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
51 to 75 of 152 Research Studies DisplayedKondo KK, Damberg CL, Mendelson A
Implementation processes and pay for performance in healthcare: A systematic review.
The authors conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of pay for performance (P4P). They concluded that P4P programs should undergo regular evaluation and should target areas of poor performance, and also that measures and incentives should align with organizational priorities, and programs should allow for changes over time in response to data and provider input.
AHRQ-funded; HS022981.
Citation: Kondo KK, Damberg CL, Mendelson A .
Implementation processes and pay for performance in healthcare: A systematic review.
J Gen Intern Med 2016 Apr;31 Suppl 1:61-9. doi: 10.1007/s11606-015-3567-0.
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Keywords: Healthcare Delivery, Provider Performance, Payment, Quality of Care
McConnell KJ, Lindrooth RC, Wholey DR
Modern management practices and hospital admissions.
The researchers investigated whether the modern management practices and publicly reported performance measures are associated with choice of hospital for patients with acute myocardial infarction (AMI). They found that, overall, a one standard deviation change in management practice scores is associated with an 8% increase in AMI admissions.
AHRQ-funded; HS018466.
Citation: McConnell KJ, Lindrooth RC, Wholey DR .
Modern management practices and hospital admissions.
Health Econ 2016 Apr;25(4):470-85. doi: 10.1002/hec.3171.
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Keywords: Hospitals, Heart Disease and Health, Cardiovascular Conditions, Quality Indicators (QIs), Quality Measures, Quality of Care, Public Reporting, Provider Performance
Rising KL, Carr BG, Hess EP
Patient-centered outcomes research in emergency care: opportunities, challenges, and future directions.
The authors explored factors unique to patient-centered emergency care research and highlighted specific areas of potential alignment within each of the five national PCORI priorities.
AHRQ-funded; HS023901.
Citation: Rising KL, Carr BG, Hess EP .
Patient-centered outcomes research in emergency care: opportunities, challenges, and future directions.
Acad Emerg Med 2016 Apr;23(4):497-502. doi: 10.1111/acem.12944.
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Keywords: Emergency Department, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Quality Improvement, Quality of Care, Evidence-Based Practice
Moghavem N, McDonald K, Ratliff JK
Performance measures in neurosurgical patient care: differing applications of patient safety indicators.
The researchers sought to determine how Patient Safety Indicator (PSI) rates and their impact on other outcomes in patients undergoing cranial neurosurgery compared with other surgeries.. They found that procedure indication was strongly associated with PSI development. The neurosurgical population had significantly higher risk-adjusted ratios of most PSIs evaluated compared with other surgical patients. Development of a PSI was strongly associated with increased length of stay and hospital cost.
AHRQ-funded; HS018558.
Citation: Moghavem N, McDonald K, Ratliff JK .
Performance measures in neurosurgical patient care: differing applications of patient safety indicators.
Med Care 2016 Apr;54(4):359-64. doi: 10.1097/mlr.0000000000000490.
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Keywords: Quality Indicators (QIs), Surgery, Hospitalization, Outcomes, Quality of Care
Watkins KE, Smith B, Akincigil A
The quality of medication treatment for mental disorders in the department of Veterans Affairs and in private-sector plans.
The objective of this paper was to compare the quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) with care provided to a comparable population treated in the private sector. The researchers found that VA performance was superior to that of the private sector by more than 30%. They concluded that their findings demonstrate the significant advantages that accrue from an organized, nationwide system of care and suggested that the much higher performance of the VA has important clinical and policy implications.
AHRQ-funded; HS003258; HS021112.
Citation: Watkins KE, Smith B, Akincigil A .
The quality of medication treatment for mental disorders in the department of Veterans Affairs and in private-sector plans.
Psychiatr Serv 2016 Apr;67(4):391-6. doi: 10.1176/appi.ps.201400537.
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Keywords: Quality of Care, Health Insurance, Medication, Behavioral Health
Konetzka RT, Perraillon MC
Use of Nursing Home Compare website appears limited by lack of awareness and initial mistrust of the data.
