National Healthcare Quality and Disparities Report
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Topics
- Anxiety (1)
- (-) Behavioral Health (18)
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- Chronic Conditions (4)
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- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Depression (4)
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- Quality Improvement (6)
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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 18 of 18 Research Studies DisplayedHoffman JA, Pergjika A, Liu L
Standardizing and improving care for pediatric agitation management in the emergency department.
In the U.S., pediatric mental health emergency department (ED) visits are increasing, with a greater number of visits involving the prescription of medication for acute agitation. Well timed, consistent application of behavioral strategies and medications may decrease the need for physical restraint of pediatric patients. The purpose of this study was to standardize agitation management in a pediatric ED and decrease pediatric patient time in physical restraints. From September 2020 to August 2021, researchers implemented a quality improvement initiative followed by a 6-month maintenance period. A barrier evaluation discovered that agitation triggers were not adequately recognized, there were few activities provided for children during lengthy ED visits, ED staff did not have confidence in techniques for verbally deescalating events, choices for medication were not consistent, and medication administered took time to take effect. Consecutive interventions included the development of a pathway and order set for agitation care, optimization of workflows for child life and psychiatry, implementation of personalized de-escalation plans, and adding the medication droperidol to the ED formulary. The measures utilize din the study included standardization of medication choice for severe agitation and time in physical restraints. The study found that during the intervention and maintenance components, there were 129 ED visits with medication administered for severe agitation and 10 ED visits where physical restraints were used. Among ED visits with medication given for severe agitation, there was an increase from 8% to 88% in standardized medication choice (olanzapine or droperidol), and a decrease in mean minutes in physical restraints from 173 to 71.
AHRQ-funded; HS026385.
Citation: Hoffman JA, Pergjika A, Liu L .
Standardizing and improving care for pediatric agitation management in the emergency department.
Pediatrics 2023 Jul 1; 152(1). doi: 10.1542/peds.2022-059586..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Improvement, Quality of Care
Richards JE, Yarborough BJH, Holden E
Implementation of suicide risk estimation analytics to support mental health care for quality improvement.
The purpose of this mixed-methods quality improvement study was to examine and describe the use of estimation analytics to enhance existing suicide prevention practices during routine mental health specialty engagements. The study found that during the 3.5 month observation period there were 4,789 patient engagements by 1939 patients. This included 161 engagements newly identified by suicide risk estimation analytics. The researchers reported that the engagement-based risk identifications did not consistently trigger additional suicide risk assessment as intended. During newly identified engagements: 57 patients reported frequent suicidal ideation and, as per preexisting workflow, 54 completed a Columbia-Suicide Severity Rating Scale (C-SSRS); 75 patients reported no or infrequent suicidal ideation, but only 10 completed a C-SSRS, per new workflow; 29 patients did not answer the Patient Health Questionnaire-9 (PHQ-9), and only 1 patient completed a C-SSRS, per new workflow. The providers interviewed (n = 8) reported important implementation concerns, including 1) lack of follow-up, 2) electronic health record- (EHR-) related inefficiencies, and 3) reliability and accuracy of the trigger. The patients interviewed (n = 20) repeated concerns about reliability and accuracy of estimation analytics. In addition, providers described concerns about access to care and potential liability associated with known suicide risk. Patients repeated the provider concerns about access and reported fears about identification of suicide risk resulting in coercive care. The researchers conclude that this unique quality improvement study underscores important implications for health care organizations considering implementation of estimation analytics to support engagement-based identification of suicide risk.
AHRQ-funded; HS026369.
Citation: Richards JE, Yarborough BJH, Holden E .
Implementation of suicide risk estimation analytics to support mental health care for quality improvement.
JAMA Netw Open 2022 Dec;5(12):e2247195. doi: 10.1001/jamanetworkopen.2022.47195..
Keywords: Behavioral Health, Quality Improvement, Quality of Care
Parast L, Burkhart Q, Bardach NS
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
The authors sought to develop and test a new quality measure assessing timeliness of follow-up mental health care for youth presenting to the emergency department (ED) with suicidal ideation or self-harm. Using Medicaid administrative data, they concluded that this new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, they recommended future work in order to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
AHRQ-funded; HS025291.
Citation: Parast L, Burkhart Q, Bardach NS .
Development and testing of an emergency department quality measure for pediatric suicidal ideation and self-harm.
Acad Pediatr 2022 Apr;22(3s):S92-s99. doi: 10.1016/j.acap.2021.03.005..
