National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Ambulatory Care and Surgery (4)
- Antibiotics (8)
- (-) Antimicrobial Stewardship (20)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Clostridium difficile Infections (1)
- Critical Care (3)
- Diagnostic Safety and Quality (1)
- Education: Patient and Caregiver (1)
- Electronic Health Records (EHRs) (1)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (1)
- Healthcare-Associated Infections (HAIs) (4)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (1)
- Health Services Research (HSR) (1)
- Hospitals (1)
- Infectious Diseases (3)
- Kidney Disease and Health (2)
- Long-Term Care (1)
- Medication (8)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (2)
- Neonatal Intensive Care Unit (NICU) (1)
- Newborns/Infants (1)
- Nursing Homes (1)
- Patient and Family Engagement (1)
- Patient Safety (6)
- Practice Patterns (1)
- Prevention (6)
- Primary Care (1)
- Provider: Health Personnel (1)
- Quality of Care (1)
- Registries (1)
- Research Methodologies (1)
- Respiratory Conditions (2)
- Training (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 20 of 20 Research Studies DisplayedBurnham CA, Hogan PG, Wallace MA
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
The authors compared microbial communities and levels of richness and diversity in community-dwelling subjects and in intensive care unit patients before and after the use of topical decolonization protocols. They found a reduction in S. aureus without eradicating endogenous microbiota.
AHRQ-funded; HS021736; HS024269.
Citation: Burnham CA, Hogan PG, Wallace MA .
Topical decolonization does not eradicate the skin microbiota of community-dwelling or hospitalized adults.
Antimicrob Agents Chemother 2016 Dec;60(12):7303-12. doi: 10.1128/aac.01289-16.
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Keywords: Antimicrobial Stewardship, Antibiotics, Infectious Diseases, Prevention, Patient Safety
Bartsch SM, Huang SS, Wong KF
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
The authors used their Regional Healthcare Ecosystem Analyst (RHEA) simulation model and found that the 32-month delay in changing carbapenem-resistant Enterobacteriaceae (CRE) breakpoints might have resulted in 1,821 additional carriers in Orange County, CA. They recommend that policymakers aim to minimize the delay in the adoption of new breakpoints for antimicrobials against emerging pathogens when containment of spread is paramount, ideally less than 1.5 years.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Huang SS, Wong KF .
Impact of delays between Clinical and Laboratory Standards Institute and Food and Drug Administration revisions of interpretive criteria for carbapenem-resistant enterobacteriaceae.
J Clin Microbiol 2016 Nov;54(11):2757-62. doi: 10.1128/jcm.00635-16.
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Keywords: Infectious Diseases, Antibiotics, Antimicrobial Stewardship
Cunha CB, D'Agata EM
Implementing an antimicrobial stewardship program in out-patient dialysis units.
The purpose of this review is to highlight the key elements and interventions of antimicrobial stewardship programs (ASP). The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting.
AHRQ-funded; HS021666.
Citation: Cunha CB, D'Agata EM .
Implementing an antimicrobial stewardship program in out-patient dialysis units.
Curr Opin Nephrol Hypertens 2016 Nov;25(6):551-55. doi: 10.1097/mnh.0000000000000281.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Ambulatory Care and Surgery, Kidney Disease and Health, Chronic Conditions
Schweizer ML, Braun BI, Milstone AM
Research methods in healthcare epidemiology and antimicrobial stewardship-quasi-experimental designs.
The authors highlighted key considerations for quasi-experimental studies in healthcare epidemiology and antimicrobial stewardship, including study design and analytic approaches to avoid selection bias and other common pitfalls of quasi-experimental studies.
AHRQ-funded; HS022872.
Citation: Schweizer ML, Braun BI, Milstone AM .
Research methods in healthcare epidemiology and antimicrobial stewardship-quasi-experimental designs.
Infect Control Hosp Epidemiol 2016 Oct;37(10):1135-40. doi: 10.1017/ice.2016.117.
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Keywords: Antimicrobial Stewardship, Patient Safety, Research Methodologies
Reich PJ, Boyle MG, Hogan PG
Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge.
