National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Events (3)
- Cardiovascular Conditions (4)
- Diabetes (1)
- Elderly (16)
- Emergency Department (1)
- Healthcare Costs (2)
- Health Information Technology (HIT) (2)
- Health Status (1)
- Heart Disease and Health (3)
- Home Healthcare (1)
- Hospital Discharge (6)
- (-) Hospitalization (22)
- Hospital Readmissions (3)
- Influenza (2)
- Injuries and Wounds (1)
- Long-Term Care (8)
- Medicare (4)
- Medication (1)
- (-) Nursing Homes (22)
- Outcomes (2)
- Patient-Centered Outcomes Research (2)
- Patient Experience (1)
- Patient Safety (1)
- Payment (1)
- Pneumonia (1)
- Policy (2)
- Primary Care (1)
- Provider Performance (1)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (1)
- Quality of Life (1)
- Racial and Ethnic Minorities (1)
- Rehabilitation (1)
- Respiratory Conditions (1)
- Risk (1)
- Stroke (1)
- Telehealth (1)
- Transitions of Care (3)
- Vaccination (1)
- Web-Based (1)
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 22 of 22 Research Studies DisplayedTandan M, Zimmerman S, Sloane PD
Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes.
Pneumonia is a frequent cause of hospitalization among nursing home (NH) residents, but little information is available as to how clinical presentation and other characteristics relate to hospitalization, and the differential use of antimicrobials based on hospitalization status. This study examined how hospitalized and nonhospitalized NH residents with pneumonia differ. The investigators concluded that respiratory rate was associated with hospitalization but was not documented for more than a quarter of residents.
AHRQ-funded; HS022298.
Citation: Tandan M, Zimmerman S, Sloane PD .
Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes.
J Am Med Dir Assoc 2020 Dec;21(12):1862-68.e3. doi: 10.1016/j.jamda.2020.07.028..
Keywords: Elderly, Nursing Homes, Pneumonia, Respiratory Conditions, Hospitalization
Field TS, Fouayzi H, Crawfo TS, Fouayzi H, Crawford S
The association of nursing home characteristics and quality with adverse events after a hospitalization.
This prospective cohort analysis measured the association of long-stay nursing home residents returning to the facility after a hospitalization and adverse events (AEs). Thirty-two nursing homes in New England states participated with a total of 555 long-stay residents contributing 762 returns from hospitalizations. The authors measured the association between AEs developing in the 45 days following discharge back to long-term care and characteristics of the nursing homes including bed size, ownership, 5-star quality ratings, registered nurse and nursing assistant hours, and the individual Centers for Medicare & Medicaid Services (CMS) quality indicators. They found no association of AEs with most nursing home characteristics. Several individual quality indicators were associated with AEs. The highest tertile of residents with depression had a hazard ratio (HR) of 1.65 and the highest tertile of the percentage taking antipsychotic medications had an HR of 1.58. Residents needing increased assistance with activities of daily living was statistically significant, but not monotonic.
AHRQ-funded; HS024422.
Citation: Field TS, Fouayzi H, Crawfo TS, Fouayzi H, Crawford S .
The association of nursing home characteristics and quality with adverse events after a hospitalization.
J Am Med Dir Assoc 2021 Oct;22(10):2196-200. doi: 10.1016/j.jamda.2021.02.027..
Keywords: Elderly, Nursing Homes, Adverse Events, Hospitalization
Weerahandi H, Bao H, Herrin J
Home health care after skilled nursing facility discharge following heart failure hospitalization.
Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. In this study, the investigators examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization.
AHRQ-funded; HS022882.
Citation: Weerahandi H, Bao H, Herrin J .
Home health care after skilled nursing facility discharge following heart failure hospitalization.
J Am Geriatr Soc 2020 Jan;68(1):96-102. doi: 10.1111/jgs.16179..
Keywords: Home Healthcare, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Hospital Readmissions, Transitions of Care, Elderly
Hong I, Goodwin JS, Reistetter TA, I, Goodwin JS, Reistetter TA
Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities.
This cohort study compared functional status improvements of poststroke patients who either went to an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF). The study used data from Medicare claims for stroke from January 2013 through November 2014. A total of 99,185 patients were studied. Patients admitted to SNFs tended to be older, female, and had a longer hospital length of stay than those admitted to IRFs. Stroke patients admitted to IRFs had larger improvements for mobility score points and for self-care on admission compared with those admitted to SNFs. There was found to be no statistical difference in the odds of 30- to 365-day mortality.
AHRQ-funded; HS024711; HS022134.
Citation: Hong I, Goodwin JS, Reistetter TA, I, Goodwin JS, Reistetter TA .
Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities.
JAMA Netw Open 2019 Dec 2;2(12):e1916646. doi: 10.1001/jamanetworkopen.2019.16646..
