National Healthcare Quality and Disparities Report
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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 25 of 52 Research Studies DisplayedAzimi H, Johnson L, Loudermilk C
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
This study’s purpose was to assess if a patient’s medication regimen complexity-intensive care unit (MRC-ICU) score could predict in-hospital mortality in patients with COVID-19. This single-center, observational study was conducted from August 2020 to January 2021. The primary outcome was the area under the receiver operating characteristic (AUROC) for in-hospital mortality for the 48-hour MRC-ICU. The authors assessed age, sequential organ failure assessment (SOFA), and World Health Organization (WHO) COVID-19 Severity Classification. They included 149 patients who had a median SOFA score of 8 (IQR 5-11), and median MRC-ICU score at 48 hours of 15. The in-hospital mortality rate of 36%. The AUROC for MRC-ICU was 0.71 compared to 0.66 for age, 0.81 SOFA, and 0.72 for the WHO Severity Classification. Univariate analysis was used to compare the 4 characteristics. SOFA, MRC-ICU, and WHO Severity Classification all demonstrated significant association with in-hospital mortality, while SOFA, MRC-ICU, and WHO Severity Classification demonstrated significant association with WHO Severity Classification at 7 days. All 4 characteristics showed significant association with mortality; however, only age and SOFA remained significant following multivariate analysis.
AHRQ-funded; HS028485; HS029009.
Citation: Azimi H, Johnson L, Loudermilk C .
Medication regimen complexity (MRC-ICU) for in-hospital mortality prediction in COVID-19 patients.
Hosp Pharm 2023 Dec; 58(6):564-68. doi: 10.1177/00185787231169460..
Keywords: COVID-19, Medication, Mortality, Intensive Care Unit (ICU)
Hughes PM, Ostrach B, Tak CR
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
This study used State-level secondary data to examine the impact of North Carolina's 2017 STOP Act on opioid overdose deaths by race. The results showed that the opioid overdose death rate among the White population decreased following the STOP Act, but found no significant change among the Black/African American population. The authors concluded that these findings have implications for health equity and may inform the development of future substance use policies.
AHRQ-funded; HS000032.
Citation: Hughes PM, Ostrach B, Tak CR .
Examining differences in opioid deaths by race in North Carolina following the STOP Act, 2010-2019.
J Subst Use Addict Treat 2023 Dec; 155:209171. doi: 10.1016/j.josat.2023.209171..
Keywords: Opioids, Mortality, Substance Abuse, Policy
Chase BA, Pocica S, Frigerio R
Mortality risk factors in newly diagnosed diabetic cardiac autonomic neuropathy.
To inform the design of interventions to reduce mortality in cardiac autonomic neuropathy (CAN) patients with diabetes, researchers explored genetic variants,
clinical attributes, and autonomic testing findings present to assess possible associations with increased mortality. They reviewed the electronic medical records of patients with advanced disease at the time when CAN was diagnosed. Some clinical characteristics, as well as sex, race, ethnicity, and incidence of type 1 or type 2 diabetes mellitus were found to be similar in both survivors and non-survivors; clinical and autonomic testing characteristics were often similarly advanced in survivors and non-survivors. The researchers concluded that their analysis provided context by estimating hazard ratios relative to when CAN is objectively diagnosed and indicated that not all risk factors confer equal mortality risk. Their findings may inform both the development of guidelines for prevention and the design of larger studies to evaluate CAN mortality risk factors.
clinical attributes, and autonomic testing findings present to assess possible associations with increased mortality. They reviewed the electronic medical records of patients with advanced disease at the time when CAN was diagnosed. Some clinical characteristics, as well as sex, race, ethnicity, and incidence of type 1 or type 2 diabetes mellitus were found to be similar in both survivors and non-survivors; clinical and autonomic testing characteristics were often similarly advanced in survivors and non-survivors. The researchers concluded that their analysis provided context by estimating hazard ratios relative to when CAN is objectively diagnosed and indicated that not all risk factors confer equal mortality risk. Their findings may inform both the development of guidelines for prevention and the design of larger studies to evaluate CAN mortality risk factors.
AHRQ-funded; HS024057.
Citation: Chase BA, Pocica S, Frigerio R .