Methicillin-resistant Staphylococcus aureus (MRSA) infections cause significant morbidity and mortality in neonatal intensive care units (NICUs). The researchers characterized the clinical and molecular epidemiology of MRSA strains colonizing NICU patients. They found that community-acquired MRSA strains are prominent in the NICU and associated with distinct risk factors.
AHRQ-funded; HS021736; HS024269.
Citation: Reich PJ, Boyle MG, Hogan PG .
Emergence of community-associated methicillin-resistant Staphylococcus aureus strains in the neonatal intensive care unit: an infection prevention and patient safety challenge.
Clin Microbiol Infect 2016 Jul;22(7):645.e1-8. doi: 10.1016/j.cmi.2016.04.013.
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Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Neonatal Intensive Care Unit (NICU), Patient Safety, Prevention, Antimicrobial Stewardship, Newborns/Infants, Healthcare-Associated Infections (HAIs)
Keller SC, Gurses AP, Abaje AI
Learning from the patient: Human factors engineering in outpatient parenteral antimicrobial therapy.
When used in hospital settings, many of the complex devices adapted for use in outpatient parenteral antimicrobial therapy (OPAT) can lead to errors that may lead to patient harm. To reduce complications from OPAT in the home, such as catheter-associated venous thromboembolism, adverse drug events, or other side effects of OPAT, the authors argue that we need to understand how OPAT is performed by patients and their caregivers and the ways in which human factors engineering can contribute to their reduction.
AHRQ-funded; HS022916.
Citation: Keller SC, Gurses AP, Abaje AI .
Learning from the patient: Human factors engineering in outpatient parenteral antimicrobial therapy.
Am J Infect Control 2016 Jul;44(7):758-60. doi: 10.1016/j.ajic.2016.01.010.
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Keywords: Adverse Events, Antimicrobial Stewardship, Education: Patient and Caregiver, Ambulatory Care and Surgery, Patient Safety
Wares JR, Lawson B, Shemin D
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
The researchers hypothesized that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of multidrug-resistant organisms (MDRO) and further that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. They found that reducing antimicrobial treatment markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. They suggested that improving the environmental decontamination efficacy between patient dialysis treatments as an effective method for reducing colonization and contamination rates.
AHRQ-funded; HS021666.
Citation: Wares JR, Lawson B, Shemin D .
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
PLoS One 2016 May 19;11(5):e0153820. doi: 10.1371/journal.pone.0153820.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Healthcare-Associated Infections (HAIs), Prevention, Ambulatory Care and Surgery, Infectious Diseases
Heid C, Knobloch MJ, Schulz LT
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
The authors identified themes associated with patient perceptions of antibiotic use and the role of patients in inpatient antimicrobial stewardship. They found that general medicine inpatients receiving at least one anti-infective medication recognized antibiotic resistance as a serious public health threat but expressed low perceived susceptibility to being personally affected by antibiotic resistance. Few participants reported being offered the opportunity to engage in shared decision making while hospitalized. The researchers concluded that the likelihood of patient engagement in stewardship practices is currently limited by low perceived susceptibility and lack of cues to act.
AHRQ-funded; HS023791.
Citation: Heid C, Knobloch MJ, Schulz LT .
Use of the health belief model to study patient perceptions of antimicrobial stewardship in the acute care setting.
Infect Control Hosp Epidemiol 2016 May;37(5):576-82. doi: 10.1017/ice.2015.342.
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Keywords: Critical Care, Antimicrobial Stewardship, Antibiotics, Patient and Family Engagement, Patient Safety
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Lo Re V, 3rd, Carbonari DM, Lewis JD
Oral azole antifungal medications and risk of acute liver injury, overall and by chronic liver disease status.
The researchers evaluated incidence rates of acute liver injury associated with oral azole antifungals. They concluded that rates of acute liver injury were similarly low for fluconazole, ketoconazole, and itraconazole. Events were more common among voriconazole and posaconazole users but were comparable. Pre-existing chronic liver disease increased risk of azole-induced liver injury.
