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
1101 to 1125 of 1160 Research Studies DisplayedAdmon AJ, Wunsch H, Iwashyna TJ
Hospital contributions to variability in the use of ICUs among elderly Medicare recipients.
Hospitals vary widely in ICU admission rates across numerous medical diagnoses. In This retrospective cohort study examined the extent to which variability in ICU use is specific to individual diagnoses or is a function of the hospital, regardless of disease. The authors concluded that hospitals account for a significant proportion of variation independent of measured patient and hospital characteristics, suggesting the need for further work to evaluate the causes of variation at the hospital level and potential consequences of variation across hospitals.
AHRQ-funded; HS020672.
Citation: Admon AJ, Wunsch H, Iwashyna TJ .
Hospital contributions to variability in the use of ICUs among elderly Medicare recipients.
Crit Care Med 2017 Jan;45(1):75-84. doi: 10.1097/CCM.0000000000002025..
Keywords: Elderly, Hospitalization, Hospitals, Intensive Care Unit (ICU), Medicare
Campione JR, Smith SA, Mardon RE
Hospital-level factors related to 30-day readmission rates.
This study investigates the relationship between inpatient quality of care as measured by the Agency for Healthcare Research and Quality (AHRQ) patient safety indicator (PSI) composite and all-cause, hospital-wide, 30-day readmission rates. It concluded that inpatient quality of care appears to have less influence on hospital readmission rates than do clinical and socioeconomic factors.
AHRQ-funded; 290201200003I.
Citation: Campione JR, Smith SA, Mardon RE .
Hospital-level factors related to 30-day readmission rates.
Am J Med Qual 2017 Jan/Feb;32(1):48-57. doi: 10.1177/1062860615612158.
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Keywords: Quality of Care, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Quality Indicators (QIs), Quality Measures
Lou I, Balentine C, Clarkson S
How long should we follow patients after apparently curative parathyroidectomy?
This study aimed to evaluate the risk of recurrent hyperparathyroidism in the 10 years after operation. It evaluated 196 patients with a 14.8 percent 10-year recurrence rate. It found that median time to recurrence was 6.3 years and 34.5 percent of all recurrences were identified more than 10 years after operation.
AHRQ-funded; HS023009.
Citation: Lou I, Balentine C, Clarkson S .
How long should we follow patients after apparently curative parathyroidectomy?
Surgery 2017 Jan;161(1):54-61. doi: 10.1016/j.surg.2016.05.049.
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Keywords: Care Management, Patient-Centered Outcomes Research, Surgery
Kang H, Wang F, Zhou S
Identifying and synchronizing health information technology (HIT) events from FDA medical device reports.
Health information technology (HIT) events, a subtype of patient safety events, pose a major threat and barrier toward a safer healthcare system. The study authors proposed a strategy to identify and synchronize HIT events from the FDA Manufacturer and User Facility Device Experience (MAUDE) database by using a filter based on structured features and classifiers based on unstructured features. The strategy will help develop and grow an HIT event-exclusive database, keeping pace with updates to MAUDE toward shared learning.
AHRQ-funded; HS022895.
Citation: Kang H, Wang F, Zhou S .
Identifying and synchronizing health information technology (HIT) events from FDA medical device reports.
Stud Health Technol Inform 2017;245:1048-52.
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Keywords: Adverse Events, Health Information Technology (HIT), Medical Devices, Health Information Technology (HIT), Patient Safety
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
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Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams
Ellimoottil C, Ryan AM, Hou H
Implications of the definition of an episode of care used in the comprehensive care for joint replacement model.
The researchers compared the Comprehensive Care for Joint Replacement (CJR) program's broad definition of an episode of care with a clinically narrow definition of an episode of care. The 90-day episode payments using the broad definition of the CJR model ranged from $17,349 to $29,465 (mean payment, $22,122). Episode payments were slightly lower (mean payment, $21,670) when the Hospital Compare definition was used.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H .
Implications of the definition of an episode of care used in the comprehensive care for joint replacement model.
JAMA Surg 2017 Jan;152(1):49-54. doi: 10.1001/jamasurg.2016.3098.
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Keywords: Surgery, Healthcare Costs, Medicare, Payment
Charles-Schoeman C, Yin Lee Y, Shahbazian A
Improvement of high-density lipoprotein function in patients with early rheumatoid arthritis treated with methotrexate monotherapy or combination therapies in a randomized controlled trial.
This study was undertaken to evaluate changes in HDL function and HDL-associated proteins over 2 years of follow-up in patients with early rheumatoid arthritis receiving either methotrexate (MTX) monotherapy, MTX + etanercept (ETN) combination therapy, or MTX + sulfasalazine (SSZ) + hydroxychloroquine (HCQ) triple therapy. It found that reduced disease activity in patients with any of the 3 therapies in the trial was associated with improvements in the HDL function profile.