Mortality risk factors in newly diagnosed diabetic cardiac autonomic neuropathy.
Clin Auton Res 2023 Dec; 33(6):903-07. doi: 10.1007/s10286-023-00975-5.
Keywords: Mortality, Risk, Diabetes
Pak TR, Young J, McKenna CS
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Important studies indicate that every hour of sepsis that elapses until antibiotics are administered increases mortality. The researchers of this study found determined that analyses in the influential studies often adjusted for limited covariates, included patients with long delays until antibiotic administration, combined sepsis and septic shock, and used linear models presuming each hour of delay has equal impact on the sepsis and the patient. The purpose of this study was to assess the effect of the analytic decisions on the relationships between time-to-antibiotics and mortality. The researchers retrospectively identified 104,248 adults admitted from 2015-2022 to five hospitals with suspected infection. The patients included 25,990 with suspected septic shock and 23,619 with sepsis without shock. The study found that changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed relationships between time-to-antibiotics and mortality. In a fully adjusted model of patients treated within 6 hours, every hour related with higher mortality for septic shock, but not sepsis without shock or suspected infection alone. Modeling every hour independently confirmed that every hour delay was related with greater mortality for septic shock, but only delays of greater than 6 hours were related with greater mortality for sepsis without shock.
AHRQ-funded; HS027170.
Citation: Pak TR, Young J, McKenna CS .
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Clin Infect Dis 2023 Nov 30; 77(11):1534-43. doi: 10.1093/cid/ciad450..
Keywords: Antibiotics, Medication, Sepsis, Mortality, Quality of Care
Bauer TM, Yaser JM, Daramola T
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
This study analyzed the outcome of cardiac rehabilitation (CR) use for patients who have undergone coronary revascularization procedures. The study looked at Medicare fee-for-service claims linked to surgical data patients discharged alive following isolated coronary artery bypass grafting (CABG) from January 2015 to October 2019. A total of 3,848/6,412 (60.0%) of patients were enrolled in CR for an average of 23.2 sessions with 770/6,412 (12.0%) completing all recommended 36 sessions. Predictors of post-discharge CR use included increasing age, discharge to home (vs extended care facility), and shorter length of stay. Unadjusted and inverse probability treatment weighting (IPTW) analyses showed significant reduction in 2-year mortality in CR users as compared to CR non-users (unadjusted 9.4%).
AHRQ-funded; HS027830.
Citation: Bauer TM, Yaser JM, Daramola T .
Cardiac rehabilitation reduces two-year mortality after coronary artery bypass grafting.
Ann Thorac Surg 2023 Nov; 116(5):1099-105. doi: 10.1016/j.athoracsur.2023.05.044..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Mortality, Outcomes
Chen VW, Chidi AP, Dong Y
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
This study’s goal was to compare the risk-adjusted cumulative sum (CUSUM) with episodic evaluation for early detection of hospitals with excess perioperative mortality. The study cohort included 697,566 patients treated at 104 Veterans’ Affairs hospitals across 24 quarters with a mean age of 60.9 years and 91.4% male. These patients underwent a noncardiac operation at a Veterans Affairs hospital, had a record in the Veterans Affairs Surgical Quality Improvement Program (January 1, 2011, through December 31, 2016), and were aged 18 years or older. For each hospital, the median number of quarters detected with observed to expected ratios, at least 1 CUSUM signal, and more than 1 CUSUM signal was 2 quarters (IQR, 1-4 quarters), 8 quarters (IQR, 4-11 quarters), and 3 quarters (IQR, 1-4 quarters). Outlier hospitals were identified 33.3% of the time (830 quarters) with at least 1 CUSUM signal within a quarter, 12.5% (311 quarters) with more than 1 CUSUM signal, and 11.0% (274 quarters) with observed to expected ratios at the end of the quarter. The CUSUM detection occurred a median of 49 days (IQR, 25-63 days) before observed to expected ratio reporting (1 signal, 35 days [IQR, 17-54 days]; 2 signals, 49 days [IQR, 26-61 days]; 3 signals, 58 days [IQR, 44-69 days]; ≥4 signals, 49 days [IQR, 42-69 days]. Of 274 hospital quarters detected with observed to expected ratios, 72.6% were concurrently detected by at least 1 CUSUM signal vs 42.7% by more than 1 CUSUM signal. There was a dose-response relationship between the number of CUSUM signals in a quarter and the median observed to expected ratio (0 signals, 0.63; 1 signal, 1.28; 2 signals, 1.58; 3 signals, 2.08; ≥4 signals, 2.49).
