data for 73,350 episodes of care from one large HHC organization utilizing dynamic time warping and hierarchical clustering analysis to characterize the patterns of risk factors over time documented in clinical notes. The study found that six temporal clusters emerged, reflecting varying patterns in how risk factors were documented. Patients with a sharp increase in documented risk factors over time had a 3 times greater probability of hospitalization or ED visit than patients with no documented risk factors. The majority of risk factors were found in the physiological domain, and a minority were found in the environmental domain.
AHRQ-funded; HS027742.
Citation: Song J, Min SH, Chae S .
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
J Am Med Inform Assoc 2023 Oct 19; 30(11):1801-10. doi: 10.1093/jamia/ocad101..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Silva GC, Gutman R
Reformulating provider profiling by grouping providers treating similar patients prior to evaluating performance.
The purpose of this study was to explore a novel approach to comparing health providers' performance that identifies groups of providers treating similar populations of patients and then assesses providers' performance within each group. To compare the performance of the proposed approach, the researchers utilized patient-level data from 119 Massachusetts skilled nursing facilities. Simulated and observed outcome data were utilized to examine the performance of the methods in different settings. In simulations, the proposed method classified providers to groups with the admission attributes of similar patients. In the presence of limited overlap in patient attributes across providers and misspecifications of the outcome model, the provider-level estimates created utilizing the novel approach identified providers that under- and overperformed when compared to the existing approaches.
AHRQ-funded; HS026830.
Citation: Silva GC, Gutman R .
Reformulating provider profiling by grouping providers treating similar patients prior to evaluating performance.
Biostatistics 2023 Oct 18; 24(4):962-84. doi: 10.1093/biostatistics/kxac019..
Keywords: Provider Performance, Quality of Care, Healthcare Delivery
Dopp AR, Hunter SB, Godley MD
Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study.
This study’s goal was to compare organization-focused and state-focused financing strategies on their provider-level reach of a youth substance use treatment model. The authors evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing the two US federal grant mechanisms on organization-level A-CRA reach outcomes. Implementation of these A-CRA grants took place from 2006 to 2021. They used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, they calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding and also tested differences in certification rate by grant type. They also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. Overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants. They did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities).
AHRQ-funded; HS000046.
Citation: Dopp AR, Hunter SB, Godley MD .
Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study.
Implement Sci 2023 Oct 12; 18(1):50. doi: 10.1186/s13012-023-01305-z..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health
Fernandez JR, Strassle PD, Richmond J
County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.
This study examined whether county-level vaccination barriers varied across racial/ethnic groups in the U.S., if they were associated with willingness to receive the COVID-19 vaccine, and if they differed across racial/ethnic groups. Data was taken from the REACH-US study. County-level vaccination barriers were measured using the COVID-19 Vaccine Coverage Index. Results showed that American Indian/Alaska Native, African American, Hispanic/Latino, and Multiracial adults were more likely than White adults to live in counties with higher overall county-level vaccination barriers. Higher sociodemographic barriers were associated with less willingness to receive the COVID-19 vaccine. History of low vaccination was associated with less willingness to receive the COVID-19 vaccine among African American adults. The researchers concluded that future vaccination programs should include efforts accounting for structural barriers to preventive healthcare and their intersection with sociodemographic factors.
AHRQ-funded; HS026122.
Citation: Fernandez JR, Strassle PD, Richmond J .
County-level barriers in the COVID-19 vaccine coverage index and their associations with willingness to receive the COVID-19 vaccine across racial/ethnic groups in the U.S.
Front Public Health 2023 Oct 12; 11:1192748. doi: 10.3389/fpubh.2023.1192748..
Keywords: COVID-19, Vaccination, Patient Adherence/Compliance, Racial and Ethnic Minorities
Thom KA, Rock C, Robinson GL
Direct gloving vs hand hygiene before donning gloves in adherence to hospital infection control practices: a cluster randomized clinical trial.
