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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 10552 Research Studies Displayed
Yakovchenko V, Morgan TR, Chinman MJ
Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the Veterans Health Administration.
While few countries and healthcare systems are on track to meet the World Health Organization's hepatitis C virus (HCV) elimination goals, the US Veterans Health Administration (VHA) has been a leader in these efforts. In this study the investigators aimed to determine which implementation strategies were associated with successful national viral elimination implementation within the VHA. They conducted a five-year, longitudinal cohort study of the VHA Hepatic Innovation Team (HIT) Collaborative between October 2015 and September 2019.
AHRQ-funded; HS019461.
Citation:
Yakovchenko V, Morgan TR, Chinman MJ .
Mapping the road to elimination: a 5-year evaluation of implementation strategies associated with hepatitis C treatment in the Veterans Health Administration.
BMC Health Serv Res 2021 Dec 18;21(1):1348. doi: 10.1186/s12913-021-07312-4..
Keywords:
Hepatitis, Chronic Conditions, Veterans
Wurcel AG, Essien UR, Ortiz C
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
This cohort study examined antibiotics prescribed and variations by race among hospitalized patients with skin and soft tissue infections (SSTIs). A subanalysis of multisite, cross-sectional data collected through a national survey of acute care hospital groups within Vizient, Inc. considering adult inpatients treated for SSTIs was used. Of the 1242 adult inpatients included from 91 US hospitals, 45% were female, 18% were Black, and 69% were White with a mean age of 58 years. Penicillin allergy with hives was found in 23%, 19% with rash, and 18% with unknown effects, with allergy found more frequent in Black patients (23%) versus White (18%). Adjusting for multiple factors, White inpatients were at an increased risk of cefazolin use and decreased risk of clindamycin use compared with Black inpatients. Cefazolin use with less likely to be prescribed to Black inpatients than White inpatients and they were likely to be prescribed clindamycin. Cefazolin is considered a first-line SSTI treatment with clindamycin not recommended given frequent dosing and high potential for adverse effects including Clostridioides difficile infection (CDI). Although penicillin allergy is described as more prevalent among White patients, the authors observed an increased prevalence among Black inpatients compared with White inpatients treated for SSTI.
Citation:
Wurcel AG, Essien UR, Ortiz C .
Variation by race in antibiotics prescribed for hospitalized patients with skin and soft tissue infections.
JAMA Netw Open 2021 Dec;4(12):e2140798. doi: 10.1001/jamanetworkopen.2021.40798..
Keywords:
Antibiotics, Skin Conditions, Racial / Ethnic Minorities, Practice Patterns, Medication
Nguyen JK, Sanghavi P
A national assessment of legacy versus new generation Medicaid data.
The purpose of the study was to review Medicaid legacy, Medicaid new generation, and Medicare claims across multiple states and compare performance on data analytic tasks. The researchers targeted the series of events that begins with a non-hospital-related medical emergency and ends with survival to discharge or death. Six data quality indicators were developed to evaluate the following: ambulance variables; code reporting for external cause of injury; linkage between claims; and death reporting on hospital discharge status codes. For death reporting on hospital discharge status codes the researchers estimated the severity of injuries and developed a model of its correlation with death in the Medicare population. The resulting model was utilized to compare reported versus expected deaths by level of injury severity in the Medicaid population. The study found that new generation Medicare claims had high performance across states and indicators, Medicaid legacy claims underperformed on multiple indicators in most states, and while new generation Medicaid claims outperformed Medicaid legacy claims on several indicators, conducting high-level analysis with that data will require substantial improvements.
AHRQ-funded; HS025720.
Citation:
Nguyen JK, Sanghavi P .
A national assessment of legacy versus new generation Medicaid data.
Health Serv Res 2022 Aug;57(4):944-56. doi: 10.1111/1475-6773.13937..
Keywords:
Medicaid, Medicare, Care Management
Hails KA, Petts RA, Hostutler CA
COVID-19 distress, negative parenting, and child behavioral problems: the moderating role of parent adverse childhood experiences.
