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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 762 Research Studies DisplayedKannan S, Song Z
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
Out-of-pocket costs for ICU care may be large at the beginning of the year due to high insurance deductibles that reset every year for US patients, and the expensive nature of ICU care. The purpose of this cross-sectional study was to explore cost-sharing changes from December to January for ICU admissions and non -ICU admissions among adults with employer-sponsored insurance. Among aggregate ICU hospitalizations, total cost-sharing averaged $1079 in December and $1871 in January, a 73.4% increase. Among non-ICU hospitalizations, total cost-sharing averaged $1043 in December and $1683 in January, a 61.3% increase. These increases and differences between ICU and non-ICU hospitalizations were greater among patients with high deductible health plans (HDHPs). For patients with HDHPs requiring an ICU stay, cost-sharing averaged $3093 per hospitalization in January vs $1301 in December.
AHRQ-funded; HS024072.
Citation: Kannan S, Song Z .
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
JAMA Health Forum 2023 May 5; 4(5):e230784. doi: 10.1001/jamahealthforum.2023.0784..
Keywords: Healthcare Costs, Hospitals, Hospitalization, Intensive Care Unit (ICU)
Simpson KR, Spetz J, Gay CL
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
The objective of this study was to estimate the relationship between hospital characteristics and adherence with Association of Women's Health, Obstetric and Neonatal Nurses nurse staffing guidelines. Registered nurses were enrolled in a cross-sectional survey; hospital characteristics were obtained from the 2018 American Hospital Association Annual Survey. The findings indicated that, overall, nurses reported strong adherence to staffing guidelines within their hospitals. Higher birth volume, teaching status, higher percentage of Medicaid-paid births, and presence of a neonatal intensive care unit were all associated with lower mean adherence scores.
AHRQ-funded; HS025715.
Citation: Simpson KR, Spetz J, Gay CL .
Hospital characteristics associated with nurse staffing during labor and birth: Inequities for the most vulnerable maternity patients.
Nurs Outlook 2023 May; 71(3):101960. doi: 10.1016/j.outlook.2023.101960..
Keywords: Hospitals, Maternal Care, Provider: Nurse, Workforce, Vulnerable Populations
Valley TS, Schutz A, Miller J
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
In order to understand factors influencing how intensive care unit (ICU) admission decisions are made, researchers conducted qualitative analysis of eight U.S. hospitals. Semi-structured, one-on-one interviews with 87 participants were supplemented by site visits and clinical observations. Four hospital-level factors were identified which influenced ICU admission decisionmaking. The researchers concluded that healthcare systems should evaluate use of ICU care and establish institutional patterns to ensure that ICU admission decisions are patient-centered as well as account for resources and hospital-specific constraints.
AHRQ-funded; HS028038.
Citation: Valley TS, Schutz A, Miller J .
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
Intensive Care Med 2023 May; 49(5):505-16. doi: 10.1007/s00134-023-07031-w..
Keywords: Intensive Care Unit (ICU), Hospitals, Shared Decision Making, Hospitalization
Desai AD, Tolpadi A, Parast L
Improving the quality of written discharge instructions: a multisite collaborative project.
This study assessed the association between participation in an Institute for Healthcare Improvement Virtual Breakthrough Series collaborative and the quality of pediatric written discharge instructions across 8 US hospitals. The authors conducted a multicenter, interrupted time-series analysis of a medical records-based quality measure focused on written discharge instruction content (0-100 scale, higher scores reflect better quality). They obtained data from a random sample of pediatric patients (n = 5739) discharged from participating hospitals between September 2015 and August 2016, and between December 2017 and January 2020. The study periods consisted of 3 phases: 1) a 14-month pre-collaborative phase; 2) a 12-month quality improvement collaborative phase when hospitals implemented multiple rapid cycle tests of change and shared improvement strategies; and 3) a 12-month postcollaborative phase. Among hospitals with high baseline performance, measure scores improved beyond expected for the precollaborative trend, but hospitals with low baseline performance, measure scores increased at a lower than expected rate.
AHRQ-funded; HS025291.
Citation: Desai AD, Tolpadi A, Parast L .
