National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Events (13)
- Ambulatory Care and Surgery (3)
- Arthritis (4)
- Cancer: Breast Cancer (1)
- Cancer: Colorectal Cancer (1)
- Cancer: Prostate Cancer (1)
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- Centers for Education and Research on Therapeutics (CERTs) (1)
- Children/Adolescents (2)
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- Comparative Effectiveness (5)
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- Critical Care (2)
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- Healthcare-Associated Infections (HAIs) (10)
- Healthcare Cost and Utilization Project (HCUP) (4)
- Healthcare Costs (5)
- Healthcare Delivery (1)
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- Health Information Technology (HIT) (1)
- Health Insurance (3)
- Hospital Discharge (3)
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- Hospital Readmissions (1)
- Hospitals (3)
- Injuries and Wounds (6)
- Medicaid (1)
- Medical Errors (1)
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- Medication: Safety (1)
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- Neurological Disorders (1)
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- Provider Performance (2)
- Public Reporting (1)
- Quality Improvement (3)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (6)
- Registries (4)
- Risk (9)
- Sex Factors (1)
- Shared Decision Making (3)
- Substance Abuse (1)
- (-) Surgery (56)
- Teams (1)
- Telehealth (1)
- Tools & Toolkits (1)
- Transplantation (1)
- Treatments (3)
- Women (2)
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
26 to 50 of 56 Research Studies DisplayedAbdelsattar ZM, Krell RW, Campbell Jr DA
Differences in hospital performance for noncancer vs cancer colorectal surgery.
The researchers investigated the differences in hospital performance for noncancer and cancer colorectal resections at 52 Michigan hospitals. They found that hospital performance ranking in risk-adjusted outcomes (mortality, morbidity, length of stay) after noncancer colorectal resections does not correlate with performance for cancer-related colorectal resections.
AHRQ-funded; HS000053; HS20937
Citation: Abdelsattar ZM, Krell RW, Campbell Jr DA .
Differences in hospital performance for noncancer vs cancer colorectal surgery.
J Am Coll Surg. 2014 Sep;219(3):450-9. doi: 10.1016/j.jamcollsurg.2014.02.034..
Keywords: Outcomes, Surgery, Quality of Care
Vargas GM, Parmar AD, Sheffield KM
Impact of liver-directed therapy in colorectal cancer liver metastases.
This study evaluated the use of liver resection, ablation, and chemoembolization (LDT) in older patients presenting with metastatic colorectal cancer in the setting of improved chemotherapy. It found that many older patients deemed to be appropriate candidates for resection of the primary tumor and receipt of systemic chemotherapy did not receive LDT.
AHRQ-funded; HS022134
Citation: Vargas GM, Parmar AD, Sheffield KM .
Impact of liver-directed therapy in colorectal cancer liver metastases.
J Surg Res. 2014 Sep;191(1):42-50. doi: 10.1016/j.jss.2014.05.070..
Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Surgery
Agos F, Shoda C, Bransford D
Part II: managing perioperative hyperglycemia in total hip and knee replacement surgeries.
Perioperative hyperglycemia management is an important factor in reducing the risk of surgical site infections (SSIs) in all patients whether they have diabetes or not. This article describes the impact of an evidence-based practice standard for perioperative hyperglycemia management in the reduction of SSIs in patients having total hip and knee replacement surgery.
AHRQ-funded; HS017892
Citation: Agos F, Shoda C, Bransford D .
Part II: managing perioperative hyperglycemia in total hip and knee replacement surgeries.
Nurs Clin North Am. 2014 Sep;49(3):299-308. doi: 10.1016/j.cnur.2014.05.004..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Orthopedics, Injuries and Wounds
Aliu O, Auger KA, Sun GH
The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care.
Using the natural experiment of Medicaid expansion in New York (NY) State in October 2001, the study investigators examined whether Medicaid expansion increased access to common musculoskeletal procedures for Medicaid beneficiaries. They concluded that Medicaid expansion in NY State significantly improved access to common musculoskeletal procedures for Medicaid beneficiaries.
