National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (13)
- Antibiotics (5)
- Antimicrobial Stewardship (6)
- Cancer (2)
- Caregiving (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (5)
- Central Line-Associated Bloodstream Infections (CLABSI) (5)
- Children/Adolescents (3)
- Clostridium difficile Infections (6)
- Comparative Effectiveness (1)
- Comprehensive Unit-based Safety Program (CUSP) (1)
- Critical Care (3)
- Data (1)
- Diagnostic Safety and Quality (1)
- Education: Continuing Medical Education (1)
- Elderly (3)
- Electronic Health Records (EHRs) (2)
- Guidelines (1)
- (-) Healthcare-Associated Infections (HAIs) (46)
- Health Information Technology (HIT) (2)
- Hospitals (9)
- Injuries and Wounds (11)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (5)
- Long-Term Care (4)
- Medical Errors (1)
- Medicare (1)
- Medication (5)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (6)
- Neonatal Intensive Care Unit (NICU) (1)
- Newborns/Infants (2)
- Nursing (1)
- Nursing Homes (4)
- Outcomes (1)
- Patient-Centered Outcomes Research (3)
- Patient Safety (30)
- Pneumonia (2)
- Policy (1)
- Pressure Ulcers (1)
- Prevention (20)
- Provider Performance (3)
- Quality Improvement (3)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (4)
- Registries (1)
- Research Methodologies (1)
- Respiratory Conditions (1)
- Risk (7)
- Sepsis (1)
- Shared Decision Making (1)
- Surgery (11)
- Urinary Tract Infection (UTI) (1)
- Women (1)
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 46 of 46 Research Studies DisplayedCannon CM, Musuuza JS, Barker AK
Risk of Clostridium difficile infection in hematology-oncology patients colonized with toxigenic C. difficile.
This study determined that the prevalence of colonization with toxigenic Clostridium difficile among patients with hematological malignancies and/or bone marrow transplant at admission to a 566-bed academic medical care center was 9.3 percent. Thirteen percent of colonized patients developed symptomatic disease during hospitalization. This population may benefit from targeted C. difficile infection control interventions.
AHRQ-funded; HS024039; HS023791.
Citation: Cannon CM, Musuuza JS, Barker AK .
Risk of Clostridium difficile infection in hematology-oncology patients colonized with toxigenic C. difficile.
Infect Control Hosp Epidemiol 2017 Jun;38(6):718-20. doi: 10.1017/ice.2017.48.
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Keywords: Cancer, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety, Risk
Seidelman J, Dicks KV, Durkin MJ
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
The authors of this research brief designed a 2-phase study (1) to define the types of clostridium difficile infections (CDI) that clinicians consider unlikely preventable by inpatient antibiotic stewardship programs and (2) to estimate the relative proportion of inpatient CDI cases at a tertiary-care hospital that belongs to this category of “nonpreventable” CDI.
AHRQ-funded; HS023866.
Citation: Seidelman J, Dicks KV, Durkin MJ .
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
Infect Control Hosp Epidemiol 2017 Jun;38(6):747-49. doi: 10.1017/ice.2017.32..
Keywords: Antibiotics, Antimicrobial Stewardship, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Inpatient Care
Metersky ML, Klompas M, Eldridge N
Changes in rates of ventilator-associated pneumonia-reply.
In response to a critical letter, the authors comment that the discordance between ventilator-associated pneumonia (VAP) rates from the Medicare Patient Safety Monitoring System (MPSMS) vs the National Healthcare Safety Network (NHSN)is likely related to differences in data sources, as discussed in their report, including conscious or unconscious bias in VAP rates reported to the NHSN. It is unlikely to be related to differences in denominators or competing risks.
AHRQ-authored.
Citation: Metersky ML, Klompas M, Eldridge N .
Changes in rates of ventilator-associated pneumonia-reply.
JAMA 2017 Apr 18;317(15):1581-82. doi: 10.1001/jama.2017.2431.
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Keywords: Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Patient Safety, Respiratory Conditions
Obremskey WT, Schmidt AH, O'Toole RV
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
The POvIV study is a prospective, multicenter, randomized trial to compare oral (PO) with intravenous (IV) antibiotic therapy in patients with postoperative wound infections after extremity fractures. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
AHRQ-funded; HS000029.