AHRQ-funded; HS013853.
Citation: Chen VW, Chidi AP, Dong Y .
Risk-adjusted cumulative sum for early detection of hospitals with excess perioperative mortality.
JAMA Surg 2023 Nov; 158(11):1176-83. doi: 10.1001/jamasurg.2023.3673..
Keywords: Quality Improvement, Surgery, Hospitals, Patient Safety, Mortality, Quality of Care
Chen JT, Mehrizi R, Aasman B
Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort.
The objective of this study was to identify risk of acute respiratory distress syndrome (ARDS) and in-hospital mortality using a long short-term memory (LSTM) framework in mechanically ventilated (MV) COVID-19 and non-COVID-19 cohorts. The results indicated that the LSTM algorithm accurately identified the risk of ARDS or death in both non-COVID-19 and COVID MV patients. The researchers concluded that a tool that alerts to the risk of ARDS or death can improve the implementation of evidence-based ARDS management and facilitate goals-of-care discussions involving high-risk patients.
AHRQ-funded; HS026188.
Citation: Chen JT, Mehrizi R, Aasman B .
Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort.
BMJ Health Care Inform 2023 Sep; 30(1). doi: 10.1136/bmjhci-2023-100782..
Keywords: COVID-19, Mortality, Hospitals, Inpatient Care
Kim D, Swaminathan S, Lee Y
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
COVID-19 resulted in clear racial/ethnic disparities in excess deaths among persons with kidney failure. It is not clear whether or how these disparities changed throughout the pandemic, especially after the deployment of COVID-19 vaccines. The purpose of this study was to examine disparities in excess mortality for the Medicare population with kidney failure from March 2020, through December 2021. The study found that there were 686,719 patients with kidney failure in January 2020. Researchers reported an increase in excess deaths beginning March 1, 2020, with a peak in January 2021. From March 1, 2020, through January 30, 2021, and there were substantial disparities in excess deaths across racial/ethnic groups. The number of excess deaths was 5582, 4303, and 2679 for non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively. The percent excess deaths was 31.9% for Hispanic patients, 27.5% for non-Hispanic Black patients, and 16.4% for non-Hispanic White patients. After the wide distribution of COVID-19 vaccines since the end of January 2021, the lowest percent excess deaths was observed among Hispanic patients, followed by Black patients, and White patients.
AHRQ-funded; HS028285.
Citation: Kim D, Swaminathan S, Lee Y .
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
Clin J Am Soc Nephrol 2023 Sep; 18(9):1207-09. doi: 10.2215/cjn.0000000000000226..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Vaccination, Kidney Disease and Health, Mortality
Cheng TL, Mistry KB
AHRQ Author: Mistry KB
Clarity on disparity: who, what, when, where, why, and how.
This purpose of this article was to explain a comprehensive framework of health disparities descriptors that can offer a systematic approach to advance the understanding of causes of health disparities and facilitate action steps to ensure health equity.
AHRQ-authored.
Citation: Cheng TL, Mistry KB .
Clarity on disparity: who, what, when, where, why, and how.
Pediatr Clin North Am 2023 Aug; 70(4):639-50. doi: 10.1016/j.pcl.2023.03.003..
Keywords: Disparities, Social Determinants of Health, Newborns/Infants, Mortality, Health Status, Racial and Ethnic Minorities, Access to Care
Zhou S, Yang G, Zhang M
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
Researchers examined the relationship between timing and type of first infection regarding mortality following left ventricular assist device implantation. The study cohort included nearly 13,000 Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support patients at 166 centers. The results showed that patients with any post-implantation infection had an increased risk of death; ventricular assist device-related infections and infections occurring in the intermediate interval (91-180 days after implantation) were associated with the largest increase in risk. The researchers recommended that infection prevention strategies should target non-ventricular assist device infections in the first 90 days, then shift to surveillance/prevention of driveline infections after 90 days.