AHRQ-funded; HS020672.
Citation: Aliu O, Auger KA, Sun GH .
The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care.
Med Care 2014 Sep;52(9):790-5. doi: 10.1097/mlr.0000000000000175..
Keywords: Access to Care, Policy, Medicaid, Surgery
Huesch MD
The impact of short breaks from cardiac surgery on mortality and stay length in California.
In this small, exploratory study, the researchers sought to investigate potential surgical “forgetting” among cardiac surgeons taking a break from performing isolated coronary artery bypass graft (CABG) surgery in a large state-wide study in California. Patients operated on by surgeons who had not performed isolated CABG in the prior calendar month stayed in hospital 0.5 day longer.
AHRQ-funded; HS021868.
Citation: Huesch MD .
The impact of short breaks from cardiac surgery on mortality and stay length in California.
J Healthc Qual 2014 Sep-Oct;36(5):42-9. doi: 10.1111/jhq.12018..
Keywords: Surgery, Outcomes, Mortality, Risk
Hockenberry JM, Helmchen LA
The nature of surgeon human capital depreciation.
The authors estimated how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). They found that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points but reduced total hospitalization costs by up to 0.59 percentage points, and among emergent patients treated by high-volume providers, an additional day away raised mortality risk by 0.398 percentage points but reduced cost by up to 1.4 percentage points. They concluded that their results are consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications.
AHRQ-funded; HS019743.
Citation: Hockenberry JM, Helmchen LA .
The nature of surgeon human capital depreciation.
J Health Econ 2014 Sep;37:70-80. doi: 10.1016/j.jhealeco.2014.06.001.
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Keywords: Healthcare Costs, Mortality, Provider Performance, Surgery
Ellimoottil C, Miller S, Ayanian JZ
Effect of insurance expansion on utilization of inpatient surgery.
The researchers examined the differential effect of the Massachusetts insurance expansion on the use of discretionary vs. nondiscretionary surgical procedures. They found that discretionary surgery increased 9.3 percent while nondiscretionary surgery decreased by 4.5 percent. The greatest increase in discretionary surgery was observed for nonwhite participants.
AHRQ-funded; HS018346.
Citation: Ellimoottil C, Miller S, Ayanian JZ .
Effect of insurance expansion on utilization of inpatient surgery.
JAMA Surg. 2014 Aug;149(8):829-36. doi: 10.1001/jamasurg.2014.857..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Health Insurance, Healthcare Utilization
Antonescu I, Scott S, Tran TT
Measuring postoperative recovery: what are clinically meaningful differences?
This paper's objective was to generate minimal clinically important difference (MCID) estimates for three postoperative recovery metrics. On the data analyzed, MCIDs were consistently smaller for patients rating their health as "excellent" or "very good" compared with those for patients rating their health as "fair" or "poor." The authors provided MCIDs and ranges around each estimate and recommended that these values be considered when planning and interpreting abdominal surgery clinical trials where patient-reported outcomes are assessed.
AHRQ-funded; HS021857.
Citation: Antonescu I, Scott S, Tran TT .
Measuring postoperative recovery: what are clinically meaningful differences?
Surgery 2014 Aug;156(2):319-27. doi: 10.1016/j.surg.2014.03.005.
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Keywords: Outcomes, Surgery
Huang LC, Conley D, Lipsitz S
The Surgical Safety Checklist and teamwork coaching tools: a study of inter-rater reliability.
The authors assessed the inter-rater reliability (IRR) of two novel observation tools for measuring surgical safety checklist performance and teamwork. They found that both the Checklist Coaching Tool and the Surgical Teamwork Tool demonstrated substantial IRR and required limited training to use, indicating that both instruments may be used to observe checklist performance and teamwork in the operating room. They recommended that further refinement and calibration of observer expectations, particularly in rating teamwork, could improve the utility of the tools.
AHRQ-funded; HS019631.