Keywords: Stroke, Cardiovascular Conditions, Rehabilitation, Health Status, Hospitalization, Nursing Homes
Werner RM, Konetzka RT, Qi M
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
The objective of this study was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The investigators concluded that Medicare's SNF copayment policy was associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy had unintended and negative effects on patient outcomes.
AHRQ-funded; HS024266.
Citation: Werner RM, Konetzka RT, Qi M .
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
Health Serv Res 2019 Dec;54(6):1184-92. doi: 10.1111/1475-6773.13227..
Keywords: Medicare, Nursing Homes, Payment, Long-Term Care, Healthcare Costs, Elderly, Hospitalization, Hospital Discharge
Kapoor A, Field T, Handler S
Characteristics of long-term care residents that predict adverse events after hospitalization.
This study examined the characteristics of long-term care (LTC) residents that predict adverse events (AEs) after discharge from recent hospitalization. This cohort study looked at AEs that occurred at 32 nursing homes from six New England states. AE incidents involving a total of 555 LTC residents with 762 transitions from the hospital back to LTC were reviewed. The association between all AEs and preventable AEs developing in the 45 days following discharge back to LTC was measured. There were 283 discharges with one or more AEs and 212 with preventable AEs. Characteristics independently associated with higher risk of AEs included hospital length of stay (LOS) 9 or more days, 18 or more regularly scheduled medications, and 19 and above on the dependency in activities of daily living (ADL) scale.
AHRQ-funded; HS024422.
Citation: Kapoor A, Field T, Handler S .
Characteristics of long-term care residents that predict adverse events after hospitalization.
J Am Geriatr Soc 2020 Nov;68(11):2551-57. doi: 10.1111/jgs.16770..
Keywords: Elderly, Long-Term Care, Nursing Homes, Hospitalization, Adverse Events, Transitions of Care, Hospital Discharge, Risk
Kapoor A, Field T, Handler S
Adverse events in long-term care residents transitioning from hospital back to nursing home.
This study looked at adverse event rates of long-term care residents transitioning back to their nursing home after hospitalization. A prospective cohort study of LTC residents discharged from hospital back to LTC from March 1, 2016, to December 31, 2017 was conducted, and residents were followed up for 45 days. A random sample of 32 nursing homes located in 6 New England states was used, and 555 LTC residents were selected, contributing 762 transitions from hospital back to the same LTC facility. Most of the cohort were female (65.5%) and non-Hispanic white (93.7%). The study used trained nurse abstractors to review nursing home records to determine if an adverse event occurred. Out of 762 discharges there were 379 adverse events. The most common adverse events were pressure ulcers, skin tears, and falls followed by health care-acquired infections. 145 adverse events were considered less serious, with 28 life-threatening, and 8 were fatal. Most of the adverse events were considered preventable or ameliorable.
AHRQ-funded; HS024596.
Citation: Kapoor A, Field T, Handler S .
Adverse events in long-term care residents transitioning from hospital back to nursing home.
JAMA Intern Med 2019 Sep;179(9):1254-61. doi: 10.1001/jamainternmed.2019.2005..
Keywords: Adverse Events, Long-Term Care, Nursing Homes, Transitions of Care, Elderly, Patient Safety, Hospital Discharge, Hospitalization
Weerahandi H, Li L, Bao H
Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization: a retrospective cohort study.
The goal of this study was to examine outcomes for Medicare patients who were hospitalized with heart failure and who had a subsequent skilled nursing facility (SNF) stay of 30 days or less. Patients were categorized by their length of stay in the SNF and followed for the 30 days after their discharge from the SNF to home. Overall, nearly one-quarter of the SNF discharges to home were readmitted within the 30 day follow-up period. The rate of readmission was highest during the first two days home, but this risk was attenuated by a longer SNF length of stay. The authors conclude that interventions to reduce readmissions may be more effective if they incorporate patient transitions from SNF to home.
AHRQ-funded; HS022882.
Citation: Weerahandi H, Li L, Bao H .
Risk of readmission after discharge from skilled nursing facilities following heart failure hospitalization: a retrospective cohort study.
J Am Med Dir Assoc 2019 Apr;20(4):432-37. doi: 10.1016/j.jamda.2019.01.135..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Hospital Discharge, Hospital Readmissions, Hospitalization, Nursing Homes
Baughman KR, Ludwick R, Jarjoura D
Advance care planning in skilled nursing facilities: a multisite examination of professional judgments.
Lack of advance care planning (ACP) may increase hospitalizations and impact the quality of life for skilled nursing facility (SNF) residents, especially African American residents who may be less likely to receive ACP discussions. In this study, the investigators examined the professional judgments of skilled nursing facility providers to see if race of SNF residents and providers, and risk for hospitalization for residents influenced professional judgments as to when ACP was needed.
AHRQ-funded; HS022162.