This study’s objective was to test a moderated mediation model to determine whether families’ COVID-19-related distress is associated with young children's emotional/behavioral functioning via negative parenting, and whether these relationships vary based on parents' adverse childhood experiences (ACEs). Participants were 267 parents recruited from five primary care sites across the United States with children ages 1.5-5 years. Internet questionnaires were completed on measures including demographics, parent ACEs, negative parenting, parent mental health, and COVID-19 distress. Negative parenting significantly mediated the relationship between COVID-19 distress and child emotional/behavioral problems. The model accounted for 42% variance in child emotional/behavioral problems.
AHRQ-funded; HS022981.
Citation:
Hails KA, Petts RA, Hostutler CA .
COVID-19 distress, negative parenting, and child behavioral problems: the moderating role of parent adverse childhood experiences.
Child Abuse Negl 2022 Aug;130(Pt 1):105450. doi: 10.1016/j.chiabu.2021.105450..
Keywords:
Children/Adolescents, COVID-19, Behavioral Health, Stress
Adams C, Wortley P, Chamberlain A
Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic?
This article examined whether declines in the crude US COVID-19 case fatality ratio is due to improved clinical care and/or other factors. The authors used multivariable logistic regression to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia from March 2020 through March 2021. Mortality risk was lowest in November 2020 compared to August 2020 and remained lower until March 2021. Among hospitalized cases, mortality risk increased in December 2020 and January 2021 before declining in March 2021. The authors concluded that improved clinical management may have contributed to lower mortality risk.
AHRQ-funded; HS025987.
Citation:
Adams C, Wortley P, Chamberlain A .
Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic?
Ann Epidemiol 2022 Aug;72:57-64. doi: 10.1016/j.annepidem.2022.05.008..
Keywords:
COVID-19, Public Health, Mortality
Beeber AS, Hoben M, Leeman J
Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol.
This paper describes an AHRQ-funded study protocol (Engage) to develop a toolkit for increasing resident and family engagement in assisted living (AL) safety. The study goals are to engage AL residents and family caregivers, AL staff, and other AL stakeholders to (1) identify common AL safety problems; (2) prioritize safety problems and identify and evaluate existing PFE interventions with the potential to address safety problems in the AL setting; and (3) develop a testable toolkit to improve PFE in AL safety. Methods, including qualitative interviews, a scoping review of persona and family engagement (PFE) interventions, and stakeholder panel meetings are discussed. The authors also detail how the protocol was modified to address the unique challenges of the COVID-19 pandemic.
AHRQ-funded; HS026473.
Citation:
Beeber AS, Hoben M, Leeman J .
Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol.
Res Nurs Health 2022 Aug;45(4):413-23. doi: 10.1002/nur.22232..
Keywords:
Patient and Family Engagement, Patient Safety, Caregiving, Public Health, Long-Term Care
Temkin-Greener H, Mao Y, McGarry B
Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility.
The purpose of this study was to examine the type and quality of care received in residential long-term care setting by racial/ ethnic minorities or residents eligible for dual Medicare and Medicaid. With 2018 Medicare data, the researchers identified 255,564 fee-for-service Medicare beneficiaries over the age of 55 who were living in 24,108 assisted living facilities across the United States and evaluated the relationship between race/ethnicity and dual status with emergency room use, inpatient hospital admission, 30-day readmission, and placement in a nursing home. The study found variations within and across assisted living facilities for racial/ethnic minority and dual residents, suggesting that outcome disparities are the most significant by dual eligibility status instead of only race/ ethnicity. The researchers concluded that these results can be used to inform and guide future research, as well as healthcare providers and policy makers.
AHRQ-funded; HS026893.
Citation:
Temkin-Greener H, Mao Y, McGarry B .
Health care use and outcomes in assisted living communities: race, ethnicity, and dual eligibility.
Med Care Res Rev 2022 Aug;79(4):500-10. doi: 10.1177/10775587211050189..
Keywords:
Elderly, Racial / Ethnic Minorities, Long-Term Care, Medicare
Koball H, Kirby J, Hartig S
The relationship between states' immigrant-related policies and access to health care among children of immigrants.