Citation: Obremskey WT, Schmidt AH, O'Toole RV .
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S32-s38. doi: 10.1097/bot.0000000000000802.
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Keywords: Antibiotics, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Medication, Patient Safety, Adverse Events, Prevention, Patient-Centered Outcomes Research, Outcomes
Hu Z, Melton GB, Arsoniadis EG
Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record.
Proper handling of missing data is important for many secondary uses of electronic health record (EHR) data. Data imputation methods can be used to handle missing data, but their use for postoperative complication detection is unclear. Overall, models with missing data imputation almost always outperformed reference models without imputation that included only cases with complete data for detection of SSI overall achieving very good average area under the curve values.
AHRQ-funded; HS024532.
Citation: Hu Z, Melton GB, Arsoniadis EG .
Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record.
J Biomed Inform 2017 Apr;68:112-20. doi: 10.1016/j.jbi.2017.03.009.
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Keywords: Data, Electronic Health Records (EHRs), Healthcare-Associated Infections (HAIs), Registries, Surgery, Injuries and Wounds, Health Information Technology (HIT), Quality Improvement, Quality of Care, Adverse Events
O'Toole RV, Joshi M, Carlini AR
Supplemental perioperative oxygen to reduce surgical site infection after high-energy fracture surgery (OXYGEN study).
This study is a clinical trial with a primary goal of assessing the efficacy of 2 different concentrations of perioperative oxygen in the prevention of surgical site infection (SSI) in adults with tibial plateau, pilon (tibial plafond), or calcaneus fractures at higher risk of infection and definitively treated with plate and screw fixation.
AHRQ-funded; HS000029.
Citation: O'Toole RV, Joshi M, Carlini AR .
Supplemental perioperative oxygen to reduce surgical site infection after high-energy fracture surgery (OXYGEN study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S25-s31. doi: 10.1097/bot.0000000000000803.
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Keywords: Injuries and Wounds, Surgery, Healthcare-Associated Infections (HAIs), Prevention, Patient Safety, Adverse Events
Padula WV, Gibbons RD, Pronovost PJ
Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel cohort model.
Hospital-acquired pressure ulcers (HAPUs) have a mortality rate of 11.6 percent, are costly to treat, and result in Medicare reimbursement penalties. The study’s objective was to use electronic health records to predict pressure ulcers and to identify coding issues leading to penalties. Its analysis identified spinal cord injuries as high risk for HAPUs and as being often inappropriately coded without paralysis.
AHRQ-funded; HS023710.
Citation: Padula WV, Gibbons RD, Pronovost PJ .
Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel cohort model.
J Am Med Inform Assoc 2017 Apr 1;24(e1):e95-e102. doi: 10.1093/jamia/ocw118.
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Keywords: Pressure Ulcers, Healthcare-Associated Infections (HAIs), Electronic Health Records (EHRs), Health Information Technology (HIT)
Harris AD, Pineles L, Anderson D
Which comorbid conditions should we be analyzing as risk factors for healthcare-associated infections?
This study sought to determine which comorbid conditions are considered causally related to central-line associated bloodstream infection (CLABSI) and surgical-site infection (SSI) based on expert consensus. Its results have produced a list of comorbid conditions that should be analyzed as risk factors for and further explored for risk adjustment of CLABSI and SSI.
AHRQ-funded; HS022291.
Citation: Harris AD, Pineles L, Anderson D .
Which comorbid conditions should we be analyzing as risk factors for healthcare-associated infections?
Infect Control Hosp Epidemiol 2017 Apr;38(4):449-54. doi: 10.1017/ice.2016.314.
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Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety, Risk, Surgery
Cocoros NM, Priebe GP, Logan LK
A pediatric approach to ventilator-associated events surveillance.
The authors propose pediatric ventilator-associated conditions (VAC) for surveillance related to antimicrobial use, with pediatric possible ventilator-associated pneumonia (PVAP) as a subset of adult ventilator-associated conditions (AVAC). Studies on generalizability and responsiveness of these metrics to quality improvement initiatives are needed, as are studies to determine whether lower pediatric ventilator-associated event (VAE) rates are associated with improvements in other outcomes.
