National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Caregiving (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (6)
- Chronic Conditions (2)
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- Healthcare-Associated Infections (HAIs) (3)
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- (-) Hospitalization (16)
- Hospital Readmissions (4)
- (-) Hospitals (16)
- Infectious Diseases (3)
- Inpatient Care (4)
- Intensive Care Unit (ICU) (2)
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- Newborns/Infants (1)
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- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedMcWilliams JM, Barnett ML, Roberts ET
Did hospital readmissions fall because per capita admission rates fell?
In this study examining the cause of falling hospital readmission rates, the investigators found that the probability of an admission occurring soon after another was lower when there were fewer admissions per patient. The authors indicate that the reduction in admission rates may explain much of the reduction in readmission rates.
AHRQ-funded; HS026727.
Citation: McWilliams JM, Barnett ML, Roberts ET .
Did hospital readmissions fall because per capita admission rates fell?
Health Aff 2019 Nov;38(11):1840-44. doi: 10.1377/hlthaff.2019.00411..
Keywords: Hospital Readmissions, Hospitals, Hospitalization, Quality of Care, Medicare
Silber JH, Rosenbaum PR, Pimentel SD
Comparing resource use in medical admissions of children with complex chronic conditions.
In this study, the investigators explored whether some hospitals display a significantly different pattern of resource utilization than others when caring for similar children with complex chronic conditions (CCCs) admitted for medical diagnoses. The investigators concluded that hospitals treating similar patients with CCCs admitted for similar medical diagnoses, varied greatly in resource utilization. They suggest that Template Matching can aid chief quality officers benchmarking their hospitals to peer institutions and can help determine types of their patients having the most aberrant outcomes, facilitating quality initiatives to target these patients.
AHRQ-funded; HS020508.
Citation: Silber JH, Rosenbaum PR, Pimentel SD .
Comparing resource use in medical admissions of children with complex chronic conditions.
Med Care 2019 Aug;57(8):615-24. doi: 10.1097/mlr.0000000000001149..
Keywords: Children/Adolescents, Chronic Conditions, Hospitals, Healthcare Utilization, Hospitalization
Auger KA, Shah SS, Huang B
Discharge medical complexity, change in medical complexity and pediatric 30-day readmission.
Investigators conducted a five-year retrospective, case-control study of pediatric hospitalizations at a tertiary care children's hospital and estimated odds of 30-day unplanned readmission using adjusted conditional logistic regression. They found that polypharmacy and use of technology at discharge pose a substantial readmission risk for children, but added technology and new complex chronic conditions do not increase risk when accounting for length of stay.
AHRQ-funded; HS204735.
Citation: Auger KA, Shah SS, Huang B .
Discharge medical complexity, change in medical complexity and pediatric 30-day readmission.
J Hosp Med 2019 Aug;14(8):474-81. doi: 10.12788/jhm.3222..
Keywords: Children/Adolescents, Chronic Conditions, Hospital Readmissions, Hospitalization, Hospitals
Hussain FS, Sosa T, Ambroggio L
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
This case-control study aimed to determine the predictive validity of an emergency transfer (ET) for outcomes in a free-standing children's hospital. Controls were matched in terms of age, hospital unit, and time of year. Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality (22% vs 9%), longer ICU length of stay (4.9 vs 2.2 days), and longer posttransfer length of stay (26.4 vs 14.7 days) compared with controls (P < .03 for each).
AHRQ-funded; HS023827.
Citation: Hussain FS, Sosa T, Ambroggio L .
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
J Hosp Med 2019 Aug;14(8):482-85. doi: 10.12788/jhm.3219..
Keywords: Transitions of Care, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Outcomes, Patient-Centered Outcomes Research, Inpatient Care, Hospitalization, Hospitals, Healthcare Delivery
Beck J, Wignall J, Jacob-Files E
Parent attitudes and preferences for discussing health care costs in the inpatient setting.
This study examined parent attitudes towards discussing their child’s health care costs in an inpatient setting with health care providers and others. Semistructured interviews were conducted with 42 parents of children who received care at a tertiary academic children’s hospital with and without chronic disease. Two domains for discussion were identified: factors that influence the parent’s desire to discuss health care costs in the inpatient setting and parent preference regarding the execution of cost discussions. Most parents highlighted concerns regarding physician involvement and felt that it was better explored with a financial counselor or social worker. They also felt that the discussions should be optional.
AHRQ-funded; HS024299.
Citation: Beck J, Wignall J, Jacob-Files E .
Parent attitudes and preferences for discussing health care costs in the inpatient setting.
Pediatrics 2019 Aug;144(2). doi: 10.1542/peds.2018-4029..
Keywords: Caregiving, Children/Adolescents, Healthcare Costs, Inpatient Care, Hospitalization, Hospitals
Glick AF, Brach C, Yin HS
AHRQ Author: Brach C
Health literacy in the inpatient setting: implications for patient care and patient safety.
This article considers how health literacy plays a part in events that lead up to children's hospitalizations both during hospital admission and after discharge. The authors discussed interventions that incorporate health-literacy-informed strategies and that target patients, families, and health care systems that should be implemented to improve patient outcomes and patient-centered and family-centered care.