The purpose of this study was to assess the effectiveness of a direct-gloving policy on adherence to infection prevention control practices in a hospital setting. In this study, hospital units were randomly assigned to either the intervention (hand hygiene not required before putting on gloves) or to usual care (hand hygiene required prior to before putting on nonsterile gloves). The primary study outcome was adherence to the expected practice upon room entry and room exit. Thirteen hospital units participated in the trial, and 3,790 health care personnel (HCP) were observed. The study found that adherence to expected practice was higher in the 6 units with the direct-gloving intervention than in the 7 usual care units even when controlling for baseline hand hygiene rates, unit type, and universal gloving policies. The intervention had no effect on hand hygiene adherence measured at entry to non-contact precautions rooms or at room exit. The intervention was related with increased total bacteria colony counts and increased detection of pathogenic bacteria on gloves in the ED and reduced colony counts in pediatrics units, with no change in either total colony count for adult intensive care unit or presence of pathogenic bacteria for adult intensive care unit.
AHRQ-funded; HS024108.
Citation: Thom KA, Rock C, Robinson GL .
Direct gloving vs hand hygiene before donning gloves in adherence to hospital infection control practices: a cluster randomized clinical trial.
JAMA Netw Open 2023 Oct 2; 6(10):e2336758. doi: 10.1001/jamanetworkopen.2023.36758..
Keywords: Hospitals, Patient Safety, Guidelines, Healthcare-Associated Infections (HAIs)
Kornfield R, Lattie EG, Nicholas J
"Our job is to be so temporary": designing digital tools that meet the needs of care managers and their patients with mental health concerns.
The purpose of this study was to improve understanding of how to integrate digital tools in routine healthcare, especially for patients with both physical and mental health needs. The researchers conducted interviews and design workshops with 1. a group of care managers who support patients with complex health needs, and 2. their patients whose health needs include mental health concerns. The researchers examined both groups' views of potential applications of digital tools within care management. The study found that care managers felt underprepared to addressing mental health issues on an ongoing basis and had concerns about the burden and confusion of providing support through new digital channels. Patients envisioned benefiting from ongoing mental health support from care managers, including support in using digital tools. The needs of patients and care managers may be so different that meeting both through the same tools represents a substantial challenge, and could require altering these professionals' roles in mental health support.
AHRQ-funded; HS028003.
Citation: Kornfield R, Lattie EG, Nicholas J .
"Our job is to be so temporary": designing digital tools that meet the needs of care managers and their patients with mental health concerns.
Proc ACM Hum Comput Interact 2023 Oct; 7(CSCW2):302. doi: 10.1145/3610093..
Keywords: Behavioral Health, Health Information Technology (HIT), Care Coordination
Vear KR, Esbrook E, Padley E
"Time and money and support": adolescents and young adults' perceived social and logistical support needs for safe abortion care.
This study’s objective was to understand what support adolescents and young adults need to access abortion amidst the changing legal landscape. A diverse nationwide sample of individuals aged 14-24 responded to a text message survey in July 2022 about the social and logistical support they would need for safe abortion access. Out of the sample of 638, there was a 78% response rate. Primary sources of social support from parents and friends were named by the respondents for potential abortion decisions. The respondents frequently cited money and transportation as logistical support needs for out-of-state abortion care.
AHRQ-funded; HS026369.
Citation: Vear KR, Esbrook E, Padley E .
"Time and money and support": adolescents and young adults' perceived social and logistical support needs for safe abortion care.
Contraception 2023 Oct; 126:110128. doi: 10.1016/j.contraception.2023.110128..
Keywords: Children/Adolescents, Young Adults, Maternal Care, Patient Safety, Access to Care
Agniel D, Cabreros I, Damberg CL
A formal framework for incorporating equity into health care quality measurement.
This paper examines how tying incentives on the basis of stratification or disparities in quality measurement may have unintended consequences or limited effects. Addressing one aspect of equity may be in competition with addressing others. The authors proposed equity weighting, a new measurement framework to advance equity on multiple fronts that addresses the shortcomings of existing approaches and explicitly calibrates incentives to align with equity goals. They used colorectal cancer screening data derived from 2017 Medicare claims to illustrate how equity weighting fixes unintended consequences in other methods and how it can be adapted to policy goals.
AHRQ-funded; HS024067.
Citation: Agniel D, Cabreros I, Damberg CL .
