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- Adverse Drug Events (ADE) (1)
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- Comparative Effectiveness (1)
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- (-) Nursing Homes (16)
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- Opioids (1)
- Outcomes (6)
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- (-) Patient-Centered Outcomes Research (16)
- Patient Safety (1)
- Pressure Ulcers (1)
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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 16 of 16 Research Studies DisplayedMangrum R, Stewart MD, Gifford DR
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
The goal of this study was to create a uniform definition of omission of care in US nursing homes. Lack of a uniform definition has made efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders were brought together in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition. The concise definition decided on was: “Omissions of care in nursing homes encompass situations when care–either clinical or nonclinical–is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident."
AHRQ-funded; 233201500014I.
Citation: Mangrum R, Stewart MD, Gifford DR .
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
J Am Med Dir Assoc 2020 Nov;21(11):1587-91.e2. doi: 10.1016/j.jamda.2020.08.016..
Keywords: Elderly, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety, Risk, Patient-Centered Outcomes Research
Zullo AR, Riester MR, Erqou S
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Evidence regarding differences in outcomes between angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) among older nursing home (NH) residents after acute myocardial infarction (AMI) is limited. The purpose of this study was to estimate the post-AMI effects of ARBs versus ACEIs on mortality, rehospitalization, and functional decline outcomes in this important population.
AHRQ-funded; HS022998.
Citation: Zullo AR, Riester MR, Erqou S .
Comparative effectiveness of angiotensin II receptor blockers and angiotensin-converting enzyme inhibitors in older nursing home residents after myocardial infarction: a retrospective cohort study.
Drugs Aging 2020 Oct;37(10):755-66. doi: 10.1007/s40266-020-00791-w..
Keywords: Elderly, Nursing Homes, Heart Disease and Health, Medication, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes
Zullo AR, Ofori-Asenso R, Wood M
Effects of statins for secondary prevention on functioning and other outcomes among nursing home residents.
Studies examining the effects of statins after acute myocardial infarction (AMI) excluded frail older adults, especially nursing home (NH) residents, and few examined functional outcomes. Older NH residents may benefit less from statins and be particularly susceptible to adverse drug events like myopathy-related functional decline. In this retrospective cohort study, the investigators evaluated the effects of statins on 1-year functional decline, rehospitalization, and death in NH residents.
AHRQ-funded; HS022998.
Citation: Zullo AR, Ofori-Asenso R, Wood M .
Effects of statins for secondary prevention on functioning and other outcomes among nursing home residents.
J Am Med Dir Assoc 2020 Apr;21(4):500-07.e8. doi: 10.1016/j.jamda.2020.01.102..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medication, Prevention, Outcomes, Evidence-Based Practice, Patient-Centered Outcomes Research
Zhang T, Lary CW, Zullo AR
Post-hip fracture mortality in nursing home residents by obesity status.
This research letter discusses a study that examined whether obesity status affected mortality in post-hip fracture patients who were nursing home residents. A national cohort of nursing home (NH) residents was examined from national Medicare fee-for-service claims linked to the Minimum Data Set (MDS) from January 2008 through the end of 2009. A total of 33, 622 long-stay residents were identified who had been hospitalized for a hip fracture. They excluded 6918 patients due to a number of factors. They classified residents based on their BMI: normal BMI, overweight, mild obesity, or moderate/severe obesity. They found that being moderate/severely obese did not increase mortality.
AHRQ-funded; HS022998.
Citation: Zhang T, Lary CW, Zullo AR .
Post-hip fracture mortality in nursing home residents by obesity status.
J Am Geriatr Soc 2019 Sep;67(9):1983-85. doi: 10.1111/jgs.16028..
Keywords: Injuries and Wounds, Surgery, Nursing Homes, Obesity, Mortality, Elderly, Long-Term Care, Patient-Centered Outcomes Research
Davidson C, Loganathan S, Bishop L
AHRQ Author: Bergofsky L, Spector W
Scalability of an IT intervention to prevent pressure ulcers in nursing homes.
Researchers assessed the scalability of the On-Time Pressure Ulcer Prevention intervention strategy in nursing homes nationwide. They found that the overall decline in pressure ulcer rates for treatment relative to matched comparison homes was statistically insignificant.
AHRQ-authored; AHRQ-funded; 2332010500023I.
Citation: Davidson C, Loganathan S, Bishop L .
Scalability of an IT intervention to prevent pressure ulcers in nursing homes.
J Am Med Dir Assoc 2019 Jul;20(7):816-21.e2. doi: 10.1016/j.jamda.2019.02.008..
