National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Ambulatory Care and Surgery (1)
- Cancer (1)
- Cardiovascular Conditions (3)
- Comparative Effectiveness (1)
- Diabetes (1)
- Elderly (10)
- Emergency Department (1)
- Evidence-Based Practice (2)
- Falls (1)
- Heart Disease and Health (4)
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- Injuries and Wounds (2)
- Long-Term Care (5)
- Medicaid (1)
- Medicare (5)
- Medication (4)
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- (-) Nursing Homes (16)
- (-) Outcomes (16)
- Patient-Centered Outcomes Research (6)
- Prevention (2)
- Provider Performance (1)
- Quality Improvement (1)
- Quality Measures (1)
- Quality of Care (2)
- Risk (1)
- Sepsis (1)
- Surgery (2)
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 DisplayedSavitz ST, Falk K, Stearns SC
Coronary revascularization outcomes in relation to skilled nursing facility use following hospital discharge.
Observational analyses comparing coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI) among elderly or frail patients are likely biased by treatment selection. PCI is typically chosen for frail patients, while CABG is more common for patients with good recovery potential. In this study. The investigators hypothesized that skilled nursing facility (SNF) use after revascularization was a measure of relative frailty associated with outcomes following coronary revascularization.
AHRQ-funded; HS000032.
Citation: Savitz ST, Falk K, Stearns SC .
Coronary revascularization outcomes in relation to skilled nursing facility use following hospital discharge.
Clin Cardiol 2021 May;44(5):627-35. doi: 10.1002/clc.23583..
Keywords: Elderly, Heart Disease and Health, Cardiovascular Conditions, Surgery, Outcomes, Nursing Homes
Downer B, Pritchard K, Thomas KS
Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis.
This study looked at the association between recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. This retrospective cohort study identified 59,383 Medicare beneficiaries who were admitted to an SNF within 3 days of discharge from hospitalization that included time in an ICU for sepsis from all of 2013 to October 2015. About 58% of SNF residents showed improvement in ADL function. The higher the improvement in ADL score the less the mortality risk compared to residents who did not improve.
AHRQ-funded; HS026133.
Citation: Downer B, Pritchard K, Thomas KS .
Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis.
J Am Geriatr Soc 2021 Apr;69(4):938-45. doi: 10.1111/jgs.16915..
Keywords: Elderly, Nursing Homes, Medicare, Sepsis, Mortality, Outcomes
Konetzka RT, Jung DH, Gorges RJ
Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles.
This study measured the outcomes of dual-eligible recipients of Medicaid home- and community-based long-term services (HCBS) compared to nursing home residents. The authors used the 2005 and 2012 Medicaid Analytic eXtract (MAX) database, a national compilation of Medicaid claims which merges Medicare claims to identify hospital admissions. A cohort of 1,312,498 older adults dually enrolled in Medicaid and Medicare and using long-term care was tracked. HCBS users were found to have 10 percent points higher annual rates of hospitalization than their nursing home counterparts when selection bias is addressed. The differences persisted across races, dementia status, and intensity of HCBS spending.
AHRQ-funded; HS000084.
Citation: Konetzka RT, Jung DH, Gorges RJ .
Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles.
Health Serv Res 2020 Dec;55(6):973-82. doi: 10.1111/1475-6773.13573..
Keywords: Elderly, Long-Term Care, Nursing Homes, Medicaid, Medicare, Outcomes
Zullo AR, Riester MR, Erqou S
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Evidence regarding differences in outcomes between angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) among older nursing home (NH) residents after acute myocardial infarction (AMI) is limited. The purpose of this study was to estimate the post-AMI effects of ARBs versus ACEIs on mortality, rehospitalization, and functional decline outcomes in this important population.
AHRQ-funded; HS022998.
Citation: Zullo AR, Riester MR, Erqou S .
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Drugs Aging 2020 Oct;37(10):755-66. doi: 10.1007/s40266-020-00791-w..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Medication, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
Zullo AR, Ofori-Asenso R, Wood M
Effects of statins for secondary prevention on functioning and other outcomes among nursing home residents.
Studies examining the effects of statins after acute myocardial infarction (AMI) excluded frail older adults, especially nursing home (NH) residents, and few examined functional outcomes. Older NH residents may benefit less from statins and be particularly susceptible to adverse drug events like myopathy-related functional decline. In this retrospective cohort study, the investigators evaluated the effects of statins on 1-year functional decline, rehospitalization, and death in NH residents.
AHRQ-funded; HS022998.
Citation: Zullo AR, Ofori-Asenso R, Wood M .
Effects of statins for secondary prevention on functioning and other outcomes among nursing home residents.