The purpose of this AHRQ-authored paper was to explore immigrants’ children’s access to preventive healthcare, and the impact of sanctuary policies (state policies that limit federal immigration enforcement involvement) and the provision of driver’s licenses for undocumented immigrants on that access. Primary outcomes included whether the child had a well child check-up, unmet medical needs, or a regular source for care. The 2008-2016 Medical Panel Expenditure Survey (MPES) merged with policy data at the state level were analyzed, with the researchers reporting that sanctuary policies and having a state driver’s license were both associated with having a regular source for care and less unmet medical needs among the children of immigrants. The researchers emphasized the importance of access to preventive care and concluded that sanctuary policies are related to increased access to preventive health care among the children of immigrants.
AHRQ-authored.
Citation:
Koball H, Kirby J, Hartig S .
The relationship between states' immigrant-related policies and access to health care among children of immigrants.
J Immigr Minor Health 2022 Aug;24(4):834-41. doi: 10.1007/s10903-021-01282-9..
Keywords:
Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Policy, Access to Care
Rudin RS, Qureshi N, Foer D
Toward an asthma patient-reported outcome measure for use in digital remote monitoring.
The purpose of this study was to create a patient-reported outcome measure (PROM) and evaluate its suitability for digital remote asthma symptom monitoring to identify uncontrolled asthma. The researchers modified the asthma control measure (ACM), an existing, non-licensed PROM, and tested it with the asthma control questionnaire (ACQ-5) on 498 individuals with asthma, all of whom were recruited through an online platform. The study concluded that the modified ACM can be used in digital remote monitoring, does not require a license, and is able to differentiate between patients with uncontrolled asthma and patients with well-controlled asthma.
AHRQ-funded; HS026432.
Citation:
Rudin RS, Qureshi N, Foer D .
Toward an asthma patient-reported outcome measure for use in digital remote monitoring.
J Asthma 2022 Aug;59(8):1697-702. doi: 10.1080/02770903.2021.1955378..
Keywords:
Asthma, Respiratory Conditions, Telehealth, Health Information Technology (HIT)
Pickens G, Smith MW, McDermott KW
Trends in treatment costs of U.S. emergency department visits.
In recent years, emergency department (ED) spending has been increasing more than in other areas of health care. Few studies have focused on changes in ED treatment costs. The purpose of this study was to analyze recent increases in emergency department treatment costs to highlight possibilities for reducing the growth of overall hospital costs. The researchers used data from the Healthcare Cost and Utilization Project (HCUP) and applied Cost-to-Charge Ratios for ED Files to the HCUP Nationwide Emergency Department Sample for 2012 through 2019. The study found that ED treatment costs experienced a 5.4% annual growth rate, increasing from $54 billion to $88 billion, with higher treatment cost per visit responsible for 4.4 of those percentage points. The researchers concluded that the study provides valuable information for decision- and policy-makers by bringing attention to components of the healthcare delivery system with the highest increasing costs as well as trends in overall ED costs.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation:
Pickens G, Smith MW, McDermott KW .
Trends in treatment costs of U.S. emergency department visits.
Am J Emerg Med 2022 Aug;58:89-94. doi: 10.1016/j.ajem.2022.05.035..
Keywords:
Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Emergency Department
Eldridge N, Wang Y, Metersky M
Trends in adverse event rates in hospitalized patients, 2010-2019.
This AHRQ-authored serial cross-sectional study’s objective was to determine the change in the rate of adverse events in hospitalized patients from 2010 to 2019. The study used data from the Medicare Patient Safety Monitoring System and included 244,542 adult patients hospitalized in 3156 acute care hospitals across 4 condition groups: acute myocardial infarction (17%), heart failure (17%) pneumonia (21%), major surgical procedures (22%), and all other conditions (22%). Information on adverse events collected included 21 measures across 4 adverse event domains: adverse drug events, hospital-acquired infections, adverse events after a procedure, and general adverse events such as pressure ulcers and falls. The study sample included 190,286 hospital discharges in the combined 4 condition-based groups and 54,256 hospital discharges for all other conditions. From 2010 to 2019, the total change for adverse events per 1000 discharges for acute myocardial infarction decreased from 218 to 139, from 168 to 116 for heart failure, from 195 to 119 for pneumonia, and from 204 to 130 for major surgical procedures. The rate for all other conditions remained unchanged at 70 adverse events per 1000 discharges.
AHRQ-authored; AHRQ-funded; 290201800005C.
Citation:
Eldridge N, Wang Y, Metersky M .
Trends in adverse event rates in hospitalized patients, 2010-2019.