AHRQ-authored.
Citation: Glick AF, Brach C, Yin HS .
Health literacy in the inpatient setting: implications for patient care and patient safety.
Pediatr Clin North Am 2019 Aug;66(4):805-26. doi: 10.1016/j.pcl.2019.03.007..
Keywords: Children/Adolescents, Health Literacy, Hospital Discharge, Hospitalization, Hospitals, Inpatient Care, Patient Safety
Ye L, Owens RL, Dykes P
Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.
The aim of this study was develop a tool that can be used to measure factors that affect patient sleep in acute care hospitals. A tool called Factors Affected Inpatient Sleep (FAIS) was developed using literature review and was validated by content validity testing. The scale was tested on 105 hospitalized patients and the most significant sleep disruptors were identified. The final FAIS scale included 14 items in three subscales. The biggest factors for sleep disruption included 1) emotional or physical impairment due to illness or hospitalization; 2) sleep disturbance due to discomfort of their care plan schedule; and 3) sleep interruption due to the hospital environment or medical care. The reliability of the scale was measured at 0.87 with Cronbach’s alpha coefficient and reliability of the subscales ranged from 0.72 to 0.81.
AHRQ-funded; HS024330.
Citation: Ye L, Owens RL, Dykes P .
Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.
Appl Nurs Res 2019 Aug;48:63-67. doi: 10.1016/j.apnr.2019.05.006..
Keywords: Health Promotion, Hospitalization, Hospitals, Inpatient Care, Sleep Problems
Barbash IJ, Wallace DJ, Kahn JM
Effects of changes in ICU bed supply on ICU utilization.
The purpose of this study was to determine the relationship between intensive care unit (ICU) bed supply and ICU admission in US hospitals. Using a difference-in-differences approach, researchers compared the risk-adjusted probability of ICU admission at hospitals that increased their ICU bed supply over time with matched hospitals that did not. Subjects were three patient groups with a low likelihood of benefiting from ICU admission: low-severity patients with acute myocardial infarction and pulmonary embolism, and high-severity patients with metastatic cancer at the end of life. Results showed that increases in ICU bed supply were associated with inconsistent changes in the probability of ICU admission that varied across patient subgroups.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Wallace DJ, Kahn JM .
Effects of changes in ICU bed supply on ICU utilization.
Med Care 2019 Jul;57(7):544-50. doi: 10.1097/mlr.0000000000001137..
Keywords: Intensive Care Unit (ICU), Critical Care, Healthcare Utilization, Hospitalization, Healthcare Delivery, Hospitals
Goldstein E, MacFadden DR, Karaca Z
AHRQ Author: Karaca Z Steiner CA
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Researchers studied the relation between the prevalence of resistance to various antibiotics in different bacteria and rates of sepsis-related outcomes. They found that, among the different combinations of antibiotics/bacteria, prevalence of resistance to fluoroquinolones in E. coli had the strongest association with septicemia hospitalization rates for individuals aged over 50 years, and with sepsis mortality rates for individuals aged 18-84 years. They also found a number of positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization/sepsis mortality rates in adults.
AHRQ-authored.
Citation: Goldstein E, MacFadden DR, Karaca Z .
Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states.
Int J Antimicrob Agents 2019 Jul;54(1):23-34. doi: 10.1016/j.ijantimicag.2019.03.004..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare Cost and Utilization Project (HCUP), Hospitals, Hospitalization, Medication, Mortality, Sepsis
Lauerman MH, Herrera AV, Albrecht JS
Interhospital transfers with wide variability in emergency general surgery.
This study examined modern hospital practices for interhospital transfers of emergency general surgery patients. A retrospective review of the Maryland Health Services Cost Review Commission database was conducted from 2013 to 2015. The majority of patients (94.1%) were not transferred with only 3.2% transferred to a hospital and 2.7% transferred from a hospital. For individual hospitals, there was a range of 0-30.5% of encounters transferred to a hospital, 0.02-14.62% transferred from a hospital and 69.25-99.95% not transferred.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Interhospital transfers with wide variability in emergency general surgery.
Am Surg 2019 Jun;85(6):595-600..
Keywords: Emergency Department, Healthcare Delivery, Hospitalization, Hospitals, Outcomes, Quality of Care, Surgery, Transitions of Care
Goodman KE, Simner PJ, Klein EY
Predicting probability of perirectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) at hospital unit admission.
This study measured the prevalence of carbapenem-resistant organisms (CROs), including carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-production organisms (CPOs) in the perirectal area in all patients admitted to the medical intensive care unit or solid organ transplant unit at Johns Hopkins Hospital between July 1, 2016 and July 1, 2017. The data was then used to develop models to predict colonization probabilities using decision tree learning. While overall, decision tree models poorly predicted CRO and CPO colonization; for patients with recent CRO-positive cultures who use proton-pump inhibitors the decision tree did accurately identify patients with CRO-positive cultures.
AHRQ-funded; HS025089.