Citation: Huang LC, Conley D, Lipsitz S .
The Surgical Safety Checklist and teamwork coaching tools: a study of inter-rater reliability.
BMJ Qual Saf 2014 Aug;23(8):639-50. doi: 10.1136/bmjqs-2013-002446.
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Keywords: Patient Safety, Surgery, Tools & Toolkits, Teams, Adverse Events, Medical Errors, Prevention
Drake FT, Mottey NE, Farrokhi ET
Time to appendectomy and risk of perforation in acute appendicitis.
This study sought to determine whether there is an association between time and perforation after acute appendicitis patients arrive at the hospital. Using data on 7,505 patients treated at 52 hospitals, they found that there was no association between perforation and in-hospital time prior to surgery among adults treated with appendectomy.
AHRQ-funded; SCOAP-CERTAIN
Citation: Drake FT, Mottey NE, Farrokhi ET .
Time to appendectomy and risk of perforation in acute appendicitis.
JAMA Surg. 2014 Aug;149(8):837-44. doi: 10.1001/jamasurg.2014.77..
Keywords: Surgery, Quality of Care, Patient Safety, Critical Care
Maggard-Gibbons M
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
This review summarized the history of American College of Surgeons National Surgical Quality Improvement Project and its components, and described the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety.
AHRQ-funded; 2902007100621.
Citation: Maggard-Gibbons M .
The use of report cards and outcome measurements to improve the safety of surgical care: the American College of Surgeons National Surgical Quality Improvement Program.
BMJ Qual Saf 2014 Jul;23(7):589-99. doi: 10.1136/bmjqs-2013-002223..
Keywords: Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Surgery, Patient Safety, Outcomes, Patient-Centered Outcomes Research, Provider Performance
Shih T, Zhang M, Kommareddi M
Center-level variation in infection rates after coronary artery bypass grafting.
This study was undertaken to compare observed and expected rates of healthcare-acquired infections (HAIs) across all 33 institutions performing isolated CABG surgery in the state of Michigan. Although predicted risk of HAI differed in absolute terms by 2.8 percent across centers, The study found that observed rates varied by 18.2 percent. Differences in observed rates of infections could not be fully explained by patient case mix.
AHRQ-funded; HS022535.
Citation: Shih T, Zhang M, Kommareddi M .
Center-level variation in infection rates after coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2014 Jul;7(4):567-73. doi: 10.1161/circoutcomes.113.000770..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Cardiovascular Conditions, Patient Safety
Nguyen C, Hernandez-Boussard T, Davies SM
Cleft palate surgery: an evaluation of length of stay, complications, and costs by hospital type.
The purpose of this study was to assess length of stay (LOS), complication rates, costs, and charges of cleft palate repair by various hospital types. Results showed that pediatric hospitals had higher comorbidities yet shorter LOS. Pediatric resources significantly decreased the relative rate of LOS greater than 2 days, and median costs and charges increased by 41% with LOS greater than 2 days.
AHRQ-funded; HS018558.
Citation: Nguyen C, Hernandez-Boussard T, Davies SM .
Cleft palate surgery: an evaluation of length of stay, complications, and costs by hospital type.
Cleft Palate Craniofac J 2014 Jul;51(4):412-9. doi: 10.1597/12-150.
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Keywords: Adverse Events, Children/Adolescents, Patient Safety, Children/Adolescents, Surgery
Dahlke AR, Merkow RP, Chung JW
Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients.
The objective of this paper was to compare three estimation models: (1) the All Information Model; (2) the Surgeon Assessment Model; and (3) the Patient-Entered Model. The investigators observed a small decline in model performance that they suggest may not be clinically meaningful. They concluded that the Surgeon Assessment and Patient-Entered models with fewer predictors can be used with relative confidence to predict a patient's risk.
AHRQ-funded; HS021857.
Citation: Dahlke AR, Merkow RP, Chung JW .
Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients.