A formal framework for incorporating equity into health care quality measurement.
Health Aff 2023 Oct; 42(10):1383-91. doi: 10.1377/hlthaff.2022.01483..
Keywords: Quality Measures, Quality Improvement, Quality of Care, Disparities
Georgette N, Michelson K, Monuteaux M
A temperature- and age-adjusted shock index for emergency department identification of pediatric sepsis.
The objective of this retrospective cohort study was to derive a temperature- and age-adjusted mean shock index (TAMSI) for early identification of sepsis and septic shock in children with suspected infection. Researchers analyzed data on children who presented with suspected infection to a single emergency department over a 10-year period. Test characteristics for the TAMSI cutoffs were compared with those for the Pediatric Advanced Life Support (PALS) tachycardia or systolic hypotension cutoffs. The results showed that TAMSI achieved a similar negative likelihood ratio and improved positive likelihood ratio compared with PALS vital sign cutoffs for the prediction of septic shock, but did not improve on PALS for sepsis prediction among children with suspected infection.
AHRQ-funded; HS026503.
Citation: Georgette N, Michelson K, Monuteaux M .
A temperature- and age-adjusted shock index for emergency department identification of pediatric sepsis.
Ann Emerg Med 2023 Oct; 82(4):494-502. doi: 10.1016/j.annemergmed.2023.03.026..
Keywords: Children/Adolescents, Emergency Department, Sepsis, Diagnostic Safety and Quality
Chen Z, Gleason LJ, Konetzka RT
Accuracy of infection reporting in US nursing home ratings.
The objective of this study was to assess the accuracy of publicly reported nursing home data on urinary tract infections (UTIs) and of pneumonia data, which are not publicly reported. Researchers developed a claims-based nursing home-level measure of hospitalized infections and estimated correlations between this and publicly reported ratings. Subjects were Medicare fee-for-service beneficiaries who were nursing home residents and hospitalized for UTI or pneumonia during the study period. Findings suggested that both UTI and pneumonia were substantially underreported in data used for national public reporting. The researchers concluded that alternative approaches were needed to improve surveillance of nursing home quality.
AHRQ-funded; HS026957.
Citation: Chen Z, Gleason LJ, Konetzka RT .
Accuracy of infection reporting in US nursing home ratings.
Health Serv Res 2023 Oct; 58(5):1109-18. doi: 10.1111/1475-6773.14195..
Keywords: Provider Performance, Nursing Homes, Long-Term Care, Pneumonia, Urinary Tract Infection (UTI), Elderly
Sequeria GM, Guler J, Reyes V
Adolescent and caregiver perspectives on receiving gender-affirming care in primary care.
The purpose of this study was to examine Transgender and gender-diverse (TGD) adolescents' and caregivers' experiences and perspectives about gender-affirming care delivery in pediatric primary care. Semi-structured, individual, virtual interviews were administered to TGD adolescents aged 14 to 17 and caregivers of TGD adolescents currently receiving gender-affirming medical care. A total of 15 adolescents and 18 caregivers (33 total participants) completed interviews. Adolescent participants primarily identified as transmasculine or trans male (73%), and caregiver participants were primarily mothers (83.3%). The study identified four themes, which included 1) barriers, such as microaggressions and poor psychosocial support, 2) benefits, such as existing trusted relationships with primary care providers (PCPs) and convenience, 3) improvement strategies, such as training and interdisciplinary collaboration, and 4) opportunities for integrating primary care and specialty gender-affirming care.
AHRQ-funded; HS026393.
Citation: Sequeria GM, Guler J, Reyes V .
Adolescent and caregiver perspectives on receiving gender-affirming care in primary care.
Pediatrics 2023 Oct 1; 152(4). doi: 10.1542/peds.2023-062210..
Keywords: Sex Factors, Children/Adolescents, Primary Care
Xie A, Koontz DW, Colantuoni EA
Application of participatory ergonomics to the dissemination of a quality improvement program for optimizing blood culture use.