AHRQ-funded; HS021636.
Citation: Cocoros NM, Priebe GP, Logan LK .
A pediatric approach to ventilator-associated events surveillance.
Infect Control Hosp Epidemiol 2017 Mar;38(3):327-33. doi: 10.1017/ice.2016.277.
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Keywords: Adverse Events, Children/Adolescents, Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Quality Improvement
Deshpande A, Cadnum JL, Fertelli D
Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?
In a survey of 5 hospitals, the researchers found that floors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the floor. Contact with objects on floors frequently resulted in transfer of pathogens to hands.
AHRQ-funded; HS020004.
Citation: Deshpande A, Cadnum JL, Fertelli D .
Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?
Am J Infect Control 2017 Mar;45(3):336-38. doi: 10.1016/j.ajic.2016.11.005.
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Keywords: Hospitals, Healthcare-Associated Infections (HAIs), Clostridium difficile Infections, Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention, Patient Safety
Mody L, Greene MT, Saint S
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to catheter-associated urinary tract infection (CAUTI) prevention via a needs assessment questionnaire. Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.
AHRQ-funded; 290201000025I; HS019767; HS024385; HS018334.
Citation: Mody L, Greene MT, Saint S .
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Infect Control Hosp Epidemiol 2017 Mar;38(3):287-93. doi: 10.1017/ice.2016.279.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Long-Term Care, Nursing Homes, Prevention
Meddings J, Reichert H, Greene MT
Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives.
This study examined the association between hospital units' results for the Hospital Survey on Patient Safety Culture (HSOPS) and catheter-associated infection rates. It found no association between results of the HSOPS and catheter-associated infection rates when measured at baseline and postintervention in two successful large national collaboratives focused on prevention of central-line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI).
AHRQ-funded; 290201000025I; 29032001T; HS019767.
Citation: Meddings J, Reichert H, Greene MT .
Evaluation of the association between Hospital Survey on Patient Safety Culture (HSOPS) measures and catheter-associated infections: results of two national collaboratives.
BMJ Qual Saf 2017 Mar;26(3):226-35. doi: 10.1136/bmjqs-2015-005012.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Comprehensive Unit-based Safety Program (CUSP), Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Prevention
Anderson DJ, Chen LF, Weber DJ
Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study.
The researchers determined the effects of three enhanced strategies for terminal room disinfection (disinfection of a room between occupying patients) on acquisition and infection due to methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, C difficile, and multidrug-resistant Acinetobacter. They found that the incidence of target organisms among exposed patients was significantly lower after adding UV (quaternary ammonium disinfectant and disinfecting ultraviolet [UV-C]) light to standard cleaning strategies.
AHRQ-funded; HS023866.
Citation: Anderson DJ, Chen LF, Weber DJ .
Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study.
Lancet 2017 Feb 25;389(10071):805-14. doi: 10.1016/s0140-6736(16)31588-4.
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Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Hospitals, Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention, Patient Safety
Moehring RW, Anderson DJ, Cochran RL
Expert consensus on metrics to assess the impact of patient-level antimicrobial stewardship interventions in acute-care settings.
Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. Researchers used a modified Delphi approach to select relevant metrics for assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. On a 9-point Likert scale, six metrics were rated >6 in all criteria and fourteen metrics rated >6 in all criteria except feasibility.
AHRQ-funded; HS023866.
Citation: Moehring RW, Anderson DJ, Cochran RL .
Expert consensus on metrics to assess the impact of patient-level antimicrobial stewardship interventions in acute-care settings.
Clin Infect Dis 2017 Feb 1;64(3):377-83. doi: 10.1093/cid/ciw787.
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Keywords: Critical Care, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Bunnell KL, Zullo AR, Collins C
Methicillin-resistant staphylococcus aureus pneumonia in critically ill trauma and burn patients: a retrospective cohort study.