JAMA 2022 Jul 12;328(2):173-83. doi: 10.1001/jama.2022.9600..
Keywords:
Adverse Events, Patient Safety, Hospitals, Inpatient Care
Nanji KC, Garabedian PM, Langlieb ME
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
The purpose of this study was assess the usability of a newly developed, comprehensive, medication-related operating room clinical decision support (CDS) software and compare it with the standard electronic health record (EHR) medication workflow. Forty participants were randomized to a CDS group (n=20) or a control group (n=20) and asked to complete 7 simulation tasks. The study found that in a simulation setting the new CDS software improved efficiency and quality of care and reduced task time, excelling over the current EHR workflow.
AHRQ-funded; HS024764.
Citation:
Nanji KC, Garabedian PM, Langlieb ME .
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
J Am Med Inform Assoc 2022 Jul 12;29(8):1416-24. doi: 10.1093/jamia/ocac035..
Keywords:
Medication, Clinical Decision Support (CDS), Health Information Technology (HIT), Surgery, Decision Making
Doty AM, Rising KL, Hsiao T
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
This study’s objective was to describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated emergency department (ED) discharge discussion. Most residents in the simulation explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients’ feelings. However, 28% of residents did not discuss diagnostic uncertainty in any form. All residents were reassuring. Those who did discuss diagnostic uncertainty used explicit and implicit language with similar frequency.
AHRQ-funded; HS025651.
Citation:
Doty AM, Rising KL, Hsiao T .
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
Patient Educ Couns 2022 Jul;105(7):2053-57. doi: 10.1016/j.pec.2021.12.002..
Keywords:
Clinician-Patient Communication, Emergency Department, Communication, Diagnostic Safety and Quality
Skube SJ, Hu Z, Simon GJ
Accelerating surgical site infection abstraction with a semi-automated machine-learning approach.
The purpose of this study was to test a supervised machine learning algorithm developed for testing surgical site infection (SSI) on performing semi-automated SSI abstraction, and to demonstrate that a semi-automated approach to health data abstraction provides a high level of accuracy and significant efficiencies. The researchers evaluated data from 6,188 patients in a 2011-2013 dataset and 5,132 patients in a 2015-2015 dataset. The study concluded that very good performance is achieved using the semi-automated machine learning-aided SSI abstraction, which also accelerates the abstraction process.
AHRQ-funded; HS024532.
Citation:
Skube SJ, Hu Z, Simon GJ .
Accelerating surgical site infection abstraction with a semi-automated machine-learning approach.
Ann Surg 2022 Jul 1;276(1):180-85. doi: 10.1097/sla.0000000000004354..
Keywords:
Healthcare-Associated Infections (HAIs), Surgery, Health Information Technology (HIT)
Mohr NM, Schuette AR, Ullrich F
An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.
The purpose of this study will be to assess the impact of provider-focused video telehealth in rural hospital emergency departments (ED) on costs and long-term outcomes for patients with sepsis. Using Medicare administrative claims, the researchers will compare telehealth-subscribing hospitals and control hospitals to assess the differences in total health care expenditures, category-specific costs, length of stay, readmissions, and mortality. The researchers intend for the study results to demonstrate the association between telehealth utilization and sepsis care total expenditures.
AHRQ-funded; HS025753.
Citation:
Mohr NM, Schuette AR, Ullrich F .
An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.
J Comp Eff Res 2022 Jul;11(10):703-16. doi: 10.2217/cer-2022-0019..
Keywords:
Telehealth, Health Information Technology (HIT), Sepsis, Rural Health, Healthcare Costs
Keller SC, Caballero TM, Tamma PD
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
This cohort study evaluated the effectiveness of the AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic prescribing in ambulatory practices by engaging clinicians and staff to incorporate antibiotic stewardship into practice culture, communication, and decision-making. The study ran from December 2019 through November 2020. A total of 389 ambulatory care practices with over 6.5 million visits to 5483 clinicians were compared from the baseline to completion of the program. Participants included 82 primary care practices, 103 urgent care practices, 34 federally supported practices, 21 pediatric-only practices, 39 pediatric urgent care practices, 21 pediatric-only practices, and 14 other practice types. Of the 389 practices who completed the program, 75% submitted completed data. Visits per practice per month decreased from a mean of 1624 at baseline to a nadir of 906 early in the COVID-19 pandemic (April 2020) and were 1797 at the end of the program. Total antibiotic prescribing decreased from 18.2% of visits at baseline to 9.5% at completion of the program. Acute respiratory infection (ARI) visits per practice per month decreased from a baseline of 321 to a nadir of 76 early in the pandemic (May 2020) and gradually increased through completion of the program (n = 239). Antibiotic prescribing for ARIs decreased from 39.2% at baseline to 24.7% at completion of the program.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation:
Keller SC, Caballero TM, Tamma PD .