Keywords: Children/Adolescents, Emergency Department, Behavioral Health, Quality Measures, Quality Indicators (QIs), Quality of Care
Morden E, Byron S, Roth L
Health plans struggle to report on depression quality measures that require clinical data.
This study examined challenges and opportunities for reporting 5 HEDIS measures which used electronic clinical data to assess adolescent and perinatal depression care quality. Two learning collaboratives were convened with 10 health plans from 5 states. The authors conducted analysis of notes from collaborative meetings and individual calls with health plans to identify key challenges and strategies for reporting. The challenges most reported included: 1) lack of access to clinical data sources where the results of patient-reported tools were documented; 2) unavailability of the results of patient-reported tools in usable data fields; 3) lack of routine depression screening and ongoing assessment occurring in provider practices.
AHRQ-funded; HS025296.
Citation: Morden E, Byron S, Roth L .
Health plans struggle to report on depression quality measures that require clinical data.
Acad Pediatr 2022 Apr;22(3s):S133-s39. doi: 10.1016/j.acap.2021.09.022..
Keywords: Children/Adolescents, Depression, Behavioral Health, Quality Indicators (QIs), Quality Measures, Quality of Care
Swietek KE, Domino ME, Grove LR
Duration of medical home participation and quality of care for patients with chronic conditions.
The objective of this study was to examine whether the length of participation in a patient-centered medical home (PCMH), an evidence-based practice, led to higher quality care for Medicaid enrollees with multiple co-morbid chronic conditions and major depressive disorder (MDD). The investigators concluded that the PCMH model was associated with higher quality of care for patients with multiple chronic conditions and MDD over time, and these benefits increased the longer a patient was enrolled.
AHRQ-funded; HS000032; HS019659.
Citation: Swietek KE, Domino ME, Grove LR .
Duration of medical home participation and quality of care for patients with chronic conditions.
Health Serv Res 2021 Oct;56(Suppl 1):1069-79. doi: 10.1111/1475-6773.13710..
Keywords: Chronic Conditions, Patient-Centered Healthcare, Quality of Care, Evidence-Based Practice, Depression, Behavioral Health
Connell SK, Burkhart Q, Tolpadi A
Quality of care for youth hospitalized for suicidal ideation and self-harm.
The authors examined performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization. Subjects were patients aged 5 to 17 years hospitalized for suicidal ideation/self-harm. Their findings revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. They recommended providing caregivers lethal means restriction counseling prior to discharge in order to help prevent readmission.
AHRQ-funded; HS025291.
Citation: Connell SK, Burkhart Q, Tolpadi A .
Quality of care for youth hospitalized for suicidal ideation and self-harm.
Acad Pediatr 2021 Sep-Oct;21(7):1179-86. doi: 10.1016/j.acap.2021.05.019..
Keywords: Children/Adolescents, Behavioral Health, Inpatient Care, Quality Measures, Quality of Care
Anderson KE, Alexander GC, Niles L
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
Investigators sought to measure quality of non-opioid use disorder (OUD) preventive and chronic illness care and care coordination for individuals with OUD compared with individuals without OUD. They used deidentified data on outpatients throughout the United States from claims for commercially insured and Medicare Advantage enrollees aged 18 years or older with diagnosis codes for OUD. They found that individuals with OUD have moderately lower quality of care across preventive and chronic illness care and care coordination for non-OUD care compared with individuals without OUD. They recommended more attention to measurement and improvement of non-OUD care for these individuals.
AHRQ-funded; HS000029.
Citation: Anderson KE, Alexander GC, Niles L .
Quality of preventive and chronic illness care for insured adults with opioid use disorder.
JAMA Netw Open 2021 Apr;4(4):e214925. doi: 10.1001/jamanetworkopen.2021.4925..
Keywords: Opioids, Medication, Substance Abuse, Quality Indicators (QIs), Quality of Care, Behavioral Health, Chronic Conditions, Prevention
Liu FF, Lew A, Andes E
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
The objective of this study was to share key strategies that led to successful mental health screening (MHS) implementation in one pediatric cystic fibrosis center and to report implementation and screening outcomes. Results showed that leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.
AHRQ-funded; HS026393.
Citation: Liu FF, Lew A, Andes E .
Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: a quality improvement project.
Pediatr Pulmonol 2020 Dec;55(12):3328-36. doi: 10.1002/ppul.24951..