J Am Med Dir Assoc 2020 Apr;21(4):500-07.e8. doi: 10.1016/j.jamda.2020.01.102..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medication, Prevention, Outcomes, Evidence-Based Practice, Patient-Centered Outcomes Research
Paredes AZ, Malik AT, Cluse M
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Emergency general surgery can have a profound impact on the functional status of even previously independent patients. In this study, the investigators examined the role and influence of discharging a patient to a skilled nursing facility. They concluded that after accounting for patient severity and perioperative course, discharge to a skilled nursing facility was an independent risk factor for death, readmission, and postdischarge complications.
AHRQ-funded; HS022694.
Citation: Paredes AZ, Malik AT, Cluse M .
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Surgery 2019 Oct;166(4):489-95. doi: 10.1016/j.surg.2019.04.034..
Keywords: Nursing Homes, Hospital Discharge, Elderly, Ambulatory Care and Surgery, Emergency Department, Outcomes, Hospital Readmissions, Outcomes, Risk
Zullo AR, Mogul A, Corsi K
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
In order to examine the effect of using more guideline-recommended medications after myocardial infarction on mortality, rehospitalization, and functional decline in the frailest and oldest segment of long-stay nursing home residents, researchers conducted a retrospective cohort study of U.S. nursing home residents aged 65 years or older. Exposure was the number of secondary prevention medications initiated after myocardial infarction; outcomes were 90-day death, rehospitalization, or functional decline. The results of the study indicate that the use of more guideline-recommended medications after myocardial infarction was associated with decreased mortality in older, predominantly frail adults, but there was no difference in rehospitalization. Functional decline outcomes were discordant and the researchers note that this does not rule out an increased risk associated with more medication use.
AHRQ-funded; HS022998.
Citation: Zullo AR, Mogul A, Corsi K .
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
Circ Cardiovasc Qual Outcomes 2019 Apr;12(4):e004942. doi: 10.1161/circoutcomes.118.004942..
Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research, Prevention
Agarwal D, Werner RM
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
The purpose of this study was to test for differences in patient outcomes when hospital and post-acute care (PAC) providers participated in accountable care organizations (ACOs). The investigators concluded that hospital and skilled nursing facilities (SNF) participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay.
AHRQ-funded; HS024266.
Citation: Agarwal D, Werner RM .
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
Health Serv Res 2018 Dec;53(6):5035-56. doi: 10.1111/1475-6773.13023..
Keywords: Hospital Readmissions, Hospitals, Medicare, Nursing Homes, Outcomes
Zullo AR, Hersey M, Lee Y
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
This study analyzed outcomes of using beta-blockers that are considered “diabetes-friendly” vs “diabetes-unfriendly” in older nursing home residents with diabetes after acute myocardial infarction (AMI). Primary outcomes included hospitalizations for hypoglycemia and hyperglycemia in the 90 days after AMI and secondary outcomes functional decline, death, all-cause re-hospitalization and fracture hospitalization. Out of 2855 nursing home residents with type-2 diabetes (T2D), 29% were prescribed a diabetes-friendly beta-blocker vs. 24% without. T2D medicine showed a reduction in hospitalization for hyperglycemia but was unassociated with hypoglycemia. For secondary outcomes T2D-friendly beta-blocks were associated with a greater rate of re-hospitalization but not death, functional decline, or fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Hersey M, Lee Y .
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
Diabetes Obes Metab 2018 Dec;20(12):2724-32. doi: 10.1111/dom.13451..
Keywords: Cardiovascular Conditions, Diabetes, Elderly, Heart Disease and Health, Hospitalization, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research
Murray KS, Prunty M, Henderson A
Functional status in patients requiring nursing home stay after radical cystectomy.
The objective of this study was to evaluate the ability to perform activities of daily living (ADLs) in patients who required nursing home (NH) care after radical cystectomy (RC), as this surgery can impair patients' ability to perform ADLs in the post-operative period. The investigators found that ADLs, as measured by the Minimum Data Set (MDS)-ADL Long Form score, worsen after RC. They suggest this should be an important part of the risks and benefits conversation with patients, their families, and caregivers.
AHRQ-funded; HS022140.
Citation: Murray KS, Prunty M, Henderson A .
Functional status in patients requiring nursing home stay after radical cystectomy.
Urology 2018 Nov;121:39-43. doi: 10.1016/j.urology.2018.07.030..
Keywords: Cancer, Nursing Homes, Outcomes, Patient-Centered Outcomes Research
Li S, Middleton A, Ottenbacher KJ
Trajectories over the first year of long-term care nursing home residence.