Citation: Baughman KR, Ludwick R, Jarjoura D .
Advance care planning in skilled nursing facilities: a multisite examination of professional judgments.
Gerontologist 2019 Mar 14;59(2):338-46. doi: 10.1093/geront/gnx129..
Keywords: Elderly, Hospitalization, Nursing Homes, Quality of Life, Racial and Ethnic Minorities
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
McConeghy KW, Lee Y, Zullo AR
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
In this retrospective cohort study, the investigators evaluated the association between influenza and hip fracture hospitalizations in long-stay (LS) nursing home (NH) residents. The study authors found that influenza like illness (ILI) hospitalizations were associated with a 13% average increase in hip fracture hospitalization risk. In a given NH week, an increase in the number ILI hospitalizations from none to two was associated with an approximate one percentage point increase in hip fracture hospitalization risk.
AHRQ-funded; HS022998.
Citation: McConeghy KW, Lee Y, Zullo AR .
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
J Gerontol A Biol Sci Med Sci 2018 Nov 10;73(12):1638-42. doi: 10.1093/gerona/glx200..
Keywords: Elderly, Injuries and Wounds, Hospitalization, Influenza, Long-Term Care, Nursing Homes
Middleton A, Li S, Kuo YF
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective of this study was to examine characteristics associated with new institutionalizations of older adults on this care trajectory. Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function.
AHRQ-funded; HS022134.
Citation: Middleton A, Li S, Kuo YF .
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
J Am Geriatr Soc 2018 Jan;66(1):56-63. doi: 10.1111/jgs.15131..
Keywords: Long-Term Care, Nursing Homes, Hospital Discharge, Elderly, Hospitalization, Medicare
Ryskina KL, Konetzka RT, Werner RM
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
The goal of this study was to test whether the improvements in nursing homes’ 5-star ratings were correlated with reductions in rates of hospitalization; the researchers’ hypothesis was that increased attention to ratings motivated nursing homes to make changes to improve ratings but did not affect hospitalization rate, resulting in a weakened association between ratings and hospitalizations. 2007-2010 Medicare hospital claims and nursing home clinical assessment data were used to compare the correlation between nursing homes’ ratings and hospitalization rates. Correlation weakened slightly after the ratings became publicly available. The researchers conclude that improvements in nursing home ratings after the release of Medicare's 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients and, although this dissociation may be due to additional factors, the 5-star ratings became less meaningful as an indicator of nursing home quality for these patients.
AHRQ-funded; HS021861.
Citation: Ryskina KL, Konetzka RT, Werner RM .
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
Inquiry 2018 Jan-Dec;55:46958018787323. doi: 10.1177/0046958018787323..
Keywords: Elderly, Nursing Homes, Medicare, Quality Indicators (QIs), Provider Performance, Quality Measures, Hospitalization, Quality of Care
Middleton A, Zhou J, Ottenbacher KJ
Hospital variation in rates of new institutionalizations within 6 months of discharge.
The primary objective of this study was to examine the hospital-level variation in rates of new institutionalizations among Medicare beneficiaries. The overall observed rate of new institutionalizations was 3.6 percent (N = 173,998). Older age, white race, Medicaid eligibility, longer hospitalization, and having a skilled nursing facility stay over the 6 months before hospitalization were associated with higher adjusted odds. Observed rates ranged from 0.9 percent to 5.9 percent across states.
AHRQ-funded; HS022134.
Citation: Middleton A, Zhou J, Ottenbacher KJ .
Hospital variation in rates of new institutionalizations within 6 months of discharge.
J Am Geriatr Soc 2017 Jun;65(6):1206-13. doi: 10.1111/jgs.14760.
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Keywords: Hospitalization, Elderly, Nursing Homes, Hospital Discharge
Haber SG, Wensky SG, McCall NT
Reducing inpatient hospital and emergency room utilization among nursing home residents.
This study examined the association among nursing home residents between strength of relationship with a primary care provider (PCP) and inpatient hospital and emergency room (ER) utilization. Both measures of strength of patient-provider relationships were associated with fewer inpatient admissions and ER visits, except regularity of PCP visits and ambulatory care sensitive conditions (ACSC) ER visits.
AHRQ-funded; HS000029.
Citation: Haber SG, Wensky SG, McCall NT .
Reducing inpatient hospital and emergency room utilization among nursing home residents.
J Aging Health 2017 Apr;29(3):510-30. doi: 10.1177/0898264316641074.
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Keywords: Elderly, Emergency Department, Hospitalization, Nursing Homes, Primary Care
Driessen J, Bonhomme A, Chang W
Nursing home provider perceptions of telemedicine for reducing potentially avoidable hospitalizations.