The researchers used a qualitative assessment of how consumers select nursing homes and of the role of information about quality, using semistructured interviews of people who recently placed a family member or friend in a nursing home. They found that consumers had a positive reaction when shown Nursing Home Compare; however, its use appeared to be limited by lack of awareness and, to some extent, initial lack of trust of the data.
AHRQ-funded; HS021877.
Citation: Konetzka RT, Perraillon MC .
Use of Nursing Home Compare website appears limited by lack of awareness and initial mistrust of the data.
Health Aff 2016 Apr;35(4):706-13. doi: 10.1377/hlthaff.2015.1377.
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Keywords: Nursing Homes, Public Reporting, Web-Based, Quality of Care, Education: Patient and Caregiver
Mukamel DB, Amin A, Weimer DL
When patients customize nursing home ratings, choices and rankings differ from the government's version.
Report cards currently published by the Centers for Medicare and Medicaid Services (CMS) offer composite quality measures, such as the one featured on the Nursing Home Compare website. Nursing Home Compare Plus is an alternative that allows patients and their families to create their own composite scores based on their own preferences and medical needs. When comparing Nursing Home Compare Plus to Medicare's five-star ratings, we found only minimal agreement on ranking of nursing homes.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Amin A, Weimer DL .
When patients customize nursing home ratings, choices and rankings differ from the government's version.
Health Aff 2016 Apr;35(4):714-9. doi: 10.1377/hlthaff.2015.1340.
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Keywords: Nursing Homes, Quality of Care, Quality Indicators (QIs), Patient Experience, Consumer Assessment of Healthcare Providers and Systems (CAHPS)
Kamal AH, Bull J, Ritchie CS
Adherence to measuring what matters measures using point-of-care data collection across diverse clinical settings.
The purpose of this paper was to evaluate the implementation of Measuring What Matters (MWM) measures by exploring documentation of quality measure adherence across six diverse clinical settings inherent to palliative care practice. The authors found that the lowest adherence involved comprehensive assessments during the first visit in hospitalized patients in the intensive care unit and that the highest adherence across all settings involved documentation of management of moderate to severe pain. They recommended additional studies for better understanding of benchmarks and acceptable ranges for adherence tailored to various clinical settings.
AHRQ-funded; HS023681; HS022763.
Citation: Kamal AH, Bull J, Ritchie CS .
Adherence to measuring what matters measures using point-of-care data collection across diverse clinical settings.
J Pain Symptom Manage 2016 Mar;51(3):497-503. doi: 10.1016/j.jpainsymman.2015.12.313.
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Keywords: Quality Measures, Palliative Care, Patient-Centered Outcomes Research, Quality of Care, Patient Safety
Kronick R
AHRQ Author: Kronick R
AHRQ's role in improving quality, safety, and health system performance.
The author, director of AHRQ, focuses on several topics including investing in research and evidence to understand how to improve the safety and quality of health care, and generating measures and data used to track and improve performance and evaluate progress of the U.S. health-care system. He concludes by discussing AHRQ’s continuing exploration of ways to expand its efforts in patient safety into nonhospital settings.
AHRQ-authored.
Citation: Kronick R .
AHRQ's role in improving quality, safety, and health system performance.
Public Health Rep 2016 Mar-Apr;131(2):229-32.
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Keywords: Patient Safety, Quality of Care, Evidence-Based Practice, Health Services Research (HSR)
Chien AT, Schiavoni KH, Sprecher E
How accountable care organizations responded to pediatric incentives in the alternative quality contract.
The authors characterized the pediatric infrastructure of adult-oriented accountable care organizations (ACOs) and obtained leaders' perspectives on their ACOs' response to pediatric incentives. They found that most ACOs augmented their pediatric quality improvement and spending reduction efforts when faced with pediatric incentives.
AHRQ-funded; HS017146.
Citation: Chien AT, Schiavoni KH, Sprecher E .
How accountable care organizations responded to pediatric incentives in the alternative quality contract.
Acad Pediatr 2016 Mar;16(2):200-7. doi: 10.1016/j.acap.2015.10.008.