Improving the quality of written discharge instructions: a multisite collaborative project.
Pediatrics 2023 May; 151(5):e2022059452. doi: 10.1542/peds.2022-059452..
Keywords: Hospital Discharge, Transitions of Care, Hospitals
Burden M, Keniston A, Gundareddy VP
Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.
In an effort to alleviate hospital capacity constraints, medical facilities frequently promote the prioritization of early morning discharges, which could potentially lead to unintended repercussions. The purpose of this study was to investigate the impact of hospitalist physicians focusing on discharging patients before attending to other tasks in comparison to their customary rounding practices. This prospective, multi-center randomized controlled trial involved three major academic hospitals. Participants included Hospital Medicine attending-level physicians and the patients under their care during the study, who were at least 18 years old, admitted to a Medicine service, and assigned to a hospitalist team through routine procedures. Physicians were randomized into two groups: 1) giving precedence to discharging patients as care permitted or 2) maintaining their usual practice. The primary outcome measure was the time of discharge order. Secondary outcomes encompassed actual discharge time, length of stay (LOS), and order timings for procedures, consultations, and imaging. The study found that between February 9, 2021, and July 31, 2021, 59 physicians were randomized to prioritize patient discharges or maintain their usual rounding practice, resulting in the discharge of 4,437 patients. In the primary adjusted analysis (intention-to-treat), there was no significant difference in discharge order time or actual discharge time between physicians who prioritized discharging patients first and those who followed their usual rounding style. Additionally, LOS and order times for other physician orders remained unchanged.
AHRQ-funded; HS027231
Citation: Burden M, Keniston A, Gundareddy VP .
Discharge in the A.M.: a randomized controlled trial of physician rounding styles to improve hospital throughput and length of stay.
J Hosp Med 2023 Apr;18(4):302-15. doi: 10.1002/jhm.13060.
Keywords: Hospital Discharge, Hospitals
Fernandes-Taylor S, Yang Q, Yang DY
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
The availability of emergency surgical services has diminished as the rural workforce has decreased. The growing need for interhospital patient transfers makes care coordination across different settings essential for maintaining high-quality care. The purpose of this study was to investigate the impact of recurrent patient-sharing between hospitals on the outcomes of emergency general surgery (EGS) patient transfers. A multicenter analysis was conducted involving inpatient acute care hospital stays in Wisconsin that required the transfer of EGS patients. Data was sourced from the Wisconsin Hospital Association (WHA), a comprehensive statewide hospital discharge database for the years 2016-2018. We postulated that a higher percentage of patients transferred between hospitals would lead to improved outcomes. The relationship between the proportion of EGS patient transfers and patient outcomes, such as in-hospital morbidity, mortality, and duration of stay, was examined. Additional factors considered were hospital organizational features and patient sociodemographic and clinical attributes. The researchers found that during the two-year study period, 118 hospitals transferred 3,197 EGS patients; 1,131 of these patients experienced in-hospital complications, death, or an extended stay (beyond the 75th percentile). The average patient age was 62 years, with 50% being female and 5% non-white. In the mixed-effects model, the proportion of shared patients between hospitals was linked to a reduced likelihood of in-hospital complications. Specifically, when the proportion of shared patients doubled between two hospitals, the relative odds of any adverse outcome shifted by 0.85.
AHRQ-funded; HS025224
Citation: Fernandes-Taylor S, Yang Q, Yang DY .
Greater patient sharing between hospitals is associated with better outcomes for transferred emergency general surgery patients.
J Trauma Acute Care Surg 2023 Apr;94(5):592-98. doi: 10.1097/ta.0000000000003789.
Keywords: Emergency Department, Hospitals, Surgery, Transitions of Care
Carroll C, Euhus R, Beaulieu N
Hospital survival in rural markets: closures, mergers, and profitability.
This study investigated how the decline in profitability has affected rural hospital survival, either independently or with a merger. The authors assessed the rate of hospital closures and mergers in predominantly rural markets during the period 2010-18, focusing on hospitals that were unprofitable at baseline. A minority (7%) closed, with a larger share (17%) merged, most commonly with organizations from outside of their local geographic market. Most unprofitable hospitals (77%) continued to operate through 2018 without closure or merger. About half returned to profitability. Their analysis suggested that although rural hospital markets are experiencing meaningful rates of closures and mergers, many hospitals have survived despite their poor financial performance.