The goal of this study was to survey a nationally representative sample of nursing home physicians and advanced practice providers to quantify provider perceptions and desired functionality of telemedicine in nursing homes to reduce potentially avoidable hospitalizations. The authors found that there is a high degree of confidence in the potential for a telemedicine solution and concrete views about its features, concluding that further research is needed to study the impact of successful implementations.
AHRQ-funded; HS018721; HS022989; HS022465; HS023779.
Citation: Driessen J, Bonhomme A, Chang W .
Nursing home provider perceptions of telemedicine for reducing potentially avoidable hospitalizations.
J Am Med Dir Assoc 2016 Jun;17(6):519-24. doi: 10.1016/j.jamda.2016.02.004.
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Keywords: Health Information Technology (HIT), Hospital Readmissions, Hospitalization, Nursing Homes, Telehealth
Sorkin DH, Amin A, Weimer DL
Rationale and study protocol for the Nursing Home Compare Plus (NHCPlus) randomized controlled trial: A personalized decision aid for patients transitioning from the hospital to a skilled-nursing facility.
This paper describes the design and rationale of a two-arm randomized controlled trial designed to test the effectiveness of Nursing Home Compare Plus (NHCPlus) compared to usual care only, in a sample of patients being discharged from the hospital to an SNF (N=229). Assessments were conducted within 24h prior to patient discharge and 30-days post discharge. A primary outcome to be examined was the use of NHC.
AHRQ-funded; HS021844.
Citation: Sorkin DH, Amin A, Weimer DL .
Rationale and study protocol for the Nursing Home Compare Plus (NHCPlus) randomized controlled trial: A personalized decision aid for patients transitioning from the hospital to a skilled-nursing facility.
Contemp Clin Trials 2016 Jan 7;47:139-45. doi: 10.1016/j.cct.2015.12.018.
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Keywords: Nursing Homes, Web-Based, Patient Experience, Hospitalization, Health Information Technology (HIT)
Pop-Vicas A, Rahman M, Gozalo PL
Estimating the effect of influenza vaccination on nursing home residents' morbidity and mortality.
This study estimated the effect of influenza vaccination on hospitalization and mortality in nursing home (NH) residents. It found that the association between vaccine match and reduction in overall mortality and pneumonia and influenza hospitalizations was strongest for A/H3N2, the influenza strain typically responsible for the most-severe influenza cases.
AHRQ-funded; HS018462.
Citation: Pop-Vicas A, Rahman M, Gozalo PL .
Estimating the effect of influenza vaccination on nursing home residents' morbidity and mortality.
J Am Geriatr Soc 2015 Sep;63(9):1798-804. doi: 10.1111/jgs.13617..
Keywords: Influenza, Nursing Homes, Vaccination, Hospitalization
Grebla RC, Keohane L, Lee Y
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
The authors compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined for those no longer subject to the qualifying stay but increased among those still subject to it. The elimination of the three-day-stay requirement was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility.
AHRQ-funded; HS000011.
Citation: Grebla RC, Keohane L, Lee Y .
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
Health Aff 2015 Aug;34(8):1324-30. doi: 10.1377/hlthaff.2015.0054.
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Keywords: Elderly, Hospitalization, Long-Term Care, Nursing Homes, Patient-Centered Outcomes Research
Keohane LM, Grebla RC, Mor V
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
In 2011, new federal regulations restricted inpatient and skilled nursing facility cost sharing and mandated limits on out-of-pocket spending in Medicare Advantage (MA) plans. The authors found that some MA beneficiaries may still have difficulty affording acute and postacute care despite greater regulation of cost sharing.
AHRQ-funded; HS000011.
Citation: Keohane LM, Grebla RC, Mor V .
Medicare Advantage members' expected out-of-pocket spending for inpatient and skilled nursing facility services.
Health Aff 2015 Jun;34(6):1019-27. doi: 10.1377/hlthaff.2014.1146.
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Keywords: Healthcare Costs, Hospitalization, Policy, Medicare, Nursing Homes
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
Spector WD, Limcangco R, Williams C
AHRQ Author: Spector WD
Potentially avoidable hospitalizations for elderly long-stay residents in nursing homes.
The authors sought to determine the relationship between clinical risk factors, facility characteristics and State policy variables, and both avoidable and unavoidable hospitalizations. Using data from the Nursing Home Stay file, 2006-2008, they found that three fifths of hospitalizations were potentially avoidable and most were for infections, injuries, and congestive heart failure. Clinical risk factors included renal disease, diabetes, and a high number of medications. Staffing, quality, and reimbursement affected avoidable, but not unavoidable, hospitalizations.
AHRQ-authored.
Citation: Spector WD, Limcangco R, Williams C .
Potentially avoidable hospitalizations for elderly long-stay residents in nursing homes.
Med Care 2013 Aug;51(8):673-81. doi: 10.1097/MLR.0b013e3182984bff.
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Keywords: Elderly, Hospitalization, Long-Term Care, Nursing Homes, Policy