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Keywords: Children/Adolescents, Health Insurance, Quality of Care, Payment, Quality Indicators (QIs)
Calaman S, Hepps JH, Bismilla Z
The creation of standard-setting videos to support faculty observations of learner performance and entrustment decisions.
The authors report their experience developing videos that represent five levels of performance for an entrustable professional activities (EPA) for patient handoffs. They describe a process that begins with mapping the EPA to the critical competencies needed to make an entrustment decision. Each competency is then defined by five milestones (behavioral descriptors of performance at five advancing levels).
AHRQ-funded; HS019456.
Citation: Calaman S, Hepps JH, Bismilla Z .
The creation of standard-setting videos to support faculty observations of learner performance and entrustment decisions.
Acad Med 2016 Feb;91(2):204-9. doi: 10.1097/acm.0000000000000853..
Keywords: Education: Continuing Medical Education, Provider Performance, Patient Safety, Quality of Care
Collinsworth AW, Priest EL, Campbell CR
A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units.
The objective of this review was to examine the effectiveness, implementation, and costs of multifaceted care approaches, including care bundles, for the prevention and mitigation of delirium in patients hospitalized in intensive care units (ICUs). It concluded that although multifaceted care approaches may reduce delirium and improve patient outcomes, greater improvements may be achieved by deploying a comprehensive bundle of care practices.
AHRQ-funded; HS021459.
Citation: Collinsworth AW, Priest EL, Campbell CR .
A review of multifaceted care approaches for the prevention and mitigation of delirium in intensive care units.
J Intensive Care Med 2016 Feb;31(2):127-41. doi: 10.1177/0885066614553925.
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Keywords: Intensive Care Unit (ICU), Prevention, Evidence-Based Practice, Critical Care, Quality of Care
Abraham J, Kannampallil T, Brenner C
Characterizing the structure and content of nurse handoffs: a Sequential Conversational Analysis approach.
This paper describes Sequential Conversational Analysis (SCA) - a mixed-method approach integrating qualitative conversational analysis with quantitative sequential pattern analysis. This approach allows characterization of the nature of nurse handoff communication, highlighting the relationships underlying verbal content. The authors also discuss how SCA can help in understanding the dynamics of communication in other settings.
AHRQ-funded; HS017586.
Citation: Abraham J, Kannampallil T, Brenner C .
Characterizing the structure and content of nurse handoffs: a Sequential Conversational Analysis approach.
J Biomed Inform 2016 Feb;59:76-88. doi: 10.1016/j.jbi.2015.11.009.
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Keywords: Communication, Quality of Care, Intensive Care Unit (ICU), Nursing, Workflow
Southern DA, Pincus HA, Romano PS
Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).
The authors presented recommendations made to the World Health Organization (WHO) by the ICD revision's Quality and Safety Topic Advisory Group (Q&S TAG) for a new conceptual approach to capturing healthcare-related harms and injuries in ICD-coded data. They concluded that this new framework for coding healthcare-related harm has great potential to improve the clinical detail of adverse event descriptions and the overall quality of coded health data.
AHRQ-funded; HS020543.
Citation: Southern DA, Pincus HA, Romano PS .
Enhanced capture of healthcare-related harms and injuries in the 11th revision of the International Classification of Diseases (ICD-11).
Int J Qual Health Care 2016 Feb;28(1):136-42. doi: 10.1093/intqhc/mzv099.
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Keywords: Adverse Events, Quality of Care, Patient Safety, Quality Indicators (QIs)
Dy SM, Herr K, Bernacki RE
Methodological research priorities in palliative care and hospice quality measurement.
The authors describe three key priorities: 1) defining the population of interest for palliative care quality indicators, 2) developing methods to measure quality from different data sources, and 3) conducting research to advance the development of patient/family-reported indicators. They apply these concepts to the key quality domain of advance care planning and address relevance to implementation of indicators in improving care in order to facilitate improved quality measurement across all populations with serious illness and care for patients and families.
AHRQ-funded; HS023681.
Citation: Dy SM, Herr K, Bernacki RE .
Methodological research priorities in palliative care and hospice quality measurement.