AHRQ-funded; HS018372.
Citation: Lo Re V, 3rd, Carbonari DM, Lewis JD .
Oral azole antifungal medications and risk of acute liver injury, overall and by chronic liver disease status.
Am J Med 2016 Mar;129(3):283-91.e5. doi: 10.1016/j.amjmed.2015.10.029.
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Keywords: Antimicrobial Stewardship, Medication, Kidney Disease and Health, Chronic Conditions, Adverse Drug Events (ADE)
Heath B, Bernhardt J, Michalski TJ
Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.
The authors described a course in the Veterans Affairs (VA) Employee Education System designed to engage nursing staff working in VA long-term care facilities as partners in antimicrobial stewardship. They found that the course addressed an important knowledge gap and recommended engaging nursing staff in advancing antimicrobial stewardship, particularly in the long-term care setting.
AHRQ-funded; HS023866.
Citation: Heath B, Bernhardt J, Michalski TJ .
Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults.
Am J Infect Control 2016 Mar;44(3):349-51. doi: 10.1016/j.ajic.2015.09.026.
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Keywords: Antimicrobial Stewardship, Provider: Health Personnel, Prevention, Training
Alvarez E, Uslan DZ, Malloy T
It is time to revise our approach to registering antimicrobial agents for health care settings.
This paper discusses antimicrobial surfaces, such as copper alloy, for the prevention of healthcare-associated infections. The authors address the current process for registering antimicrobial products, flaws in the registration requirements, and the need for evidence-based approaches to reduce healthcare-associated infections.
AHRQ-funded; HS021188.
Citation: Alvarez E, Uslan DZ, Malloy T .
It is time to revise our approach to registering antimicrobial agents for health care settings.
Am J Infect Control 2016 Feb;44(2):228-32. doi: 10.1016/j.ajic.2015.09.015.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Prevention, Evidence-Based Practice, Registries
Knackstedt ED, Stockmann C, Davis CR
Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship.
The researchers reviewed patient discharges with outpatient parenteral antimicrobial therapy (OPAT) to determine whether OPAT was modifiable or unnecessary at a large tertiary care children’s hospital. At least one modification definitely or possibly would have been recommended for 78 percent of episodes. For more than 40 percent of episodes, OPAT was potentially not indicated.
AHRQ-funded; HS023320.
Citation: Knackstedt ED, Stockmann C, Davis CR .
Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship.
Infect Control Hosp Epidemiol 2015 Feb;36(2):222-4. doi: 10.1017/ice.2014.27..
Keywords: Antimicrobial Stewardship, Children/Adolescents, Ambulatory Care and Surgery
Kelesidis T, Braykov N, Uslan DZ
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
This study characterized the indications for antibiotic therapy, agents used, duration, combinations, and microbiological justification in 6 acute-care US facilities with varied location, size, and type of antimicrobial stewardship programs. It concluded that the use of broad-spectrum empirical therapy was prevalent in 6 US acute care facilities. Fluoroquinolones, vancomycin, and antipseudomonal penicillins were the most frequently used antibiotics, particularly for respiratory indications
AHRQ-funded; HS021188.
Citation: Kelesidis T, Braykov N, Uslan DZ .
Indications and types of antibiotic agents used in 6 acute care hospitals, 2009-2010: a pragmatic retrospective observational study.
Infect Control Hosp Epidemiol 2016 Jan;37(1):70-9. doi: 10.1017/ice.2015.226.
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Keywords: Antimicrobial Stewardship, Critical Care, Hospitals, Medication, Respiratory Conditions
Russell D, Beekmann SE, Polgreen PM
Routine use of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: Which way is the pendulum swinging?
This study assessed the state of utilization of contact precautions (CP) as well as adjunctive measures to reduce the risk of transmission for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus in US hospitals. It found that the most widely used trigger for initiation of CP for both pathogens was positive clinical culture. Practices for discontinuation of isolation varied widely. Evidence-based guidelines regarding CP and horizontal interventions are needed.