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Depression, Anxiety, Behavioral Health, Screening, Implementation, Quality Improvement, Quality of Care, Diagnostic Safety and Quality
Mueller KL, Naganathan S, Griffey RT
Counseling on Access to Lethal Means-Emergency Department (CALM-ED): a quality improvement program for firearm injury prevention.
The authors evaluated the feasibility of the Counseling on Access to Lethal Means intervention in the Emergency Department (CALM-ED) by non-physician personnel. Their quality improvement study was conducted in an urban, academic ED with over 90,000 annual patient visits, and considered adult patients who were discharged after presenting to the ED with a suicidal crisis. They found that an ED-based CALM quality-improvement intervention was feasible for implementation by non-physician personnel and was well received by patients and families. They concluded that the intervention has the potential to help saves lives at times of suicide crisis.
AHRQ-funded; HS025052.
Citation: Mueller KL, Naganathan S, Griffey RT .
Counseling on Access to Lethal Means-Emergency Department (CALM-ED): a quality improvement program for firearm injury prevention.
West J Emerg Med 2020 Aug 20;21(5):1123-30. doi: 10.5811/westjem.2020.5.46952.
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Keywords: Emergency Department, Injuries and Wounds, Prevention, Quality Improvement, Quality of Care, Domestic Violence, Behavioral Health
Coley RY, Boggs JM, Beck A
Defining success in measurement-based care for depression: a comparison of common metrics.
This study compared response and remission measures with effect size and severity-adjusted effect size (SAES) measures and examined the relationship between baseline symptom severity and treatment success for depression. Electronic records from two large integrated health systems were used to identify new psychotherapy episodes. Findings showed that response was preferable for comparing treatment outcomes, as it did not favor more or less baseline symptom severity, indicated clinically meaningful improvement, and was transparent and easy to calculate.
AHRQ-funded; HS026369.
Citation: Coley RY, Boggs JM, Beck A .
Defining success in measurement-based care for depression: a comparison of common metrics.
Psychiatr Serv 2020 Apr;71(4):312-18. doi: 10.1176/appi.ps.201900295..
Keywords: Depression, Behavioral Health, Patient-Centered Outcomes Research, Outcomes, Quality of Care, Quality Measures
Israel N, McMillen JC, Adams DR
Development of quality management capacity in child-serving nonprofit agencies.
In this study, the authors explored quality management capabilities and their development at nine different child serving agencies. Respondents described four emergent core quality management capabilities, although none of the nine agencies excelled at all four. The researchers discussed quality management capability and implications for research, policy, and practice.
AHRQ-funded; HS000084.
Citation: Israel N, McMillen JC, Adams DR .
Development of quality management capacity in child-serving nonprofit agencies.
Adm Policy Ment Health 2020 Jan;47(1):94-106. doi: 10.1007/s10488-019-00971-w..
Keywords: Children/Adolescents, Behavioral Health, Organizational Change, Quality Improvement, Quality of Care
Olin S, Storfer-Isser A, Morden E
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
This study examined the performance of health plans on two Healthcare Effectiveness Data and Information Set (HEDIS) measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. This study then identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggested that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
ARHQ-funded; HS020503; HS025296.
Citation: Olin S, Storfer-Isser A, Morden E .
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
Psychiatr Serv 2019 Nov;70(11):1020-26. doi: 10.1176/appi.ps.201900089..
Keywords: Children/Adolescents, Medication, Behavioral Health, Quality Measures, Quality of Care, Health Insurance
Terp S, Wang B, Burner E
Civil monetary penalties resulting from violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies, 2002 to 2018.
This study analyzed civil monetary penalties resulting from Emergency Medical and Treatment Act (EMTALA) violations involving psychiatric emergencies from 2002 to 2018. Psychiatric treatment settlements are larger with the average settlement being $85,488 compared to $32,004 for non-psychiatric-related cases. Five of six of the largest settlements during the study period were psychiatric-related. The penalties were for failure to provide appropriate medical screening examinations, receive stabilizing treatment, or arrange appropriate transfer. Almost half (41%) occurred in the Southeast Region and 20% in the Central region.
AHRQ-funded; HS022402; HS025281.
Citation: Terp S, Wang B, Burner E .
Civil monetary penalties resulting from violations of the Emergency Medical Treatment and Labor Act (EMTALA) involving psychiatric emergencies, 2002 to 2018.
Acad Emerg Med 2019 May;26(5):470-78. doi: 10.1111/acem.13710..
Keywords: Emergency Department, Medical Errors, Medical Liability, Behavioral Health, Quality of Care
Parast L, Bardach NS, Burkhart Q
Development of new quality measures for hospital-based care of suicidal youth.