Surgery 2014 Jul;156(1):39-45. doi: 10.1016/j.surg.2014.03.002.
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Keywords: Adverse Events, Shared Decision Making, Risk, Surgery
Martin BI, Franklin GM, Deyo RA
How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.
In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among injured workers, this study compared the use of complex fusion techniques, adverse outcomes within 3 months, and costs for California and Washington State with workers’ compensation policies that differed in their coverage restrictions. The researchers found that California’s broader coverage policy was associated with more aggressive practice, higher rates of reoperation, readmission and other complications.
AHRQ-funded; HS018405
Citation: Martin BI, Franklin GM, Deyo RA .
How do coverage policies influence practice patterns, safety, and cost of initial lumbar fusion surgery? A population-based comparison of workers' compensation systems.
Spine J. 2014 Jul;14(7):1237-46. doi: 10.1016/j.spinee.2013.08..
Keywords: Health Insurance, Surgery, Healthcare Costs, Healthcare Utilization
Daniels AH, Daiello LA, Lareau CR
Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients.
The authors conducted a study to evaluate the prevalence of cognitive impairment (CI) compared with normal cognition (NC) in elderly hip fracture patients 65 years and older. Results showed many patients had unrecognized CI before surgery and had significantly more pain and fear than the NC group.
AHRQ-funded; HS017735
Citation: Daniels AH, Daiello LA, Lareau CR .
Preoperative cognitive impairment and psychological distress in hospitalized elderly hip fracture patients.
Ame J Orthop. 2014 Jul; 43(7):E146-52..
Keywords: Elderly, Injuries and Wounds, Neurological Disorders, Surgery
Gadzinski AJ, Dimick JB, Ye Z
Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals.
This study evaluated discharge practice patterns and use of post-acute care after surgical admissions at critical access hospitals (CAHs). It found that for each of six common surgical procedures, a greater proportion of patients was transferred to another hospital. However, the proportion of patients at CAHs using post-acute care is equal to or less than that of patients treated in non-CAHs.
AHRQ-funded; HS018346
Citation: Gadzinski AJ, Dimick JB, Ye Z .
Transfer rates and use of post-acute care after surgery at critical access vs non-critical access hospitals.
JAMA Surg. 2014 Jul;149(7):671-7. doi: 10.1001/jamasurg.2013.5694..
Keywords: Surgery, Critical Care, Hospital Discharge, Quality of Care
Schweizer ML, Cullen JJ, Perencevich EN
Costs associated with surgical site infections in Veterans Affairs hospitals.
This study evaluated surgical site infections(SSIs) in 1,756 Veterans Administration patients to determine the excess costs associated with total, deep, and superficial SSIs. It found that the highest risk-adjusted costs occurred with deep SSIs and SSIs associated with neurosurgery patients.
AHRQ-funded; HS021992
Citation: Schweizer ML, Cullen JJ, Perencevich EN .
Costs associated with surgical site infections in Veterans Affairs hospitals.
JAMA Surg. 2014 Jun;149(6):575-581. doi:10.1001/jamasurg.2013.4663..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Healthcare Costs
Bilimoria KY, Cella D, Butt Z
Current challenges in using patient-reported outcomes for surgical care and performance measurement: everybody wants to hear from the patient, but are we ready to listen?
This viewpoint article discussed patient-reported outcomes (PROs). It concludes that PROs undoubtedly capture some of the most important aspects of how successful an operation is, and PRO scores may be the best measure of patient-centered care, but considerable logistical and methodological issues must be addressed before PROs are ready for widespread national implementation.
AHRQ-funded; HS021857.
Citation: Bilimoria KY, Cella D, Butt Z .
Current challenges in using patient-reported outcomes for surgical care and performance measurement: everybody wants to hear from the patient, but are we ready to listen?
JAMA Surg 2014 Jun;149(6):505-6. doi: 10.1001/jamasurg.2013.5285.