AHRQ-funded.
Citation: Carroll C, Euhus R, Beaulieu N .
Hospital survival in rural markets: closures, mergers, and profitability.
Health Aff 2023 Apr; 42(4):498-507. doi: 10.1377/hlthaff.2022.01191..
Keywords: Hospitals, Rural Health, Rural/Inner-City Residents
Meille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Leyenaar JK, Hill V, Lam V
Direct admission to hospital for children in the United States.
The purpose of this paper is to develop a policy statement to present recommendations to optimize the quality and safety of this hospital admission approach for children, as one in four unscheduled hospital admissions for children and adolescents in the United States occurs via direct admission, defined as hospital admission without first receiving care in the hospital's emergency department. Recommendations in the proposed policy statement provide guidance related to: (i) direct admission written guidelines, (ii) clear systems of communication between members of the health care team and with families of children requiring admission, (iii) triage systems to identify patient acuity and disease severity, (iv) identification of hospital resources needed to support direct admission systems of care, (v) consideration of patient populations that may be at increased risk of adverse outcomes during the hospital admission process, (vi) addressing the relevance of local factors and resources, and (vii) ongoing evaluation of direct admission processes and outcomes. The recommendations are intended to support the implementation of safe direct admission processes and to foster awareness of outcomes associated with this common portal of hospital admission.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Hill V, Lam V .
Direct admission to hospital for children in the United States.
Pediatrics 2023 Mar;151(3):e2022060973. doi: 10.1542/peds.2022-060973.
Keywords: Children/Adolescents, Hospitals, Hospitalization
Mullens CL, Mead M, Kalata S
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
The authors conducted an economic evaluation to examine variations in prices for surgical procedures under the Hospital Price Transparency Rule at U.S. hospitals in and outside of networks. The results showed that median negotiated prices were significantly higher at hospitals within networks compared with independent hospitals for 15 of the 16 procedures evaluated. The authors noted that these results ought to be interpreted in the context of certain limitations and that it will be important to understand the mechanisms behind these variations in negotiated prices for surgical care in order to identify areas of unwarranted variation.
AHRQ-funded; HS028606; HS000053.
Citation: Mullens CL, Mead M, Kalata S .
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
JAMA Netw Open 2023 Feb; 6(2):e2255849. doi: 10.1001/jamanetworkopen.2022.55849..
Keywords: Surgery, Healthcare Costs, Hospitals
Wolf RM, Hall M, Williams DJ
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
This study’s objective was to determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. The authors examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Of 29,834 included encounters, 12.6% had pharmacologic restraint use, with three hospitals the highest utilizers of all drug classes. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175. There were no significant differences in pharmacologic restraint use found in the hospital-level analysis.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals.
J Hosp Med 2023 Feb; 18(2):120-29. doi: 10.1002/jhm.13009..
Keywords: Children/Adolescents, Behavioral Health, Hospitals, Medication
Carey K, Lin MY
Safety-net hospital performance under comprehensive care for joint replacement.
The objective of this study was to investigate the relative progress of safety-net hospitals (SNHs) under Medicare's Comprehensive Care for Joint Replacement (CJR) mandatory bundled payment model and to identify contributors to SNHs' realization of success under the CJR program. Secondary data on all CJR hospitals from 2016-2020 were taken from CMS public use files and from the American Hospital Association. The findings indicated that SNHs were less successful in meeting spending targets when compared to CJR hospitals overall. The authors concluded that the formula used by CMS to determine spending targets may not be sufficient to address disparities in SNH financial performances under mandatory bundled payment.
AHRQ-funded; HS027786.
Citation: Carey K, Lin MY .
Safety-net hospital performance under comprehensive care for joint replacement.
Health Serv Res 2023 Feb; 58(1):101-06. doi: 10.1111/1475-6773.14042..