This retrospective cohort study examined changes in situation for Medicare fee-for-service beneficiaries newly admitted to long-term nursing homes from July 2012 to December 2013 for the first year after admission. Data was used from the Minimum Data Set and Medicare Provider and Analysis Reviews claims data. Median length of stay in long-term care was 127 days, and for any institution 158 days. At 12 months post admission, 35% had died, 36.9% remained in long-term care, 23.4% were in the community, and 4.7% were in acute care hospitals or other institutions.
AHRQ-funded; HS022134.
Citation: Li S, Middleton A, Ottenbacher KJ .
Trajectories over the first year of long-term care nursing home residence.
J Am Med Dir Assoc 2018 Apr;19(4):333-41. doi: 10.1016/j.jamda.2017.09.021.
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Keywords: Long-Term Care, Nursing Homes, Elderly, Medicare, Patient-Centered Outcomes Research, Outcomes
Jung HY, Trivedi AN, Grabowski DC
Does more therapy in skilled nursing facilities lead to better outcomes in patients with hip fracture?
The study objectives were: (1) to examine temporal trends in therapy hour volumes and (2) to evaluate whether more therapy hours are associated with improved patient outcomes. It concluded that increases in the quantity of therapy during the study period cannot be explained by changes in case mix at skilled nursing facility (SNF) admission.
AHRQ-funded; HS020756.
Citation: Jung HY, Trivedi AN, Grabowski DC .
Does more therapy in skilled nursing facilities lead to better outcomes in patients with hip fracture?
Phys Ther 2016 Jan;96(1):81-9. doi: 10.2522/ptj.20150090.
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Keywords: Outcomes, Injuries and Wounds, Medicare, Nursing Homes
Leland NE, Gozalo P, Bynum J
What happens to patients when they fracture their hip during a skilled nursing facility stay?
This study characterized outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home receiving skilled nursing facility (SNF) services. In the first 90 days following hospitalization for surgical repair of the hip fracture, 24.1 percent of patients died, 7.3 percent were discharged to the community but remained fewer than 30 days, and 14.0 percent achieved successful community discharge.
AHRQ-funded; HS000011.
Citation: Leland NE, Gozalo P, Bynum J .
What happens to patients when they fracture their hip during a skilled nursing facility stay?
J Am Med Dir Assoc 2015 Sep;16(9):767-74. doi: 10.1016/j.jamda.2015.03.026..
Keywords: Nursing Homes, Falls, Injuries and Wounds, Outcomes
Hakkarainen TW, Ayoung-Chee P, Alfonso R
Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review.
This systematic review of current literature surrounding the structural, process of care, and outcomes measurement for patients in skilled nursing facilities (SNFs) found that the role of the care setting and care delivery in contributing to outcomes has not been well-studied. In particular, there was very little published information addressing surgical or trauma patients discharged to SNFs.
AHRQ-funded; HS020025
Citation: Hakkarainen TW, Ayoung-Chee P, Alfonso R .
Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review.
J Surg Res. 2015 Feb;193(2):772-80. doi: 10.1016/j.jss.2014.06.002..
Keywords: Nursing Homes, Outcomes, Surgery, Quality of Care
Spector WD
AHRQ Author: Spector WD
Response to letter to the editor regarding the paper "potentially avoidable hospitalization for elderly long-stay residents in nursing homes".
The author argues against the strategy than is implied by Dr. Powers’ letter to the editor. Rather than adding one aspect of care organization at a time to administrative data, he states that we should identify a small set of easily collected measures that generally modify the effects of care organization innovations. With these in place, we can then add measures like consistent assignment to better understand how it improves clinical outcomes.
AHRQ-authored
Citation: Spector WD .
Response to letter to the editor regarding the paper "potentially avoidable hospitalization for elderly long-stay residents in nursing homes".
Med Care 2014 Jan;52(1):93-4. doi: 10.1097/mlr.0000000000000072..
Keywords: Hospitalization, Elderly, Outcomes, Long-Term Care, Nursing Homes
Werner RM, Konetzka RT, Kim MM
Quality improvement under nursing home compare: the association between changes in process and outcome measures.
The researchers tested the extent to which improvements in outcomes of care are explained by changes in nursing home processes. Of the 5 outcome measures examined, they found that only improvements in the percentage of nursing home residents in moderate or severe pain were associated with changes in nursing home processes of care. They concluded that understanding the mechanism behind improvements in nursing home outcomes may be key to successfully achieving broad quality improvements across nursing homes.
AHRQ-funded; HS021861.
Citation: Werner RM, Konetzka RT, Kim MM .
Quality improvement under nursing home compare: the association between changes in process and outcome measures.
Med Care 2013 Jul;51(7):582-8. doi: 10.1097/MLR.0b013e31828dbae4.
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Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality Measures, Quality of Care, Provider Performance, Outcomes