AHRQ-funded; HS026003.
Citation: Zhou S, Yang G, Zhang M .
Mortality following durable left ventricular assist device implantation by timing and type of first infection.
J Thorac Cardiovasc Surg 2023 Aug; 166(2):570-79.e4. doi: 10.1016/j.jtcvs.2021.10.056..
Keywords: Mortality, Cardiovascular Conditions, Medical Devices, Heart Disease and Health
Bamdad MC, Vitous CA, Rivard SJ
What we talk about when we talk about coping: a qualitative study of surgery resident's coping after complications and deaths.
The purpose of this study was to examine how surgery residents cope with negative patient outcomes including complications and death. There has been a dearth of scholarly work examining surgery resident coping strategies. The researchers included 28 mid-level and senior residents from 14 academic, community, and hybrid training programs across the United States to participate in interviews. The study found that residents described both internal and external strategies for how they cope with complications and deaths. Internal strategies included compartmentalization of emotions or experiences, thoughts of forgiveness, a sense of inevitability, and beliefs surrounding resilience. External strategies included support from colleagues and mentors, personal practices or rituals, such as exercise or psychotherapy, and commitment to change.
AHRQ-funded; HS000053; HS026772.
Citation: Bamdad MC, Vitous CA, Rivard SJ .
What we talk about when we talk about coping: a qualitative study of surgery resident's coping after complications and deaths.
Ann Surg 2023 Aug 1; 278(2):e422-e28. doi: 10.1097/sla.0000000000005854..
Keywords: Provider: Physician, Surgery, Mortality
Sikora A, Devlin JW, Yu M
Evaluation of medication regimen complexity as a predictor for mortality.
This single-center, observational cohort study of adult intensive care units (ICUs) sought to evaluate the benefit of adding medication regimen complexity-ICU scores to illness severity-based hospital mortality prediction models. While medication regimen complexity was associated with increased hospital mortality, the authors concluded from their findings that a prediction model that included medication regimen complexity only modestly improved mortality prediction.
AHRQ-funded; HS029009; HS028485.
Citation: Sikora A, Devlin JW, Yu M .
Evaluation of medication regimen complexity as a predictor for mortality.
Sci Rep 2023 Jul 4; 13(1):10784. doi: 10.1038/s41598-023-37908-1..
Keywords: Medication, Mortality
Paglino E, Lundberg, DJ, Zhou Z
Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022.
Researchers estimated all-cause excess mortality for the US by county and month by using a Bayesian hierarchical model focused on data from 2015-2019. Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. The researchers concluded that their results highlight the need for investments in rural health as the pandemic's rural impact increases.
AHRQ-funded; HS013853.
Citation: Paglino E, Lundberg, DJ, Zhou Z .
Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022.
Sci Adv 2023 Jun 23; 9(25):eadf9742. doi: 10.1126/sciadv.adf9742..
Keywords: COVID-19, Mortality
Feyman Y, Avila CJ, Auty S
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
This study examined whether minority veterans experienced higher rates of all-cause mortality than White veterans during the COVID-19 pandemic. The authors used administrative data from the Veterans Health Administration’s Corporate Data Warehouse. Veterans were excluded in the analysis if they were missing county of residence or race-ethnicity data. Overall, veteran mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. Non-Hispanic White veterans experienced the smallest relative increase in mortality (17%), while Native American veterans had the highest increase (40%). Black Veterans (32%) and Hispanic Veterans (26%) had somewhat lower excess mortality, although these changes were significantly higher compared to White veterans. Disparities were smaller compared to the general population.
AHRQ-funded; HS026395.
Citation: Feyman Y, Avila CJ, Auty S .
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
Health Serv Res 2023 Jun; 58(3):642-53. doi: 10.1111/1475-6773.14112..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities, Disparities
Lundberg DJ, Wrigley-Field E, Cho A
COVID-19 mortality by race and ethnicity in US metropolitan and nonmetropolitan areas, March 2020 to February 2022.