The overuse of blood cultures in pediatric ICUs (PICUs) may lead to the unnecessary utilization of antibiotics and related resistance to antibiotics. The purpose of this study was to utilize a participatory ergonomics (PE) approach to disseminate a quality improvement (QI) program for optimizing blood culture use in PICUs and assess the dissemination process and its impact on blood culture reduction. The study found that overall, the participating sites were able to implement the program successfully and reduce their blood culture rates from 149.4 blood cultures per 1,000 patient-days/month before implementation to 100.5 blood cultures per 1,000 patient-days/month after implementation. Differences in the dissemination process, as well as in local interventions and implementation strategies, were observed across sites. Site-specific variations in the rates of blood cultures were weakly negatively associated with the number of preintervention interactions with the coordinating team but not associated with their experiences with the six domains of the dissemination process or their interventions.
AHRQ-funded; HS025642; HS025238.
Citation: Xie A, Koontz DW, Colantuoni EA .
Application of participatory ergonomics to the dissemination of a quality improvement program for optimizing blood culture use.
Jt Comm J Qual Patient Saf 2023 Oct; 49(10):529-38. doi: 10.1016/j.jcjq.2023.06.004..
Keywords: Quality Improvement, Quality of Care, Children/Adolescents, Intensive Care Unit (ICU)
Strauss AT, Sidoti CN, Sung HC
Artificial intelligence-based clinical decision support for liver transplant evaluation and considerations about fairness: a qualitative study.
This study’s objective was to use human-centered design methods to elicit providers' perceptions of AI-based clinical decision support (AI-CDS) for liver transplant listing decisions. This multicenter qualitative study involved semistructured interviews with 53 multidisciplinary liver transplant providers from 2 transplant centers. The author’s analysis yielded 6 themes important for the design of fair AI-CDS for liver transplant listing decisions: (1) transparency in the creators behind the AI-CDS and their motivations; (2) understanding how the AI-CDS uses data to support recommendations (ie, interpretability); (3) acknowledgment that AI-CDS could mitigate emotions and biases; (4) AI-CDS as a member of the transplant team, not a replacement; (5) identifying patient resource needs; and (6) including the patient's role in the AI-CDS.
AHRQ-funded; HS024600.
Citation: Strauss AT, Sidoti CN, Sung HC .
Artificial intelligence-based clinical decision support for liver transplant evaluation and considerations about fairness: a qualitative study.
Hepatol Commun 2023 Oct; 7(10). doi: 10.1097/hc9.0000000000000239..
Keywords: Clinical Decision Support (CDS), Transplantation, Health Information Technology (HIT)
Shapiro HFJ, Loder E, Shapiro DJ
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
The purpose of this multicenter retrospective cohort study was to compare prescribing patterns of preventive medications between pediatric and adult neurologists for young adults with migraine. The primary study outcome was whether the patient received a prescription for any preventive medication during the study period. Among the 767 included patients, 37.8% were seen by a pediatric neurologist. Preventive medications were prescribed for 45.2% of patients seen by a pediatric neurologist and 43.2% of patients seen by an adult neurologist. In the mixed effects logistic regression model, clinician specialty was not related with preventive medication use Female sex and number of visits during the study period were related with receiving preventive medication. The study concluded that proportion of young adults being prescribed migraine medications did not differ according to clinician specialty.
AHRQ-funded; HS000063.
Citation: Shapiro HFJ, Loder E, Shapiro DJ .
Association between clinician specialty and prescription of preventive medication for young adults with migraine: a retrospective cohort study.
Headache 2023 Oct; 63(9):1232-39. doi: 10.1111/head.14628..
Keywords: Young Adults, Medication, Pain, Neurological Disorders
Mullens CL, Lussiez A, Scott JW
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
This study’s objective was to compare surgical outcomes and expenditures at hospitals located in Health Professional Shortage Areas to nonshortage area designated hospitals among Medicare beneficiaries. This cross-sectional retrospective study used data from 842,787 Medicare beneficiary patient admissions to hospitals with and without Health Professional Shortage Area designations for common operations including appendectomy, cholecystectomy, colectomy, and hernia repair from 2014 to 2018. Primary outcomes measures were 30-day mortality, hospital readmissions, and 30-day surgical episode payments. Patients (mean age=75.6 years, males=44.4%) undergoing common surgical procedures in shortage area hospitals were less likely to be White (84.6% vs 88.4%) and less likely to have≥2 Elixhauser comorbidities (75.5% vs 78.2%). Patients undergoing surgery at Health Professional Shortage Area hospitals had lower risk-adjusted rates of 30-day mortality (6.05% vs 6.69%) and readmission (14.99% vs 15.74%). Medicare expenditures at Health Professional Shortage Area hospitals were also lower than nonshortage designated hospitals ($28,517 vs $29,685).