Citation: Goodman KE, Simner PJ, Klein EY .
Predicting probability of perirectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) at hospital unit admission.
Infect Control Hosp Epidemiol 2019 May;40(5):541-50. doi: 10.1017/ice.2019.42..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Hospitalization, Infectious Diseases
Khamash DF, Mongodin EF, White JR
The association between the developing nasal microbiota of hospitalized neonates and Staphylococcus aureus colonization.
This research studied the association between hospitalized neonates who develop Staphylococcus aureus infections and nasal microbiota populations that preceded infection. Nares samples were obtained for neonates who were screened weekly for S. aureus. DNA was extracted and DNA of the bacterias were sequenced. It was found that controls and treated cases had a higher abundance of genes that contributed to the synthesis of natural antimicrobial compounds from several commensal bacterial types.
AHRQ-funded; HS022872.
Citation: Khamash DF, Mongodin EF, White JR .
The association between the developing nasal microbiota of hospitalized neonates and Staphylococcus aureus colonization.
Open Forum Infect Dis 2019 Apr;6(4):ofz062. doi: 10.1093/ofid/ofz062..
Keywords: Healthcare-Associated Infections (HAIs), Hospitalization, Hospitals, Infectious Diseases, Newborns/Infants
Leeman H, Cosgrove SE, Williams D
Assessing burden of central line-associated bloodstream infections present on hospital admission.
Investigators described patients presenting to an academic medical center with central line-associated bloodstream infection present on hospital admission over 1 year. Of the 130 admissions, they found that about half presented from home infusion, followed by oncology clinic, hemodialysis, and skilled nursing facility. They concluded that efforts to reduce such infections should address patients across the entire health care system.
AHRQ-funded; HS025782.
Citation: Leeman H, Cosgrove SE, Williams D .
Assessing burden of central line-associated bloodstream infections present on hospital admission.
Am J Infect Control 2020 Feb;48(2):216-18. doi: 10.1016/j.ajic.2019.08.010..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitalization, Home Healthcare, Hospitals, Infectious Diseases
Markham JL, Richardson T, Hall M
Association of weekend admission and weekend discharge with length of stay and 30-day readmission in children's hospitals.
Worse outcomes among adults presenting for/receiving care on weekends (ie, "the weekend effect") have been observed for many diseases. However, little is known about the overall impact of the weekend effect in hospitalized children. The purpose of this study was to determine the association between 1.) weekend admission and length of stay (LOS) and 2.) weekend discharge and 30-day all-cause readmission.
AHRQ-funded; HS024735.
Citation: Markham JL, Richardson T, Hall M .
Association of weekend admission and weekend discharge with length of stay and 30-day readmission in children's hospitals.
J Hosp Med 2019 Feb;14(2):75-82. doi: 10.12788/jhm.3085..
Keywords: Children/Adolescents, Hospitals, Hospital Readmissions, Hospital Discharge, Hospitalization
McAlearney AS, Fareed N, Gaughan A
Empowering patients during hospitalization: perspectives on inpatient portal use.
This study looked at the effects of instituting an inpatient portal at hospitals and its impact on feelings of patient empowerment. Patients (n=120) who used an inpatient portal were interviewed at day 15 of hospitalization or 6 months after discharge. They also interviewed care team members (n=331) at 4 weeks, 6 months, and 1 year after implementation about their perspectives on patient use of the portal. Three features were most commonly used: 1) ordering meals, 2) looking up health information, and 3) viewing the care team. Most patients did not feel comfortable using the secure message feature. The inpatient portal promoted independence, reduced anxiety, informed families, and increased empowerment. The findings suggest that hospitals should encourage implementation of inpatient portals in their institution.
AHRQ-funded; HS024091; HS024767; HS024379.
Citation: McAlearney AS, Fareed N, Gaughan A .
Empowering patients during hospitalization: perspectives on inpatient portal use.
Appl Clin Inform 2019 Jan;10(1):103-12. doi: 10.1055/s-0039-1677722..
Keywords: Health Information Technology (HIT), Patient and Family Engagement, Hospitalization, Hospitals
Chukmaitov A, Harless DW, Bazzoli GJ
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
This study evaluates quality performance of hospitals participating in Medicare Shared Savings and Pioneer Accountable Care Organization (ACO) programs relative to nonparticipating hospitals. The authors studied preventable hospitalizations for conditions sensitive to high-quality ambulatory care and 30-day all-cause readmissions potentially influenced by hospital care. A decrease was found in preventable hospitalizations for COPD and asthma and for diabetes complications for ACO participating hospitals, but no significant differences for preventable chronic heart failure hospitalizations and 30-day readmissions.
AHRQ-funded; HS023332.
Citation: Chukmaitov A, Harless DW, Bazzoli GJ .
Preventable hospital admissions and 30-day all-cause readmissions: does hospital participation in accountable care organizations improve quality of care?
Am J Med Qual 2019 Jan/Feb;34(1):14-22. doi: 10.1177/1062860618778786..
Keywords: Hospital Readmissions, Hospitals, Quality of Care, Provider Performance, Hospitalization