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
JAMA Netw Open 2022 Jul;5(7):e2220512. doi: 10.1001/jamanetworkopen.2022.20512..
Keywords:
Antimicrobial Stewardship, Antibiotics, Medication, COVID-19, Public Health, Respiratory Conditions
Woods-Hill CZ, Colantuoni EA, Koontz DW
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
The purpose of this AHRQ-funded prospective study was to assess the relationship between a 14-site PICU blood culture collaborative, the Bright STAR (Testing Stewardship for Antibiotic Reduction) collaborative, and culture rates, antibiotic use, and patient outcomes. The researchers collected data from each participating PICU across the United States and from the Children’s Hospital Association Pediatric Health Information System. The main outcome was blood culture rates, with secondary outcomes including: broad-spectrum antibiotic use and PICU rates of central line-associated bloodstream infection (CLABSI), Clostridioides difficile infection, readmission, length of stay, sepsis, severe sepsis/septic shock, and mortality. The study found that the blood culture rate preimplementation across the 14 PICUs was 149.4 per 1000 patient days per month, and the rate postimplementation was 100.5 for a 33% relative reduction postimplementation. For those same periods, the rate of antibiotic use decreased from 506 days per 1000 patient-days per month preimplementation to 440 days per 1000 patient-days per month postimplementation, which reflects a 13% relative reduction. Rates of CLABSI decreased from 1.8 to 1.1 per 1000 central venous line days per month, a 36% relative reduction. The variables of length of stay, readmission, sepsis, severe sepsis/septic shock, and mortality were similar before and after implementation. The researchers concluded that collaborative interventions can reduce blood culture and antibiotic use in the PICU.
AHRQ-funded; HS025642.
Citation:
Woods-Hill CZ, Colantuoni EA, Koontz DW .
Association of diagnostic stewardship for blood cultures in critically ill children with culture rates, antibiotic use, and patient outcomes: results of the Bright STAR Collaborative.
JAMA Pediatr 2022 Jul;176(7):690-98. doi: 10.1001/jamapediatrics.2022.1024..
Keywords:
Children/Adolescents, Sepsis, Critical Care, Antibiotics, Medication, Diagnostic Safety and Quality, Antimicrobial Stewardship
Manjunath J, Silverberg JI
Association of sleep disturbances with geriatric age in atopic dermatitis patients.
The purpose of this cross-sectional study was to investigate the association of geriatric age with atopic dermatitis (AD) severity and sleep disturbances (SD). Patients over the age of 18 seen at an eczema clinic were recruited and completed a self-administered questionnaire for encounters between 2014 and 2019. AD severity was assessed using the patient-oriented eczema measure (POEM), eczema area and severity index, Scoring AD (SCORAD), SCORAD-itch, investigator global assessment, and patient global assessment. The frequency of SD due to eczema was assessed using POEM. The impact of itching on the activity of falling asleep was assessed using 5 dimensions (5D) of itch. Fatigue was assessed using the patient-reported outcome measurement information system (PROMIS)-global health. Difficulty sleeping, falling asleep, and staying asleep was assessed using PROMIS-SD. The study found that geriatric AD patients had more profound SD, particularly staying asleep and fatigue, despite having AD severity similar to younger adult AD patients. The researchers concluded that future research is needed to understand why there is a difference between geriatric and non-geriatric patients as related to increased itching from atopic dermatitis and sleep disorders.
AHRQ-funded; HS023011.
Citation:
Manjunath J, Silverberg JI .
Association of sleep disturbances with geriatric age in atopic dermatitis patients.
J Am Acad Dermatol 2022 Jul;87(1):206-08. doi: 10.1016/j.jaad.2021.07.039..