AHRQ-funded; HS018517.
Citation: Charles-Schoeman C, Yin Lee Y, Shahbazian A .
Improvement of high-density lipoprotein function in patients with early rheumatoid arthritis treated with methotrexate monotherapy or combination therapies in a randomized controlled trial.
Arthritis Rheumatol 2017 Jan;69(1):46-57. doi: 10.1002/art.39833.
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Keywords: Arthritis, Medication, Comparative Effectiveness
Wilfley DE, Staiano AE, Altman M
Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment: conference key findings and next steps.
This conference sought ways to improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment and to expand payment for these services. Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team.
AHRQ-funded; HS022816.
Citation: Wilfley DE, Staiano AE, Altman M .
Improving Access and Systems of Care for Evidence-Based Childhood Obesity Treatment: conference key findings and next steps.
Obesity 2017 Jan;25(1):16-29. doi: 10.1002/oby.21712.
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Keywords: Obesity, Children/Adolescents, U.S. Preventive Services Task Force (USPSTF), Behavioral Health, Access to Care
Trautner BW, Greene MT, Krein SL
Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel.
This study assessed knowledge about infection prevention among nursing home personnel and identified gaps potentially addressable through a quality improvement collaborative. It found that, while 99.1 percent of licensed personnel recognized the definition of asymptomatic bacteriuria, only 36.1 percent knew that pyuria could not distinguish a urinary tract infection from asymptomatic bacteriuria.
AHRQ-funded; 290201000025I.
Citation: Trautner BW, Greene MT, Krein SL .
Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel.
Infect Control Hosp Epidemiol 2017 Jan;38(1):83-88. doi: 10.1017/ice.2016.228.
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Keywords: Antimicrobial Stewardship, Education: Continuing Medical Education, Healthcare-Associated Infections (HAIs), Nursing Homes, Prevention, Patient Safety
Gounder PP, Holman RC, Seeman SM
AHRQ Author: Steiner CA
Infectious disease hospitalizations among American Indian/Alaska native and non-American Indian/Alaska native persons in Alaska, 2010-2011.
The researchers used a merged state database to determine infectious disease (ID) hospitalization rates among American Indian/Alaska native (AI/AN) and non-American Indian/Alaska native persons in Alaska. They concluded that a substantial disparity in ID hospitalization rates exists between AI/AN and non-AI/AN persons, and the most common reason for ID hospitalization among AI/AN persons was lower respiratory tract infection.
AHRQ-authored.
Citation: Gounder PP, Holman RC, Seeman SM .
Infectious disease hospitalizations among American Indian/Alaska native and non-American Indian/Alaska native persons in Alaska, 2010-2011.
Public Health Rep 2017 Jan/Feb;132(1):65-75. doi: 10.1177/0033354916679807.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Hospitalization, Disparities, Racial and Ethnic Minorities
Zullo MD, Gathright EC, Dolansky MA
Influence of depression on utilization of cardiac rehabilitation postmyocardial infarction: A study of 158 991 Medicare beneficiaries.
The purpose of this study was to examine the association between depression diagnosis and participation in cardiac rehabilitation (CR) in a large sample of Medicare beneficiaries with recent myocardial infarction (MI). It concluded that diagnosis of depression in Medicare beneficiaries was strongly associated with attending CR and attending more sessions of CR compared with those without depression. Depression is not a barrier to CR participation after MI in Medicare beneficiaries.
AHRQ-funded; HS019795.
Citation: Zullo MD, Gathright EC, Dolansky MA .
Influence of depression on utilization of cardiac rehabilitation postmyocardial infarction: A study of 158 991 Medicare beneficiaries.
J Cardiopulm Rehabil Prev 2017 Jan;37(1):22-29. doi: 10.1097/hcr.0000000000000222.
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Keywords: Heart Disease and Health, Depression, Medicare, Patient Adherence/Compliance, Comparative Effectiveness
Tjia J, Lemay CA, Bonner A
Informed family member involvement to improve the quality of dementia care in nursing homes.
Researchers described the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40 percent of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process.
AHRQ-funded; HS019351.
Citation: Tjia J, Lemay CA, Bonner A .
Informed family member involvement to improve the quality of dementia care in nursing homes.
J Am Geriatr Soc 2017 Jan;65(1):59-65. doi: 10.1111/jgs.14299.
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Keywords: Shared Decision Making, Dementia, Medication, Nursing Homes, Patient and Family Engagement
Ford JH, 2nd, Oliver KA, Giles M
Maintenance of certification: how performance in practice changes improve tobacco cessation in addiction psychiatrists' practice.
This study reports on findings from a Maintenance of Certification (MOC) Performance in Practice (PIP) module designed and evaluated by addiction psychiatrists who are members of the American Academy of Addiction Psychiatry. It found that simple change projects designed to improve clinical practice led to substantial changes in self-reported chart documentation for the selected measure.