Previous research has determined that Hispanic and non-Hispanic Black residents in the United States experienced significantly higher COVID-19 mortality rates in 2020 than non-Hispanic White residents due to structural racism. In 2021, these disparities were observed to decrease. The purpose of this study was to evaluate the extent to which national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and the subsequent Omicron wave reflect decreases in mortality vs other factors, such as the changing geography of the pandemic. The researchers conducted this cross-sectional study using data from the United States Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, in U.S. resident adults aged 25 years and older. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between the initial wave and Omicron waves was decomposed. The study included death certificates for 977, 018 U.S. that included a mention of COVID-19. The rate of COVID-19 deaths among adults residing in nonmetropolitan areas increased 5.4% during the initial wave to a peak of 23.4% during the Delta wave; the proportion was 21.5% during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100,000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 40.7% of the decrease (40.7%); 19.6% of the decrease was explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults resided. The remaining 39.6% of the decrease was explained by decreases in death rates in non-Hispanic Black adults. The researchers concluded that the majority of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial wave and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic distribution of the pandemic.
AHRQ-funded; HS013853.
Citation: Lundberg DJ, Wrigley-Field E, Cho A .
COVID-19 mortality by race and ethnicity in US metropolitan and nonmetropolitan areas, March 2020 to February 2022.
JAMA Netw Open 2023 May; 6(5):e2311098. doi: 10.1001/jamanetworkopen.2023.11098..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities
Bamdad MC, Vitous CA, Rivard SJ
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
This qualitative study examined the impact of complications and deaths on surgery residents to facilitate development of improved support systems. Twenty-eight mid-level and senior residents (PGY3 and above) from 14 different training programs across the US were given semi-structured interviews. The interviewees described an initial emotional response of sadness, frustration, or grief. Simultaneously or soon after went through an examination period where they looked at how and why the outcome occurred with the goal of learning from it. The last phase was having a feeling of ownership, which was strengthened by involved in patient care and length of rotation.
AHRQ-funded; HS026772.
Citation: Bamdad MC, Vitous CA, Rivard SJ .
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
J Surg Educ 2022 Mar-Apr; 79(2):452-62. doi: 10.1016/j.jsurg.2021.09.011..
Keywords: Surgery, Provider: Physician, Adverse Events, Mortality
Tan MS, Heise CW, Gallo T
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
The objectives of this retrospective observational study were to evaluate the relationship between a modified Tisdale QTc-risk score (QTc-RS), inpatient mortality, and length of stay in a broad inpatient population with an order for a medication with a known risk of torsades de pointes (TdP). Inpatient data from 28 healthcare facilities in the western US were used. The results indicated that there is a strong relationship between increased mortality as well as longer duration of hospitalization with an increasing QTc-RS.
AHRQ-funded; HS026662.
Citation: Tan MS, Heise CW, Gallo T .
Relationship between a risk score for QT interval prolongation and mortality across rural and urban inpatient facilities.
J Electrocardiol 2023 Mar;77:4-9. doi: 10.1016/j.jelectrocard.2022.11.008.
Keywords: Heart Disease and Health, Cardiovascular Conditions, Mortality, Rural Health, Urban Health, Risk
Diaz A, Lindau ST, Obeng-Gyasi S
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
The purpose of this cross-sectional study was to compare postoperative mortality among Medicare beneficiaries based on the level of neighborhood deprivation where they live and the hospital quality where they received care. The researchers examined outcomes among Medicare beneficiaries undergoing one of five common surgical procedures (colon resection, coronary artery bypass, cholecystectomy, appendectomy, or incisional hernia repair) between 2014 and 2018. Hospital quality was assigned using the Centers for Medicare & Medicaid Services Star Rating. Each beneficiary's neighborhood was identified at the census tract level and sorted into quintiles based on its Area Deprivation Index score. A risk matrix across hospital quality and neighborhood deprivation was created to determine the relative contribution of each to mortality after surgery. Data were analyzed from June 1 to December 31, 2021. The study included 1,898,829 Medicare beneficiaries. Patients from all neighborhood deprivation group quintiles sought care at hospitals across hospital quality levels. Thirty-day risk-adjusted mortality varied across high- and low-quality hospitals and across the least and most deprived neighborhoods. When combined, comparing patients from the least deprived neighborhoods going to high-quality hospitals vs patients from the most deprived neighborhoods going to low-quality hospitals, the variation increased further. The researchers concluded that both a patient's neighborhood and the hospital where they received treatment were associated with the risk of death after commonly performed inpatient surgical procedures. The associations of these factors on mortality may be additive. Efforts to address variation in postoperative mortality should include both hospital quality improvement and addressing drivers of neighborhood deprivation.