AHRQ-funded; HS028606; HS028672.
Citation: Mullens CL, Lussiez A, Scott JW .
Association of health professional shortage area hospital designation with surgical outcomes and expenditures among Medicare beneficiaries.
Ann Surg 2023 Oct 1; 278(4):e733-e39. doi: 10.1097/sla.0000000000005762..
Keywords: Hospitals, Surgery, Medicare, Healthcare Costs, Workforce, Outcomes
Ryus CR, Janke AT, Kunnath N
Association of hospital discharge against medical advice and coded housing instability in the US.
This study examined the relationship between discharge type and housing instability, then identified primary reasons for hospitalization among self-discharged patients with housing instability. This cross-sectional, retrospective study analyzed the National Inpatient Sample between January 2017 and December 2019, available from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. Among 85,402,831 hospitalizations analyzed, 1.6% resulted in self-discharge. Compared to admissions with planned discharges, self-discharges were more likely to have coded housing instability. Among hospitalizations resulting in self-discharge, admissions with coded housing instability were more likely to result in self-discharge than those without coded housing instability. Relationships between housing instability and self-discharges were found among major medical conditions: septicemia, acute myocardial infarction, and respiratory failure. Alcohol-related disorders and opioid-related disorders were among the highest self-discharge volumes, but relationships were minimal.
AHRQ-funded; HS028963.
Citation: Ryus CR, Janke AT, Kunnath N .
Association of hospital discharge against medical advice and coded housing instability in the US.
J Gen Intern Med 2023 Oct; 38(13):3082-85. doi: 10.1007/s11606-023-08240-1..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Social Determinants of Health, Vulnerable Populations, Hospital Readmissions
Gupta AB, Greene MT, Fowler KE
Associations between hospitalist shift busyness, diagnostic confidence, and resource utilization: a pilot study.
Hospitalists are frequently attending to multiple tasks when overseeing patient care, and patients are at risk for diagnostic errors. The purpose of this single-center, prospective, pilot observational study was to measure hospitalist workload and examine its influences on diagnostic performance in a real-world clinical setting. The researchers had hospitalists admitting new patients to the hospital complete an abbreviated Mindful Attention Awareness Tool and a survey on diagnostic confidence upon shift completion. Complete data were available for 37 unique hospitalists who admitted 160 unique patients. The study found that increases in admissions and pages were related with higher odds of hospitalists reporting it was "difficult to focus on what is happening in the present." Increased pages was associated with a decrease in the number of differential diagnoses listed.
AHRQ-funded; HS024385; HS025891.
Citation: Gupta AB, Greene MT, Fowler KE .
Associations between hospitalist shift busyness, diagnostic confidence, and resource utilization: a pilot study.
J Patient Saf 2023 Oct 1; 19(7):447-52. doi: 10.1097/pts.0000000000001157..
Keywords: Hospitals, Diagnostic Safety and Quality, Patient Safety
Pederson CA, Dir AL, Schwartz K
Associations between outpatient treatment and the use of intensive psychiatric healthcare services.
This study examined concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (median = 13.4) and had a psychiatric Medicaid claim (N = 33,590). Outcome was use of psychiatric services coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistical regression analyses by the authors indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. The authors found that for remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care.
AHRQ-funded; HS022681; HS023318
Citation: Pederson CA, Dir AL, Schwartz K .
Associations between outpatient treatment and the use of intensive psychiatric healthcare services.
Clin Child Psychol Psychiatry 2023 Oct; 28(4):1380-92. doi: 10.1177/13591045231154106..
Keywords: Behavioral Health, Healthcare Utilization