Keywords: Hospitals, Surgery, Orthopedics, Provider Performance
Aswani MS, Roberts ET
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
The objective of this study was to investigate the limitations of peer grouping and associated challenges in the measurement of social risk in Medicare's Hospital Readmission Reduction Program (HRRP). Public data on hospitals in the HRRP were used to examine the relationship between hospital dual share and readmission rates within peer groups as well as changes in hospital peer group assignments, readmission rates, and penalties, and the relationship between state Medicaid eligibility rules and peer groups. The findings indicated that peer grouping is limited in the extent to which it accounts for differences in hospitals' patient populations. The authors concluded that problems arise from the construction of peer groups and the measure of social risk used to define them.
AHRQ-funded; HS026727.
Citation: Aswani MS, Roberts ET .
Social risk adjustment in the hospital readmission reduction program: pitfalls of peer grouping, measurement challenges, and potential solutions.
Health Serv Res 2023 Feb; 58(1):51-59. doi: 10.1111/1475-6773.13969..
Keywords: Hospital Readmissions, Hospitals, Risk
Westley L, Manworren RCB, Griffith DM
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
The purpose of this study was to quantify issues related to hospital incident command systems (HICS) implemented to expand mental and behavioral healthcare (MBHC) services during the COVID-19 pandemic, and track progress toward HICS goals. The researchers analyzed data on patient census, nurse vacancies, staff injuries, and staff perceptions and resources were developed. The study found that after HICS implementation, 84% of nurses reported confidence in providing care to youth with acute MBHC needs.
AHRQ-funded; HS026385.
Citation: Westley L, Manworren RCB, Griffith DM .
Using hospital incident command systems to respond to the pediatric mental and behavioral health crisis of the COVID-19 pandemic.
J Nurs Adm 2023 Feb; 53(2):96-103. doi: 10.1097/nna.0000000000001254..
Keywords: COVID-19, Children/Adolescents, Behavioral Health, Hospitals
Beaulieu ND, Chernew ME, McWilliams JM
Organization and performance of US health systems.
The objectives of this evidence review were to identify and describe health systems in the US, to assess differences between physicians and hospitals in and outside of health systems, and to compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. A total of 580 health systems in a great variety of sizes were identified; prices for physician, hospital services, and total spending were assessed in 2018 commercial claims data. Health system physicians and hospitals were shown to deliver a large portion of medical services. Clinical quality performance and patient experience measures were slightly better in systems; however, spending and prices were significantly higher, especially in small practices. The authors concluded that slight quality differentials in combination with large price differentials suggested that health systems have not realized their potential for better care at equal or lower cost.
AHRQ-funded; HS024072.
Citation: Beaulieu ND, Chernew ME, McWilliams JM .
Organization and performance of US health systems.
JAMA 2023 Jan 24; 329(4):325-35. doi: 10.1001/jama.2022.24032..
Keywords: Health Systems, Healthcare Delivery, Provider Performance, Quality Measures, Quality of Care, Hospitals
Goto M, Hasegawa S, Balkenende EC
Effectiveness of ultraviolet-c disinfection on hospital-onset gram-negative rod bloodstream infection: a nationwide stepped-wedge time-series analysis.
This study evaluated the effectiveness of enhanced terminal room cleaning with ultraviolet C (UV-C) disinfection in reducing gram-negative rod (GNR) infections. The authors used information regarding UV-C use and the timing of implementation through a survey of all Veterans Health Administration (VHA) hospitals providing inpatient acute care from January 2010 and December 2018. Among 128 Veterans Health Administration hospitals, 120 provided complete survey responses with 40 reporting implementations of UV-C systems. UV-C use was associated with a 19% lower incident of hospital-onset (HO) GNR bloodstream infection (BSI).
AHRQ-funded; HS027472.
Citation: Goto M, Hasegawa S, Balkenende EC .
Effectiveness of ultraviolet-c disinfection on hospital-onset gram-negative rod bloodstream infection: a nationwide stepped-wedge time-series analysis.
Clin Infect Dis 2023 Jan 13; 76(2):291-98. doi: 10.1093/cid/ciac776..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Hospitals, Prevention, Sepsis
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
Likosky DS, Strobel RJ, Wu X
Interhospital failure to rescue after coronary artery bypass grafting.