J Pain Symptom Manage 2016 Feb;51(2):155-62. doi: 10.1016/j.jpainsymman.2015.10.019.
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Keywords: Research Methodologies, Palliative Care, Quality Measures, Quality Indicators (QIs), Quality of Care
Southern DA, Hall M, White DE
Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data.
The authors identified opportunities and challenges in improving the utility of ICD-11 for quality and safety applications. The 246 online survey respondents specified desires for the ICD revision: more code content for adverse events/complications; a desire for code clustering mechanisms; the need for diagnosis timing information; and the addition of better code definitions to reference materials. The authors concluded that the World Health Organization's ICD revision process is addressing each of these desires.
AHRQ-funded; HS020543.
Citation: Southern DA, Hall M, White DE .
Opportunities and challenges for quality and safety applications in ICD-11: an international survey of users of coded health data.
Int J Qual Health Care 2016 Feb;28(1):129-35. doi: 10.1093/intqhc/mzv096.
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Keywords: Quality of Care, Patient Safety, Quality Indicators (QIs)
Minami CA, Sheils CR, Bilimoria KY
Process improvement in surgery.
The authors reviewed aspects of process improvement-quality improvement that are relevant to the currently practicing surgeon. They discussed commonly used quality improvement data platforms, process improvement methodologies, examples of successful local quality improvement initiatives, the role of regional surgical improvement collaboratives, common barriers to quality improvement efforts, and potential solutions to overcome them.
AHRQ-funded; HS000078.
Citation: Minami CA, Sheils CR, Bilimoria KY .
Process improvement in surgery.
Curr Probl Surg 2016 Feb;53(2):62-96. doi: 10.1067/j.cpsurg.2015.11.001.
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Keywords: Healthcare Delivery, Quality of Care, Quality Improvement, Quality Measures, Surgery
Ricciardi R, Moy E, Wilson NJ
AHRQ Author: Ricciardi R and Moy E
Finding the true north: lessons from the National Healthcare Quality and Disparities Report.
The authors delineate important features and findings of the 2014 report. For example, it shows that one measure of patient safety improved quickly. The rate of central line–associated bloodstream infection per 1000 medical and surgical discharges (age 18+ years or obstetric admissions) improved at an annual rate of change of more than 10 percent. This success reflects the direct impact that nurses can have in making care safer for their patients.
AHRQ authors Ricciardi and Moy
Citation: Ricciardi R, Moy E, Wilson NJ .
Finding the true north: lessons from the National Healthcare Quality and Disparities Report.
J Nurs Care Qual 2016 Jan-Mar;31(1):9-12. doi: 10.1097/ncq.0000000000000164..
Keywords: Quality of Care, Disparities, Patient Safety, Nursing, Central Line-Associated Bloodstream Infections (CLABSI)
Fisher ES, Shortell SM, Savitz LA
Implementation science: A potential catalyst for delivery system reform.
Understanding which of the multitude of technological, policy, and organizational changes under way are most effective at improving care is a critical challenge. This article describes 3 ideas that could be helpful: application of a well-grounded conceptual framework; distinguishing 3 distinct types of innovations that health systems are using to improve care; and a focus on building the information systems needed to accelerate timely learning.
AHRQ-funded; HS024075.
Citation: Fisher ES, Shortell SM, Savitz LA .
Implementation science: A potential catalyst for delivery system reform.
JAMA 2016 Jan 26;315(4):339-40. doi: 10.1001/jama.2015.17949..
Keywords: Healthcare Delivery, Implementation, Quality Improvement, Quality of Care, Health Systems
Walkey AJ, Weinberg J, Wiener RS
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
The researchers evaluated the effect of analytic approaches accounting for do-not-resuscitate (DNR) status on risk-adjusted hospital mortality rates and performance rankings. They found that after accounting for patient DNR status and between-hospital variation in the association between DNR status and mortality, hospitals with higher DNR rates had lower mortality.
AHRQ-funded; HS020672.
Citation: Walkey AJ, Weinberg J, Wiener RS .
Association of do-not-resuscitate orders and hospital mortality rate among patients with pneumonia.