AHRQ-funded; HS028606.
Citation: Diaz A, Lindau ST, Obeng-Gyasi S .
Association of hospital quality and neighborhood deprivation with mortality after inpatient surgery among Medicare beneficiaries.
JAMA Netw Open 2023 Jan; 6(1):e2253620. doi: 10.1001/jamanetworkopen.2022.53620..
Keywords: Hospitals, Quality of Care, Surgery, Mortality, Social Determinants of Health
Bogetz JF, Revette A, Rosenberg AR
"I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions.
This study’s goal was to elucidate aspects important to preparedness at end of life (EOL) among bereaved parents of children with complex chronic conditions (CCCs). Participants answered 21 open-response queries on communication, decision-making, and EOL experiences as part of the Survey of Caring for Children with CCCs. Findings showed that most bereaved parents of children with CCCs described feeling unprepared for their child's EOL, despite palliative care and advance care planning, suggesting preparedness is a nuanced concept beyond "readiness." Recommendations included more research to identify supportive elements among parents facing their child's EOL.
AHRQ-funded; HS022986.
Citation: Bogetz JF, Revette A, Rosenberg AR .
"I could never prepare for something like the death of my own child": parental perspectives on preparedness at end of life for children with complex chronic conditions.
J Pain Symptom Manage 2020 Dec;60(6):1154-62.e1. doi: 10.1016/j.jpainsymman.2020.06.035..
Keywords: Children/Adolescents, Caregiving, Mortality, Chronic Conditions, Palliative Care
Onaitis MW, Furnary AP, Kosinski AS
Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.
This study compared the effectiveness of lobectomy and segmentectomy for treatment of clinical stage IA (T1N0) lung cancer patients. The Society of Thoracic Surgeons General Thoracic Surgery Database was linked to Medicare data in 14,286 lung cancer patients who underwent segmentectomy (n = 1654) or lobectomy (n = 12,632) from 2002 to 2015. Survival rates were found to be similar.
AHRQ-funded; HS022279.
Citation: Onaitis MW, Furnary AP, Kosinski AS .
Equivalent survival between lobectomy and segmentectomy for clinical stage IA lung cancer.
Ann Thorac Surg 2020 Dec;110(6):1882-91. doi: 10.1016/j.athoracsur.2020.01.020..
Keywords: Cancer: Lung Cancer, Cancer, Surgery, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Collinsworth AW, Priest EL, Masica AL
Evaluating the cost-effectiveness of the ABCDE bundle: impact of bundle adherence on inpatient and 1-year mortality and costs of care.
This study examined the cost-effectiveness of the Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility (ABCDE) bundle intervention to improve short- and long-term clinical outcomes for patients requiring ICU care. A 2-year, prospective, cost-effectiveness study in 12 adult ICUs in six hospitals belonging to a large, integrated healthcare delivery system was conducted. Hospitals in the study included a large, urban center and five community hospitals. ICU types included medical/surgical, trauma, neurologic, and cardiac care units. The cohort included 2,953 adults with an ICU stay greater than 24 hours who were on a ventilator for more than 24 hours and less than 14 days. ICUs with high ABCDE bundle adherence significantly decreased odds of inpatient mortality and had significantly higher costs of inpatient care. The incremental cost-effectiveness ratio of high bundle adherence was $15,077 per life saved, and $1,057 per life-year saved.
AHRQ-funded; HS021459.
Citation: Collinsworth AW, Priest EL, Masica AL .
Evaluating the cost-effectiveness of the ABCDE bundle: impact of bundle adherence on inpatient and 1-year mortality and costs of care.
Crit Care Med 2020 Dec;48(12):1752-59. doi: 10.1097/ccm.0000000000004609..