Keywords:
Elderly, Sleep Problems, Skin Conditions
Topham EW, Bristol A, Luther B
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted post-discharge patient outcomes. Through interviews with four English-speaking caregivers, findings showed that, once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to post-discharge knowledge gaps. This study of caregiver experiences suggests that AHRQ’s IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
AHRQ-funded; HS026248.
Citation:
Topham EW, Bristol A, Luther B .
Caregiver inclusion in IDEAL discharge teaching: implications for transitions from hospital to home.
Prof Case Manag 2022 Jul-Aug;27(4):181-93. doi: 10.1097/ncm.0000000000000563..
Keywords:
Hospital Discharge, Transitions of Care, Caregiving
Merkow RP, Chung JW, Slota JM
Correlation of the US News and World Report-calculated nurse staffing index with actual hospital-reported nurse staffing.
This study’s objective was to understand how the Nurse Staffing Index (NSI) used in the US News and World Report “Best Hospitals” rankings correlates to actual nurse staffing levels. Nurse staffing data was obtained from publicly available data in the states of Illinois, California, and New Jersey. No other states had publicly accessible data. Hospital characteristics were obtained from the 2016 American Hospital Association (AHA) survey. The NSI was calculated using AHA data and is defined as the number of FTE RNs per adjusted patient day. Hospital characteristics were assessed using Hospital Compare data. Higher actual hospital-reported nurse staffing in Illinois and New Jersey was paradoxically associated with lower nurse staffing when measured by the NSI. California hospital-reported staffing intensity was weakly correctly with the NSI and RN nursing hours per patient day was not correlated with any of the 9 structural measures of hospital quality, while NSI was positively correlated with 3 of the 9 measures, particularly hospital volume status. None of the 11 outcome measures the authors assessed were associated with RN nursing hours per patient day or the NSI in either Illinois or California. All 12 patient experience measures were significantly and positively correlated with RN nursing hours in Illinois. However, none of the patient experience measures were significantly associated with the NSI in Illinois. The authors concluded that the NSI may not measure actual nurse staffing as intended.
AHRQ-funded; HS024516; HS026385.
Citation:
Merkow RP, Chung JW, Slota JM .
Correlation of the US News and World Report-calculated nurse staffing index with actual hospital-reported nurse staffing.
J Nurs Care Qual 2022 Jul-Sep;37(3):195-98. doi: 10.1097/ncq.0000000000000619..
Keywords:
Consumer Assessment of Healthcare Providers and Systems (CAHPS), Provider: Nurse, Workforce
Sorra J, Zebrak K, Yount N
Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices.
Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of this study was to develop survey items to assess clinician and staff perspectives about the extent to which the organizational culture in hospitals and medical offices supports value and efficiency. The investigators concluded when added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets they developed extended those surveys by assessing additional dimensions of organizational culture that affect care delivery.
AHRQ-funded; 290201000025I.
Citation:
Sorra J, Zebrak K, Yount N .
Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices.
BMJ Qual Saf 2022 Jul;31(7):493-502. doi: 10.1136/bmjqs-2020-012407..
Keywords:
Surveys on Patient Safety Culture, Organizational Change, Value
Hoffmann JA, Johnson JK, Pergjika A
Development of quality measures for pediatric agitation management in the emergency department.
This study’s objective was to develop quality measures for pediatric emergency department (ED) agitation management informed by multidisciplinary perspectives. A multidisciplinary panel was created to develop quality measures for pediatric ED agitation management through the modified Delphi method. The panelists included 36 physicians, nurses, social workers, security, child life specialists, hospital data analysts, and parents. Measures were ranked by panelists in importance and feasibility on a 9-point scale during 2 survey rounds, with a teleconference discussion between surveys. Consensus was defined at >75% of panelists ranking a quality measure greater or equal to 7 in importance and median feasibility of greater or equal to 4. Consensus was reached on 20 quality measures that incorporated multidisciplinary perspectives.
AHRQ-funded; HS026385.
Citation:
Hoffmann JA, Johnson JK, Pergjika A .
Development of quality measures for pediatric agitation management in the emergency department.
J Healthc Qual 2022 Jul-Aug;44(4):218-29. doi: 10.1097/jhq.0000000000000339..