Researchers conducted an observational study to evaluate whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. Subjects were patients undergoing grafting surgery across 90 hospitals between 2011 and 2017. Results indicated the predicted mortality risk was similar across hospital observed:expected mortality terciles. Observed and expected failure to rescue rates were positively correlated among patients with major and overall complications. The researchers concluded that interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals; this includes early recognition and management of complications.
AHRQ-funded; HS026003.
Citation: Likosky DS, Strobel RJ, Wu X .
Interhospital failure to rescue after coronary artery bypass grafting.
J Thorac Cardiovasc Surg 2023 Jan;165(1):134-43.e3. doi: 10.1016/j.jtcvs.2021.01.064..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Surgery, Hospitals, Adverse Events
Kelly MM, Hoonakker PLT, Nacht CL
Parent perspectives on sharing pediatric hospitalization clinical notes.
This qualitative study sought to identify parent perceptions of the benefits and challenges of real-time note access during their child's hospitalization and strategies to optimize note-sharing at the bedside. The study conducted 60-minute interviews with 28 parents who were given access to their child's admission and daily progress notes on a bedside tablet (iPad) and interviewed upon discharge. The parents described 6 benefits of having note access, which: provided a recap and improved their knowledge about their child's care plan, enhanced communication, facilitated empowerment, increased autonomy, and incited positive emotions. Potential challenges described included: causing confusion, hindering communication with the health care team, highlighting problems with note content, and inciting negative emotions. The parents recommended 4 strategies to support sharing: provide preemptive communication about expectations, optimize the note release process, consider parent-friendly note template modifications, and offer informational resources for parents.
AHRQ-funded; HS027214.
Citation: Kelly MM, Hoonakker PLT, Nacht CL .
Parent perspectives on sharing pediatric hospitalization clinical notes.
Pediatrics 2023 Jan; 151(1). doi: 10.1542/peds.2022-057756..
Keywords: Children/Adolescents, Hospitals, Clinician-Patient Communication, Communication, Hospitalization
Doherty JR, Schaefer A, Goodman DC
Texas hospital's perspectives about NICU performance measures: a mixed-methods study.
This exploratory mixed-methods study was conducted to determine Texas hospital leaders’ perspectives about neonatal intensive care (NICU) performance measures. First a survey was sent along with a copy of the Dartmouth Atlas of Neonatal Intensive Care to clinical and administrative leaders of 150 NICUs in Texas. The authors asked respondents to review the chapter that reported Texas-specific results and respond to a variety of open and closed-ended questions about the overall usefulness of the report. Secondly, they conducted semistructured qualitative interviews with a subset of survey respondents to better understand their perspectives. There was a 50% survey response rate. Respondents generally found the report to be interesting and useful, and 87.7% of all respondents reported being in favor of receiving future reports with their own hospital's data benchmarked against other anonymous NICU peers. All measures in the Atlas were considered favorably. The respondents also felt that a report with performance data would serve as a mechanism to drive change by identifying opportunities for improvement.
AHRQ-funded; HS024075.
Citation: Doherty JR, Schaefer A, Goodman DC .
Texas hospital's perspectives about NICU performance measures: a mixed-methods study.
Qual Manag Health Care 2023 Jan-Mar;32(1):8-15. doi: 10.1097/qmh.0000000000000347..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Provider Performance, Hospitals
Peng L, Luo G, Walker A
Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals.
The goals of this study were to compare a single-site, COVID-19 computer diagnosis system that used the Federated Averaging (FedAvg) algorithm with 3-client Federated learning (FL) models, and to evaluate the performance of the four FL variations. Researchers leveraged a FL healthcare collaborative that included data from five US and European healthcare systems encompassing 42 hospitals. They concluded that FedAvg could significantly improve generalization of the model in comparison with other personalization FL algorithms--FedProx, FedBN, and FedAMP--but at the cost of poor internal validity.
AHRQ-funded; HS026379.
Citation: Peng L, Luo G, Walker A .
Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals.
J Am Med Inform Assoc 2022 Dec 13;30(1):54-63. doi: 10.1093/jamia/ocac188..