Keywords: Elderly, Health Information Technology (HIT), Nursing Homes, Patient-Centered Outcomes Research, Prevention, Pressure Ulcers
Zullo AR, Mogul A, Corsi K
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
In order to examine the effect of using more guideline-recommended medications after myocardial infarction on mortality, rehospitalization, and functional decline in the frailest and oldest segment of long-stay nursing home residents, researchers conducted a retrospective cohort study of U.S. nursing home residents aged 65 years or older. Exposure was the number of secondary prevention medications initiated after myocardial infarction; outcomes were 90-day death, rehospitalization, or functional decline. The results of the study indicate that the use of more guideline-recommended medications after myocardial infarction was associated with decreased mortality in older, predominantly frail adults, but there was no difference in rehospitalization. Functional decline outcomes were discordant and the researchers note that this does not rule out an increased risk associated with more medication use.
AHRQ-funded; HS022998.
Citation: Zullo AR, Mogul A, Corsi K .
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
Circ Cardiovasc Qual Outcomes 2019 Apr;12(4):e004942. doi: 10.1161/circoutcomes.118.004942..
Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research, Prevention
Zullo AR, Hersey M, Lee Y
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
This study analyzed outcomes of using beta-blockers that are considered “diabetes-friendly” vs “diabetes-unfriendly” in older nursing home residents with diabetes after acute myocardial infarction (AMI). Primary outcomes included hospitalizations for hypoglycemia and hyperglycemia in the 90 days after AMI and secondary outcomes functional decline, death, all-cause re-hospitalization and fracture hospitalization. Out of 2855 nursing home residents with type-2 diabetes (T2D), 29% were prescribed a diabetes-friendly beta-blocker vs. 24% without. T2D medicine showed a reduction in hospitalization for hyperglycemia but was unassociated with hypoglycemia. For secondary outcomes T2D-friendly beta-blocks were associated with a greater rate of re-hospitalization but not death, functional decline, or fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Hersey M, Lee Y .
Outcomes of "diabetes-friendly" vs "diabetes-unfriendly" beta-blockers in older nursing home residents with diabetes after acute myocardial infarction.
Diabetes Obes Metab 2018 Dec;20(12):2724-32. doi: 10.1111/dom.13451..
Keywords: Cardiovascular Conditions, Diabetes, Elderly, Heart Disease and Health, Hospitalization, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research
Murray KS, Prunty M, Henderson A
Functional status in patients requiring nursing home stay after radical cystectomy.
The objective of this study was to evaluate the ability to perform activities of daily living (ADLs) in patients who required nursing home (NH) care after radical cystectomy (RC), as this surgery can impair patients' ability to perform ADLs in the post-operative period. The investigators found that ADLs, as measured by the Minimum Data Set (MDS)-ADL Long Form score, worsen after RC. They suggest this should be an important part of the risks and benefits conversation with patients, their families, and caregivers.
AHRQ-funded; HS022140.
Citation: Murray KS, Prunty M, Henderson A .
Functional status in patients requiring nursing home stay after radical cystectomy.
Urology 2018 Nov;121:39-43. doi: 10.1016/j.urology.2018.07.030..
Keywords: Cancer, Nursing Homes, Outcomes, Patient-Centered Outcomes Research
Li S, Middleton A, Ottenbacher KJ
Trajectories over the first year of long-term care nursing home residence.
This retrospective cohort study examined changes in situation for Medicare fee-for-service beneficiaries newly admitted to long-term nursing homes from July 2012 to December 2013 for the first year after admission. Data was used from the Minimum Data Set and Medicare Provider and Analysis Reviews claims data. Median length of stay in long-term care was 127 days, and for any institution 158 days. At 12 months post admission, 35% had died, 36.9% remained in long-term care, 23.4% were in the community, and 4.7% were in acute care hospitals or other institutions.
AHRQ-funded; HS022134.
Citation: Li S, Middleton A, Ottenbacher KJ .
Trajectories over the first year of long-term care nursing home residence.
J Am Med Dir Assoc 2018 Apr;19(4):333-41. doi: 10.1016/j.jamda.2017.09.021.
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Keywords: Long-Term Care, Nursing Homes, Elderly, Medicare, Patient-Centered Outcomes Research, Outcomes
Zullo AR, Zhang T, Beudoin FL
Pain treatments after hip fracture among older nursing home residents.
In this retrospective cohort study the investigators examined the association between use of opioids versus other analgesics with death and functioning after hip fracture in older nursing home (NH) residents. The investigators concluded that a rigorous study addressing the limitations of their study is critical to validate their preliminary findings and provide evidence about the effect of using opioid versus nonopioid analgesics to optimize acute pain in NH residents with a hip fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Beudoin FL .
Pain treatments after hip fracture among older nursing home residents.
J Am Med Dir Assoc 2018 Feb;19(2):174-76. doi: 10.1016/j.jamda.2017.11.008..