AHRQ-funded; HS021962.
Citation: Ford JH, 2nd, Oliver KA, Giles M .
Maintenance of certification: how performance in practice changes improve tobacco cessation in addiction psychiatrists' practice.
Am J Addict 2017 Jan;26(1):34-41. doi: 10.1111/ajad.12480.
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Keywords: Behavioral Health, Education: Continuing Medical Education, Provider: Health Personnel, Quality Improvement, Tobacco Use
Pierce R, Lessler J, Popoola VO
Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme.
The researchers measured the association between colonization pressure from decolonized and non-decolonized neonates and methicillin-resistant staphylococcus aureus (MRSA) and MRSA acquisition to inform use of this strategy for control of endemic MRSA. They concluded that untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission.
AHRQ-funded; HS022872.
Citation: Pierce R, Lessler J, Popoola VO .
Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme.
J Hosp Infect 2017 Jan;95(1):91-97. doi: 10.1016/j.jhin.2016.10.022.
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Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Neonatal Intensive Care Unit (NICU), Prevention, Newborns/Infants
Flory JH, Roy J, Gagne JJ
Missing laboratory results data in electronic health databases: implications for monitoring diabetes risk.
Researchers assessed the value of lab results added to diagnosis codes and dispensing claims to identify incident diabetes. Inclusion of lab results increased the number of diabetes outcomes identified by 21 percent. In settings where capture of lab results was relatively complete, the absence of lab results was associated with implausibly low rates of the outcome.
AHRQ-funded; HS023898.
Citation: Flory JH, Roy J, Gagne JJ .
Missing laboratory results data in electronic health databases: implications for monitoring diabetes risk.
J Comp Eff Res 2017 Jan;6(1):25-32. doi: 10.2217/cer-2016-0033.
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Keywords: Diabetes, Diagnostic Safety and Quality, Electronic Health Records (EHRs)
George EI, Ročková V, Rosenbaum PR
Mortality rate estimation and standardization for public reporting: Medicare’s Hospital Compare.
The authors calibrated Bayesian recommendation systems by checking, out of sample, whether predictions aggregate to give correct general advice derived from another sample. Their process leads to substantial revisions in the Hospital Compare model for acute myocardial infarction mortality. They found that indirect standardization, as currently used by Hospital Compare, fails to adequately control for differences in patient risk factors and systematically underestimates mortality rates at the low volume hospitals. They proposed direct standardization instead.
AHRQ-funded; HS021854.
Citation: George EI, Ročková V, Rosenbaum PR .
Mortality rate estimation and standardization for public reporting: Medicare’s Hospital Compare.
Journal of the American Statistical Association 2017;112(519):933-47. doi: 10.1080/01621459.2016.1276021.
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Keywords: Hospitals, Medicare, Mortality, Provider Performance
Decker SL, Lipton BJ
AHRQ Author: Decker SL, Lipton BJ
Most newly insured people in 2014 were long-term uninsured.
This study found that in 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.
AHRQ-authored.
Citation: Decker SL, Lipton BJ .
Most newly insured people in 2014 were long-term uninsured.
Health Aff 2017 Jan;36(1):16-20. doi: 10.1377/hlthaff.2016.0984.
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Keywords: Health Insurance, Uninsured, Medicaid, Policy
Leland NE, Fogelberg DJ, Halle AD
Occupational therapy and management of multiple chronic conditions in the context of health care reform.
One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. Occupational therapy is uniquely positioned to contribute to more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, the authors aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system.
AHRQ-funded; HS022907.
Citation: Leland NE, Fogelberg DJ, Halle AD .
Occupational therapy and management of multiple chronic conditions in the context of health care reform.
Am J Occup Ther 2017 Jan/Feb;71(1):7101090010p1-10p6. doi: 10.5014/ajot.2017.711001.
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Keywords: Chronic Conditions, Policy, Patient-Centered Outcomes Research, Primary Care
Makris UE, Edwards TC, Lavallee DC
Patient priority weighting of the Roland Morris Disability Questionnaire does not change results of the lumbar epidural steroid injections for spinal stenosis trial.
The researchers reevaluated whether outcomes for older adults receiving epidural steroid injections with or without corticosteroid improve after using patient-prioritized Roland-Morris Disability Questionnaire (RDQ) items. Their findings provide additional evidence that epidural injection of corticosteroid + lidocaine offered minimal or no short-term benefit as compared with epidural injection of lidocaine alone for older adults with lumbar spinal stenosis.
AHRQ-funded; HS019222; HS022418.
Citation: Makris UE, Edwards TC, Lavallee DC .