Keywords: COVID-19, Diagnostic Safety and Quality, Imaging, Hospitals
Liao JM, Huang Q, Wang E
Performance of physician groups and hospitals participating in bundled payments among Medicare beneficiaries.
This cohort study compared how physician group practices (PGPs) performed in bundled payments compared with hospitals. The authors used 2011 to 2018 Medicare claims data to compare the association of participants in the Bundled Payments for Care Improvement (BCPI) initiative with episode outcomes. Primary outcome was 90-day total episode spending. The total sampled comprised data from 1,288,781 Medicare beneficiaries, of whom mean age was 76.2 years, 59.7% women, and 85.5% White, with 592,071 individuals receiving care from 6405 physicians in in BPCI-participating PGPs and 24,758 propensity-matched physicians in non-BPCI-participating PGPs. For PGPs, BPCI participation was associated with greater reductions in episode spending for surgical (difference, -$1648 to -$1088) but not for medical episodes (difference, -$410 to $206). Hospital participation in BPCI was associated with greater reductions in episode spending for both surgical ($1345 to -$675) and medical -$1139 to -$386) episodes.
AHRQ-funded; HS027595.
Citation: Liao JM, Huang Q, Wang E .
Performance of physician groups and hospitals participating in bundled payments among Medicare beneficiaries.
JAMA Health Forum 2022 Dec 2; 3(12):e224889. doi: 10.1001/jamahealthforum.2022.4889..
Keywords: Provider Performance, Payment, Hospitals, Medicare, Quality of Care
Bolte TB, Swanson MB, Kaldjian AM
Hospitals that report severe sepsis and septic shock bundle compliance have more structured sepsis performance improvement.
This study linked survey data on quality improvement (QI) practices from Iowa hospitals to severe sepsis/septic shock (SEP-1) performance data and mortality. All Iowa hospitals (100%) completed the survey. SEP-1 reporting hospitals were more likely to have sepsis QI practices, including reporting sepsis quality to providers (64% versus 38%) and using the case review process to develop sepsis care plans. Increased SEP-1 scores were not associated with sepsis QI practices. A sepsis registry was associated with decreased odds of being in the bottom quartile of sepsis mortality, and presence of a sepsis committee was associated with lower hospital-specific mortality.
AHRQ-funded; HS025753.
Citation: Bolte TB, Swanson MB, Kaldjian AM .
Hospitals that report severe sepsis and septic shock bundle compliance have more structured sepsis performance improvement.
J Patient Saf 2022 Dec 1;18(8):e1231-e36. doi: 10.1097/pts.0000000000001062..
Keywords: Sepsis, Hospitals, Quality Improvement, Quality Indicators (QIs), Quality of Care
Encinosa W, Nguyen P
AHRQ Author: Encinosa W
Is the recent surge in physician-hospital consolidation finally producing cost-savings?
This article revisits earlier integration studies using IBM MarketScan data 2010–2016 to re-examine the relationship between primary care physicians integrated with hospitals and spending under the Affordable Care Act (ACA) during that period. The authors observe an association between physician-hospital integration and overall cost-savings, a reversal of the relationship noted in earlier studies. They recommend that future research examine the precise mechanism of physician-hospital clinical integration in greater detail.
AHRQ-authored.
Citation: Encinosa W, Nguyen P .
Is the recent surge in physician-hospital consolidation finally producing cost-savings?
J Gen Intern Med 2022 Dec;37(16):4289-91. doi: 10.1007/s11606-022-07634-x..
Keywords: Healthcare Costs, Provider: Physician, Hospitals, Primary Care
Levinson Z, Cantor J, Williams MV
The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.
Investigators sought to identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics. They found that hospitals with large Black patient shares experienced greater strain during the pandemic. These hospitals received more federal relief; however, funding was not targeted overall toward hospitals with high ICU occupancy rates.
AHRQ-funded; HS024067.
Citation: Levinson Z, Cantor J, Williams MV .
The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.
Health Serv Res 2022 Dec;57(Suppl 2):279-90. doi: 10.1111/1475-6773.14028..
Keywords: COVID-19, Intensive Care Unit (ICU), Critical Care, Racial and Ethnic Minorities, Hospitals