Keywords: Opioids, Pain, Nursing Homes, Long-Term Care, Elderly, Medication, Injuries and Wounds, Patient-Centered Outcomes Research, Healthcare Utilization
Steinman MA, Zullo AR, Lee Y
Association of β-blockers with functional outcomes, death, and rehospitalization in older nursing home residents after acute myocardial infarction.
The researchers studied the association of beta-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older. Use of beta-blockers after AMI was associated with functional decline in older nursing home residents with substantial cognitive or functional impairment, but not in those with relatively preserved mental and functional abilities.
AHRQ-funded; HS022998.
Citation: Steinman MA, Zullo AR, Lee Y .
Association of β-blockers with functional outcomes, death, and rehospitalization in older nursing home residents after acute myocardial infarction.
JAMA Intern Med 2017 Feb;177(2):254-62. doi: 10.1001/jamainternmed.2016.7701.
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Keywords: Nursing Homes, Patient-Centered Outcomes Research, Medication, Adverse Drug Events (ADE), Heart Disease and Health
Marra MV, Simmons SF, Shotwell MS
Elevated serum osmolality and total water deficit indicate impaired hydration status in residents of long-term care facilities regardless of low or high body mass index.
The researchers assessed hydration status and the adequacy of total water intake, and further determined relationships between hydration status, total water intake, and body mass index (BMI) in long-term care residents. They found that dehydration and inadequate total water intake is prevalent in long-term care residents across all BMI categories. They recommended that the type of liquid beverages, type of ONS, and type of between-meal snacks are factors that could be targeted for nutrition interventions designed to prevent or reverse dehydration.
AHRQ-funded; HS018580.
Citation: Marra MV, Simmons SF, Shotwell MS .
Elevated serum osmolality and total water deficit indicate impaired hydration status in residents of long-term care facilities regardless of low or high body mass index.
J Acad Nutr Diet 2016 May;116(5):828-36.e2. doi: 10.1016/j.jand.2015.12.011.
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Keywords: Elderly, Long-Term Care, Nursing Homes, Patient-Centered Outcomes Research
Lepore M, Leland NE
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
The authors examined nationwide facility-level nursing home data for the period 2007-2010. They found that increasing the proportion of Medicare-covered patient days in a nursing home was significantly associated with improvements in the quality of daily pain, pressure ulcers, and performing activities of daily living.
AHRQ-funded; HS022907.
Citation: Lepore M, Leland NE .
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
Health Aff 2015 Dec;34(12):2121-8. doi: 10.1377/hlthaff.2015.0303.
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Keywords: Long-Term Care, Medicare, Nursing Homes, Patient-Centered Outcomes Research, Quality Improvement
Beffa LR, Petroski GF, Kruse RL
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
The authors evaluated the effects of elective open AAA repair (OAR) and endovascular AAA repair (EVAR) and evaluated comorbidities for their impact on functional trajectories after discharge. They found that procedure type was not significantly related to postoperative function or to the subsequent rate of improvement. OAR and EVAR were associated with similar initial declines and comparable postoperative trajectories, suggesting that less invasive EVAR was not associated with improved functional preservation compared with OAR. Longer stays were associated with poorer functional trajectories.
AHRQ-funded; HS022140.
Citation: Beffa LR, Petroski GF, Kruse RL .
Functional status of nursing home residents before and after abdominal aortic aneurysm repair.
J Vasc Nurs 2015 Sep;33(3):106-11. doi: 10.1016/j.jvn.2015.02.003.
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Keywords: Adverse Events, Elderly, Nursing Homes, Patient-Centered Outcomes Research, Surgery
Grebla RC, Keohane L, Lee Y
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
The authors compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined for those no longer subject to the qualifying stay but increased among those still subject to it. The elimination of the three-day-stay requirement was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility.
AHRQ-funded; HS000011.
Citation: Grebla RC, Keohane L, Lee Y .
Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.
Health Aff 2015 Aug;34(8):1324-30. doi: 10.1377/hlthaff.2015.0054.
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Keywords: Elderly, Hospitalization, Long-Term Care, Nursing Homes, Patient-Centered Outcomes Research
Thomas KS, Rahman M, Mor V
Influence of hospital and nursing home quality on hospital readmissions.
The authors sought to determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. They found that patients discharged from higher-quality hospitals and patients who received care in higher-quality NHs were less likely to be rehospitalized within 30 days. They concluded that the passage of the Affordable Care Act changed the accountability of hospitals for patients' outcomes after discharge, and that their study highlights the joint accountability of hospitals and NHs for rehospitalization of patients.
AHRQ-funded; HS000011.
Citation: Thomas KS, Rahman M, Mor V .
Influence of hospital and nursing home quality on hospital readmissions.
Am J Manag Care 2014 Nov;20(11):e523-31.
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Keywords: Quality of Care, Hospitals, Nursing Homes, Patient-Centered Outcomes Research, Hospital Readmissions