Patient priority weighting of the Roland Morris Disability Questionnaire does not change results of the lumbar epidural steroid injections for spinal stenosis trial.
Spine 2017 Jan;42(1):42-48. doi: 10.1097/brs.0000000000001647.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Back Health and Pain, Medication
Nabozny MJ, Kruser JM, Steffens NM
Patient-reported limitations to surgical buy-in: a qualitative study of patients facing high-risk surgery.
The researchers characterized how patients buy-in to treatments beyond the operating room and what limits they would place on additional life-supporting treatments. Their recordings of patients' pre- and post-operative conversations with surgeons showed that patients expressed trust in their surgeon to make decisions about additional treatments if a serious complication occurred. However, patients expressed a preference for significant treatment limitations that were not discussed with their surgeon preoperatively.
AHRQ-funded; HS000078.
Citation: Nabozny MJ, Kruser JM, Steffens NM .
Patient-reported limitations to surgical buy-in: a qualitative study of patients facing high-risk surgery.
Ann Surg 2017 Jan;265(1):97-102. doi: 10.1097/sla.0000000000001645.
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Keywords: Surgery, Palliative Care, Risk, Clinician-Patient Communication, Patient Safety
Stepanikova I, Oates GR
Perceived discrimination and privilege in health care: the role of socioeconomic status and race.
This study examined how perceived racial privilege and perceived racial discrimination in health care varied with race and socioeconomic status (SES). It found that in whites, higher income and education contributed to increased perceptions of privileged treatment and decreased perceptions of discrimination. The pattern was reversed in blacks, who reported more discrimination and less privilege at higher income and education levels.
AHRQ-funded; HS023009.
Citation: Stepanikova I, Oates GR .
Perceived discrimination and privilege in health care: the role of socioeconomic status and race.
Am J Prev Med 2017 Jan;52(1s1):S86-s94. doi: 10.1016/j.amepre.2016.09.024.
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Keywords: Disparities, Health Status, Racial and Ethnic Minorities, Social Determinants of Health
Doberne JW, Redd T, Lattin D
Perspectives and uses of the electronic health record among US pediatricians: a national survey.
This survey found that the electronic health record (EHR) was the most commonly used source of initial patient information. Seventy-two percent of 808 pediatricians participating reported requiring between 2 and 10 minutes to complete an initial review of the EHR. Several moderately severe information barriers were reported regarding the display of information in the EHR.
AHRQ-funded; HS022981.
Citation: Doberne JW, Redd T, Lattin D .
Perspectives and uses of the electronic health record among US pediatricians: a national survey.
J Ambul Care Manage 2017 Jan/Mar;40(1):59-68. doi: 10.1097/jac.0000000000000167.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Children/Adolescents, Practice Patterns
Scherr KA, Fagerlin A, Hofer T
Physician recommendations trump patient preferences in prostate cancer treatment decisions.
This study assessed the influence of patient preferences and urologist recommendations in treatment decisions for clinically localized prostate cancer. It found that patients' initial treatment preferences did not predict receipt of active treatment versus surveillance. Instead, receipt of active treatment was predicted primarily by urologists' recommendations.
AHRQ-funded; HS021764.
Citation: Scherr KA, Fagerlin A, Hofer T .
Physician recommendations trump patient preferences in prostate cancer treatment decisions.
Med Decis Making 2017 Jan;37(1):56-69. doi: 10.1177/0272989x16662841.
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Keywords: Cancer: Prostate Cancer, Shared Decision Making, Patient and Family Engagement, Patient-Centered Healthcare, Clinician-Patient Communication
Parchman ML, Von Korff M, Baldwin LM
Primary care clinic re-design for prescription opioid management.
The researchers describe a framework comprised of 6 Building Blocks to guide efforts within the primary care clinic setting to address the use of opioids for chronic pain. In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing chronic opioid therapy patients in primary care settings.
AHRQ-funded; HS023750.
Citation: Parchman ML, Von Korff M, Baldwin LM .
Primary care clinic re-design for prescription opioid management.
J Am Board Fam Med 2017 Jan-Feb;30(1):44-51. doi: 10.3122/jabfm.2017.01.160183.
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Keywords: Chronic Conditions, Opioids, Pain, Substance Abuse, Teams
Ward MM, Baloh J, Zhu X
Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals.
An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by AHRQ. The authors apply the Promoting Action on Research Implementation in Health Services (PARIHS) framework in studying its implementation to identify elements that are most closely related to successful implementation. The current findings provide support for the PARIHS framework.
AHRQ-funded; HS018396.
Citation: Ward MM, Baloh J, Zhu X .
Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals.
Health Care Manage Rev 2017 Jan/Mar;42(1):2-13. doi: 10.1097/hmr.0000000000000086.
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Keywords: Evidence-Based Practice, Hospitals, Rural Health, TeamSTEPPS, Implementation