JAMA Intern Med 2016 Jan;176(1):97-104. doi: 10.1001/jamainternmed.2015.6324.
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Keywords: Hospitals, Mortality, Quality of Care, Quality Indicators (QIs), Quality Measures, Pneumonia, Provider Performance, Respiratory Conditions
Kanouse DE, Schlesinger M, Shaller D
How patient comments affect consumers' use of physician performance measures.
In order to evaluate the relationship between patient characteristics and the frequency and duration of incident steroid use, the researchers applied a 2-part hurdle model to Medicare data. Their study identified differences in predictors of frequency and duration of medication use and suggests the utility of two-part models to examine drug utilization patterns.
AHRQ-funded; HS016978; HS016980.
Citation: Kanouse DE, Schlesinger M, Shaller D .
How patient comments affect consumers' use of physician performance measures.
Med Care 2016 Jan;54(1):24-31. doi: 10.1097/mlr.0000000000000443..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient and Family Engagement, Patient Experience, Clinician-Patient Communication
Calderwood MS, Vaz LE, Tse Kawai A
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
In October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. The researchers evaluated the policy's differential impact in hospitals with high vs low operating margins. They concluded that Medicare's payment policy may have had an impact on reducing central line-associated bloodstream infections in hospitals with low operating margins.
AHRQ-funded; HS018414.
Citation: Calderwood MS, Vaz LE, Tse Kawai A .
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
Infect Control Hosp Epidemiol 2016 Jan;37(1):100-3. doi: 10.1017/ice.2015.250.
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Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Medicare, Quality of Care, Payment, Sepsis
Koru G, Alhuwail D, Topaz M
Investigating the challenges and opportunities in home care to facilitate effective information technology adoption.
This investigation of the pressing challenges and opportunities for achieving effectiveness in IT adoption found that coordinating clinical and administrative workflows was an important challenge. Inadequate access to patients' medical history and difficulties with medication reconciliation detracted from the quality of care. Hiring, training, scheduling, and retaining qualified personnel constituted another important challenge.
AHRQ-funded; HS022352.
Citation: Koru G, Alhuwail D, Topaz M .
Investigating the challenges and opportunities in home care to facilitate effective information technology adoption.
J Am Med Dir Assoc 2016 Jan;17(1):53-8. doi: 10.1016/j.jamda.2015.10.008.
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Keywords: Home Healthcare, Health Information Technology (HIT), Quality of Care
Moy E, Coffey RM, Moore BJ
AHRQ Author: Moy E
Length of stay in EDs: variation across classifications of clinical condition and patient discharge disposition.
The researchers used a census of one state's data to measure length of emergency departments stays by patients' conditions and dispositions and exlore differences between means and medians as quality metrics. For the 10 most common diagnoses, patients with relatively minor injuries typically required the shortest mean stay (3 hours or less); conditions resulting in admission or transfer tended to be more serious, resulting in longer stays.
AHRQ-authored.
Citation: Moy E, Coffey RM, Moore BJ .
Length of stay in EDs: variation across classifications of clinical condition and patient discharge disposition.
Am J Emerg Med 2016 Jan;34(1):83-7. doi: 10.1016/j.ajem.2015.09.031..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Quality Measures, Hospitalization, Quality of Care
Yanes AF, McElroy LM, Abecassis ZA
Observation for assessment of clinician performance: a narrative review.
The authors summarized studies utilizing video recorded or in-person observations for assessing clinician performance in medicine and surgery. They found that observations are useful for the improvement of healthcare delivery through the identification of clinician lapses and weaknesses that affect quality and safety. Further, limitations of observations included the Hawthorne effect and the necessity of trained observers to capture and analyze the notes or videos.
AHRQ-funded; HS000078.
Citation: Yanes AF, McElroy LM, Abecassis ZA .
Observation for assessment of clinician performance: a narrative review.
BMJ Qual Saf 2016 Jan;25(1):46-55. doi: 10.1136/bmjqs-2015-004171.
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Keywords: Healthcare Delivery, Quality of Care, Patient Safety, Quality Measures