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Keywords: Patient-Centered Outcomes Research, Quality Measures, Surgery
Echenique IA, Cohen D, Rudow DL
Impact of repeat testing of living kidney donors within 14 days of the transplant procedure: a multicenter retrospective survey.
The researchers surveyed 15 living donor kidney and/or liver transplant programs in New York State to determine if the requirement for re-testing of the donor within 14 days of the transplant procedure would result in delays and cancelled transplants. They found that no cancellations occurred but 2 centers experienced delays.
AHRQ-funded; HS021060
Citation: Echenique IA, Cohen D, Rudow DL .
Impact of repeat testing of living kidney donors within 14 days of the transplant procedure: a multicenter retrospective survey.
Transpl Infect Dis. 2014 Jun;16(3):403-11. doi: 10.1111/tid.12219..
Keywords: Transplantation, Patient Safety, Surgery
Wu JM, Matthews CA, Conover MM
Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery.
Using current, population-based surgical rates from 2007 to 2011, the researchers estimated the lifetime risk of stress urinary incontinence surgery, pelvic organ prolapse surgery or both to be 20 percent by the age of 80.
AHRQ-funded; HS017950.
Citation: Wu JM, Matthews CA, Conover MM .
Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery.
Obstet Gynecol. 2014 Jun;123(6):1201-6. doi: 10.1097/AOG.0000000000000286..
Keywords: Risk, Surgery, Women
Dy CJ, Bozic KJ, Pan TJ
Risk factors for early revision after total hip arthroplasty.
In order to obtain a better understanding of the risk factors for early revision total hip arthroplasty (THA), the researchers used statewide databases to identify a total of 207,256 patients who underwent primary THA. They found a number of identifiable factors, including younger age, Medicaid, and low hospital volume increase the risk of undergoing early revision THA.
AHRQ-funded; HS016075
Citation: Dy CJ, Bozic KJ, Pan TJ .
Risk factors for early revision after total hip arthroplasty.
Arthritis Care Res. 2014 Jun;66(6):907-15. doi: 10.1002/acr.22240..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Risk
Cox CL, Huston LJ, Dunn WR
Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.
This study of 1,512 ACLR patients who were followed for 6 years found that both articular cartilage injury and meniscus tears/treatment at the time of ACLR were significant predictors of International Knee Documentation Center (IKDC) and Knee injury Osteoarthritis Outcome Score (KOOS) scores after ACLR. Having a grade 4 medial femoral condyle lesion significantly reduced a patient’s Marx activity level score at 6 years.
AHRQ-funded; HS016075
Citation: Cox CL, Huston LJ, Dunn WR .
Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.
Am J Sports Med. 2014 May;42(5):1058-67. doi: 10.1177/0363546514525910..
Keywords: Outcomes, Surgery, Risk
Martin BI, Lurie JD, Tosteson AN
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. The researchers found that their claims-based hierarchical coding algorithm of spine-related medical encounters correctly classified more than 90 percent of Medicare patients into their respective SPORT cohorts.
AHRQ-funded; HS018405
Citation: Martin BI, Lurie JD, Tosteson AN .
Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses.
Spine. 2014 Apr 20;39(9):769-79. doi: 10.1097/brs.0000000000000275..
Keywords: Comparative Effectiveness, Surgery, Outcomes, Medicare
Jones WS, Dolor RJ, Hasselblad V
Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia.
This systematic review found that there is no difference in clinical outcomes for patients with critical limb ischemia treated with endovascular or surgical revascularization. This review of 23 studies found no differences in overall death, amputation, or amputation-free survival at 2 or more years following treatment.
AHRQ-funded; 290200710066I
Citation: Jones WS, Dolor RJ, Hasselblad V .
Comparative effectiveness of endovascular and surgical revascularization for patients with peripheral artery disease and critical limb ischemia: systematic review of revascularization in critical limb ischemia.
Am Heart J. 2014 Apr;167(4):489-498.e7. doi: 10.1016/j.ahj.2013.12.012..
Keywords: Comparative Effectiveness, Outcomes, Surgery, Mortality