AHRQ-funded; HS021188.
Citation: Russell D, Beekmann SE, Polgreen PM .
Routine use of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: Which way is the pendulum swinging?
Infect Control Hosp Epidemiol 2016 Jan;37(1):36-40. doi: 10.1017/ice.2015.246.
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Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention, Antimicrobial Stewardship, Patient Safety
Chung P, Currie B, Guo Y
Investigation to identify a resource-efficient case-control methodology for determining antibiotics associated with Clostridium difficile infection.
This study consisted of a series of case-control studies involving two groups of patients admitted to the hospital, the first group with clostridium difficile infection (CDI), and a control group without CDI. The purpose was to determine the relationship between the use of antibiotics and the presence of CDI. A simple matching strategy was found to be an efficient and feasible compromise strategy to identify high-risk antibiotics associated with CDI.
AHRQ-funded; 290200600012I
Citation: Chung P, Currie B, Guo Y .
Investigation to identify a resource-efficient case-control methodology for determining antibiotics associated with Clostridium difficile infection.
Am J Infect Control. 2014 Oct;42(10 Suppl):S264-8. doi: 10.1016/j.ajic.2014.05.001..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Antimicrobial Stewardship
Furuno JP, Comer AC, Johnson JK
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
The researchers describe the design and implementation of a skilled nursing facility (SNF) specific antibiogram to improve empirical antibiotic prescribing. They estimated the frequency of inappropriate antibiotic prescribing in 3 Maryland SNFs and measured the effectiveness of the antibiograms on antibiotic prescribing in 1 of the SNFs.
AHRQ-funded; 290200600020I
Citation: Furuno JP, Comer AC, Johnson JK .
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S56-61. doi: 10.1086/677818..
Keywords: Long-Term Care, Antimicrobial Stewardship, Nursing Homes, Diagnostic Safety and Quality
Barnett ML, Linder JA
Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010.
To estimate the association of ongoing CDC efforts to reduce antibiotic prescribing for acute bronchitis, the researchers evaluated the change in antibiotic prescribing rates for this condition in the U.S. between 1996 and 2010. They found that the antibiotic prescribing rate for this condition was 71 percent initially and increased during the study period.
AHRQ-funded; HS018419
Citation: Barnett ML, Linder JA .
Antibiotic prescribing for adults with acute bronchitis in the United States, 1996-2010.
JAMA. 2014 May 21;311(19):2020-2. doi: 10.1001/jama.2013.286141..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare Utilization, Medication
Barnett ML, Linder JA
Antibiotic prescribing to adults with sore throat in the United States, 1997-2010.
In only about 10 percent of cases of sore throat (those related to A Streptococcus infection) are antibiotics indicated. However, a new study, combined with an earlier study, finds that despite efforts to reduce overprescribing, antibiotic use dropped from roughly 80 to 70 percent around 1993 and then to around 60 percent by 2000 where it has remained as of 2010.
AHRQ-funded; HS018419
Citation: Barnett ML, Linder JA .
Antibiotic prescribing to adults with sore throat in the United States, 1997-2010.
JAMA Intern Med. 2014 Jan;174(1):138-40. doi: 10.1001/jamainternmed.2013.11673..
Keywords: Antibiotics, Antimicrobial Stewardship, Medication, Healthcare Utilization
Donnelly JP, Baddley JW, Wang HE
Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments.
Using national surveillance data for acute respiratory tract infections (ARTIs), this study characterized patterns of antibiotic usage in U.S. emergency departments between 2001 and 2010. It found significant progress toward reductions on inappropriate antibiotic use among children; however, adults with ARTI continued to receive inappropriately high amounts of antibiotics.
AHRQ-funded; HS013852
Citation: Donnelly JP, Baddley JW, Wang HE .
Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments.
Antimicrob Agents Chemother. 2014 Mar;58(3):1451-7. doi: 10.1128/AAC.02039-13..
Keywords: Antimicrobial Stewardship, Emergency Medical Services (EMS), Medication, Critical Care