Keywords: Intensive Care Unit (ICU), Critical Care, Mortality, Healthcare Costs
Patel SA, Krasnow M, Long K
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Researchers examined whether neighborhood environment modifies the disparity in 30-day heart failure (HF) readmissions and mortality between Black and White patients in the Southeastern United States. They created a geocoded retrospective cohort of patients hospitalized for acute HF from 2010-2018 within Emory Healthcare. They found that excess 30-day HF readmissions and mortality were present among Black patients in every neighborhood strata and increased with progressive neighborhood socioeconomic deprivation.
AHRQ-funded; HS026081.
Citation: Patel SA, Krasnow M, Long K .
Excess 30-day heart failure readmissions and mortality in black patients increases with neighborhood deprivation.
Circ Heart Fail 2020 Dec;13(12):e007947. doi: 10.1161/circheartfailure.120.007947..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Racial and Ethnic Minorities, Mortality, Social Determinants of Health, Low-Income, Disparities
Bowman JA, Nuño M, Jurkovich GJ
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
Researchers characterized interhospital variability in intensive care unit (ICU) vs non-ICU admission of older patients with isolated rib fractures and evaluated whether greater hospital-level use of ICU admission is associated with improved outcomes. This study included trauma patients who were admitted to trauma centers participating in the National Trauma Data Bank. The researchers found that admission location of older patients with isolated rib fractures was variable across hospitals, but hospitalization at a center with greater ICU use was associated with improved outcomes. They recommended that hospitals with low ICU use admit more such patients to an ICU.
AHRQ-funded; HS022236.
Citation: Bowman JA, Nuño M, Jurkovich GJ .
Association of hospital-level intensive care unit use and outcomes in older patients with isolated rib fractures.
JAMA Netw Open 2020 Nov 2;3(11):e2026500. doi: 10.1001/jamanetworkopen.2020.26500..
Keywords: Elderly, Injuries and Wounds, Intensive Care Unit (ICU), Hospitals, Patient-Centered Outcomes Research, Outcomes, Mortality
Althoff KN, Leifheit KM, Park JN
Opioid-related overdose mortality in the era of fentanyl: monitoring a shifting epidemic by person, place, and time.
Investigators described US trends in opioid-related overdose mortality rates by race, age, urbanicity, and opioid type before and after the emergence of fentanyl. Using the CDC’s WONDER database, they found a disproportionate increase in opioid-related overdose deaths among urban non-Hispanic Black Americans and recommended interventions for this population in order to halt the increase in overdose deaths.
AHRQ-funded; HS000046.
Citation: Althoff KN, Leifheit KM, Park JN .
Opioid-related overdose mortality in the era of fentanyl: monitoring a shifting epidemic by person, place, and time.
Drug Alcohol Depend 2020 Nov 1;216:108321. doi: 10.1016/j.drugalcdep.2020.108321..
Keywords: Opioids, Medication, Substance Abuse, Mortality, Racial and Ethnic Minorities, Social Determinants of Health
Mohr NM, Zebrowski AM, Gaieski DF
Inpatient hospital performance is associated with post-discharge sepsis mortality.
The objective of this study was to test the hypothesis that hospitals with high risk-adjusted inpatient sepsis mortality also have high post-discharge mortality, readmissions, and discharge to nursing homes. Sepsis hospitalization survivors among age-qualifying Medicare beneficiaries were followed for 180 days post-discharge; mortality, readmissions, and new admission to skilled nursing facilities were measured. Findings showed that hospitals with the highest risk-adjusted sepsis inpatient mortality also had higher post-discharge mortality and increased readmissions, suggesting that post-discharge complications were a modifiable risk that may be affected during inpatient care. Recommendations for future work include seeking to elucidate inpatient and healthcare practices that can reduce sepsis post-discharge complications.
AHRQ-funded; HS023614; HS025753.
Citation: Mohr NM, Zebrowski AM, Gaieski DF .
Inpatient hospital performance is associated with post-discharge sepsis mortality.
Crit Care 2020 Oct 27;24(1):626. doi: 10.1186/s13054-020-03341-3..
Keywords: Sepsis, Mortality, Hospital Discharge, Hospitals, Provider Performance, Quality of Care, Inpatient Care, Hospital Readmissions