This study researched the value of 4 new quality measures developed to assess hospital-based care for suicidal youth. The four quality measures focused on counseling caregivers about restricting access to lethal means of self-harm, and the benefits and risks of antidepressant medications. They were divided into measures for the emergency department (ED) and inpatient measures. Survey field tests were conducted with caregivers of youth who were admitted to the ED or inpatient care for suicidality at 1 of 2 children’s hospitals between July 2013 and June 2014. Most caregivers did receive counseling about restricting their child’s access to lethal means of self-harm and also reported higher rates of counseling of benefits on antidepressants both in the ED and in the inpatient setting than the risks.
AHRQ-funded; HS020506.
Citation: Parast L, Bardach NS, Burkhart Q .
Development of new quality measures for hospital-based care of suicidal youth.
Acad Pediatr 2018 Apr;18(3):248-55. doi: 10.1016/j.acap.2017.09.017..
Keywords: Caregiving, Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Education: Patient and Caregiver, Emergency Department, Hospitalization, Hospitals, Inpatient Care, Behavioral Health, Prevention, Quality of Care, Quality Measures
Joyce NR, Huskamp HA, Hadland SE
The alternative quality contract: impact on service use and spending for children with ADHD.
The authors used Blue Cross-Blue Shield of Massachusetts (BCBSMA) claims for 2006-2011 to compare youths enrolled in provider organizations participating in the alternative quality contract (AQC) with those not participating. They found that the AQC was associated with small increases in the probability of any outpatient visits and in the probability and number of medication management visits among children with attention-deficit hyperactivity disorder (ADHD). Further, spending did not change, and there was no evidence of reductions in service utilization or spending for children with ADHD in the first three years of AQC implementation.
AHRQ-funded; HS022998.
Citation: Joyce NR, Huskamp HA, Hadland SE .
The alternative quality contract: impact on service use and spending for children with ADHD.
Psychiatr Serv 2017 Dec;68(12):1210-12. doi: 10.1176/appi.ps.201700143.
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Keywords: Children/Adolescents, Behavioral Health, Payment, Quality of Care, Healthcare Costs
Forman-Hoffman VL, Middleton JC, McKeeman JL
Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review.
The researchers describe the process by which they created an online interactive community resources map for use in the Connect for Health randomized controlled trial. The trial was conducted in the 6 pediatric practices that cared for the highest percentage of children with overweight or obesity. Parents and community partners identified several community resources that could help support behavior change.
AHRQ-funded; 290201200008I.
Citation: Forman-Hoffman VL, Middleton JC, McKeeman JL .
Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review.
Implement Sci 2017 Jul 24;12(1):93. doi: 10.1186/s13012-017-0626-4.
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Keywords: Children/Adolescents, Communication, Behavioral Health, Quality of Care, Quality Improvement
Watkins KE, Smith B, Akincigil A
The quality of medication treatment for mental disorders in the department of Veterans Affairs and in private-sector plans.
The objective of this paper was to compare the quality of mental health care provided by the U.S. Department of Veterans Affairs (VA) with care provided to a comparable population treated in the private sector. The researchers found that VA performance was superior to that of the private sector by more than 30%. They concluded that their findings demonstrate the significant advantages that accrue from an organized, nationwide system of care and suggested that the much higher performance of the VA has important clinical and policy implications.
AHRQ-funded; HS003258; HS021112.
Citation: Watkins KE, Smith B, Akincigil A .
The quality of medication treatment for mental disorders in the department of Veterans Affairs and in private-sector plans.
Psychiatr Serv 2016 Apr;67(4):391-6. doi: 10.1176/appi.ps.201400537.
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Keywords: Quality of Care, Health Insurance, Medication, Behavioral Health
Minden SL, Ding L, Cleary PD
Improving the quality of mental health care in multiple sclerosis.
The researchers surveyed multiple sclerosis (MS) patients across the U.S. to determine how many experienced mental health problems and received treatment over the preceding year. Also studied were patient experiences with and ratings of care, type of treatment provider, and the location of care. The researchers found a high unmet need for mental health treatment among persons with MS.
AHRQ-funded; HS016978
Citation: Minden SL, Ding L, Cleary PD .
Improving the quality of mental health care in multiple sclerosis.
J Neurol Sci. 2013 Dec 15;335(1-2):42-7. doi: 10.1016/j.jns.2013.08.021..
Keywords: Behavioral Health, Quality of Care, Chronic Conditions