Keywords:
Children/Adolescents, Quality Measures, Quality Indicators (QIs), Quality of Care, Emergency Department
VanderVeen DK, Oke I, Nihalani BR
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
The purpose of this longitudinal cohort study was to assess whether children’s eyes that deviate from age-adjusted normative biometry measures are predictive of variations in target refraction and IOL power selection after cataract surgery. The researchers prospectively collected biometry data from the normal eyes of children under 10 years of age (100 eyes) with biometry data from eyes undergoing cataract surgery (162 eyes). The study analysis found greater myopic shift associated with younger age and male gender and concluded that adjustments can be made for cataract surgery for children’s eyes whose measures deviate from the norm for their age.
AHRQ-funded; HS000063.
Citation:
VanderVeen DK, Oke I, Nihalani BR .
Deviations from age-adjusted normative biometry measures in children undergoing cataract surgery: implications for postoperative target refraction and IOL power selection.
Am J Ophthalmol 2022 Jul;239:190-201. doi: 10.1016/j.ajo.2022.02.022..
Keywords:
Children/Adolescents, Eye Disease and Health, Surgery
Haessler S, Guo N, Deshpande A
Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample.
This study compared the clinical practice and outcomes in severe community-acquired pneumonia (sCAP) patients to those in non-sCAP patients using guideline-defined criteria for sCAP. The definition for sCAP includes a principal diagnosis of pneumonia or a secondary pneumonia diagnosis paired with a principal diagnosis of sepsis or respiratory failure. One-hundred seventy-seven US hospitals within the Premier Healthcare Database were used to identify 154,799 patients with pneumonia, with 14.1% meeting criteria for sCAP. The sCAP patients had higher organ failure scores and inpatient mortality, longer lengths of stay, and higher costs than those with nonsevere disease. Patients with sCAP had twice the rate of positive blood cultures and respiratory cultures and more often had isolates resistant to first-line community-acquired pneumonia antibiotics. The most common pathogen acquired from blood cultures was Streptococcus pneumoniae and from the respiratory tract Staphylococcus aureus and Pseudomonas species. The most common antibiotics prescribed were vancomycin (65%) and piperacillin-tazobactam (42.8%), regardless of cultures positive for a resistant organism.
AHRQ-funded; HS024277.
Citation:
Haessler S, Guo N, Deshpande A .
Etiology, treatments, and outcomes of patients with severe community-acquired pneumonia in a large U.S. sample.
Crit Care Med 2022 Jul;50(7):1063-71. doi: 10.1097/ccm.0000000000005498..
Keywords:
Community-Acquired Infections, Pneumonia, Respiratory Conditions, Outcomes
Korthuis PT, Cook RR, Lum PJ
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Opioid Use Disorder (OUD) treatment medications can improve outcomes for human immunodeficiency virus (HIV) and also reduce opioid use. The purpose of the study was to determine if outpatient naltrexone treatment could also reduce opioid use and improve outcomes for HIV. The researchers reported that enrollment was stopped early because of slower than expected recruitment, resulting in 114 final participants with untreated OUD and HIV, with 62% positive for fentanyl, 60% positive for cocaine, and 47% positive for other opioids at the baseline. The intervention compared treatment as usual (TAU) of methadone or buprenorphine with extended-release naltrexone (XR-NTX) on group differences in viral suppression at 24 weeks and past 30-day use of opioids at 24 weeks. The study reported that at 24 weeks the outcome of viral suppression was similar for TAU and XR-NTX, and that fewer XR-NTX participants initiated medication than TAU participants. The outcome of previous 30-day use of opioids was similar for TAU as compared to XR-NTX. Of those participants who did initiate medication, those administered XR-NTX experienced less days of opioid use when compared with TAU in the prior 30 days. The researchers reported that the study evidence was not conclusive but did support that XR-NTX is not inferior to TAU for HIV viral suppression, and that study participants who started XR-NTX used less opioids at 24 weeks than participants who were administered TAU.
AHRQ-funded; HS026370.
Citation:
Korthuis PT, Cook RR, Lum PJ .
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Addiction 2022 Jul;117(7):1961-71. doi: 10.1111/add.15836..
Keywords:
Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Behavioral Health, Medication, Treatments, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