The authors sought to determine the incidence of MRSA pneumonia in early-onset and late-onset pneumonia and to identify risk factors for MRSA in the trauma-burn intensive care unit (ICU). They found that the 11.4% overall incidence of MRSA pneumonia in the studied trauma-burn cohort was similar to what has been reported in other trauma populations, although MRSA was equally likely to be identified in early- and late-onset pneumonia. They suggested that risk factors other than duration of hospitalization may be important considerations in the decision to initiate MRSA-active empiric therapy for pneumonia in the trauma-burn ICU.
AHRQ-funded; HS022998.
Citation: Bunnell KL, Zullo AR, Collins C .
Methicillin-resistant staphylococcus aureus pneumonia in critically ill trauma and burn patients: a retrospective cohort study.
Surg Infect 2017 Feb/Mar;18(2):196-201. doi: 10.1089/sur.2016.115.
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Keywords: Critical Care, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Intensive Care Unit (ICU), Methicillin-Resistant Staphylococcus aureus (MRSA)
Albrecht JS, Croft L, Morgan DJ
Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes.
This qualitative study explored current use and perceptions of glove and gown use in nursing homes. Analysis of recordings of three focus group discussions revealed that direct care staff reported using gowns and gloves primarily as self-protection against contact with bodily fluids, not to prevent MRSA transmission. Glove use was described as common and more acceptable to staff and residents than gown use.
AHRQ-funded; HS024560; HS022135.
Citation: Albrecht JS, Croft L, Morgan DJ .
Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes.
J Am Med Dir Assoc 2017 Feb;18(2):158-61. doi: 10.1016/j.jamda.2016.08.016.
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Keywords: Healthcare-Associated Infections (HAIs), Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Nursing Homes, Prevention, Patient Safety
Gans I, Jain A, Sirisreetreerux N
Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association.
This study found heterogeneity in the use of single- versus multiple-dose antibiotic prophylaxis for surgical repair of closed long bone fractures. Many surgeons were unsure of current evidence-based recommendations regarding perioperative antibiotic use. Most respondents indicated they would be receptive to high-level evidence regarding the single- versus multiple-dose perioperative prophylactic antibiotics for the treatment of closed long bone fractures.
AHRQ-funded; HS024547.
Citation: Gans I, Jain A, Sirisreetreerux N .
Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association.
Patient Saf Surg. 2017 Jan 16;11:2. doi: 10.1186/s13037-016-0118-5.
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Keywords: Injuries and Wounds, Healthcare-Associated Infections (HAIs), Medication, Prevention, Surgery
Musuuza JS, Roberts TJ, Carayon P
Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences.
The objective of this project was to describe the process of daily chlorhexidine gluconate (CHG) bathing and identify the barriers and facilitators that can influence its successful adoption and sustainability in an ICU of a Veterans Administration Hospital. Patient bathing in ICUs was largely influenced by scheduling/workload and patient factors such as clinical stability, hypersensitivity to CHG, patient refusal, presence of IV lines and general hygiene.
AHRQ-funded; HS024039.
Citation: Musuuza JS, Roberts TJ, Carayon P .
Assessing the sustainability of daily chlorhexidine bathing in the intensive care unit of a Veteran's Hospital by examining nurses' perspectives and experiences.
BMC Infect Dis 2017 Jan 14;17(1):75. doi: 10.1186/s12879-017-2180-8.
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Keywords: Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Prevention
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
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
Calderwood MS, Kleinman K, Huang SS
Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings.
The researchers evaluated the volume-outcome relationship as well as the year-to-year stability of performance rankings following coronary artery bypass graft (CABG) surgery and hip arthroplasty. They concluded that aggregate surgical site infection risk is highest in hospitals with low annual procedure volumes. Even for higher volume hospitals, year-to-year random variation makes past experience an unreliable estimator of current performance.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Kleinman K, Huang SS .
Surgical site infections: volume-outcome relationship and year-to-year stability of performance rankings.
Med Care 2017 Jan;55(1):79-85. doi: 10.1097/mlr.0000000000000620.
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Keywords: Surgery, Healthcare-Associated Infections (HAIs), Adverse Events, Injuries and Wounds, Hospitals, Provider Performance, Quality Indicators (QIs), Quality of Care, Patient Safety, Elderly