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
51 to 75 of 2768 Research Studies DisplayedSheetz KH, Ibrahim AM, Regenbogen SE
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
This population-based study examined whether surgeon experience with laparoscopy influenced payments for laparoscopy versus open surgery colectomies. The study used 182,852 national Medicare beneficiaries undergoing colectomies between 2010 and 2012. Surgeons with the most laparoscopic experience did experience an average payment savings of $5456 per patient in laparoscopic versus open cases. For surgeons in the lowest quartile of experience there was no difference.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Regenbogen SE .
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
Ann Surg 2018 Dec;268(6):1036-42. doi: 10.1097/sla.0000000000002312..
Keywords: Elderly, Surgery, Medicare, Healthcare Costs, Provider: Physician
Hornor MA, Liu JY, Hu QL
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
This evidence review uses enhanced recovery pathways (ERPs) protocols developed for the AHRQ-funded Safety Program for Improving Surgical Care and Recovery (ISCR Program) to develop ERPs for acute appendectomy surgery. The authors classified appendicitis into uncomplicated (nonperforated) and complicated (perforated or gangrenous) to help with risk stratification. They identified 13 components for appendectomy for review. The processes are organized by perioperative phase, and each phase includes the rationale, evidence review, summary of guidelines, and a recommendation summary of the evidence for or against inclusion in the ERP. Preoperative management components included: education and counseling; preoperative antibiotics; initial nonsurgical management for perforated appendicitis with abscess or phlegmon, venous thromboembolism prophylaxis, delay for operation for 12-24 hours for uncomplicated appendicitis. Intraoperative management components include: laparoscopic surgical technique, peritoneal drain placement, urinary catheter placement, and prophylactic nasogastric tube insertion. Postoperative management components include same-day surgery discharge for uncomplicated appendicitis, antibiotics, early oral alimentation, and early mobilization. Of the ERPs reviewed: there was no evidence to support the routine use of abdominal drainage in patients undergoing appendectomies, urinary catheter insertion for laparoscopic surgery, use of prophylactic nasogastric tube placement, postoperative antibiotic use for uncomplicated appendicitis, and early oral alimentation for uncomplicated appendicitis.
AHRQ-funded.
Citation: Hornor MA, Liu JY, Hu QL .
Surgical technical evidence review for acute appendectomy conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery.
J Am Coll Surg 2018 Dec;227(6):605-17.e2. doi: 10.1016/j.jamcollsurg.2018.09.024..
Keywords: Surgery, Quality Improvement, Quality of Care, Patient Safety, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Varda BK, Finkelstein JB, Wang HH
The association between continuous antibiotic prophylaxis and UTI from birth until initial postnatal imaging evaluation among newborns with antenatal hydronephrosis.
This study examined whether the routine use of continuous antibiotic prophylaxis (CAP) before initial postnatal imaging is effective to prevent urinary tract infection (UTI) in infants with a history of antenatal urinary tract dilation (AUTD). A single-institution, retrospective cohort study of infants with a history of AUTD was conducted. A random sample of 500 infants was selected with six excluded for other congenital anomalies. Of the 494 remaining, 157 (32%) received CAP. There was no difference found in UTI incidence among those treated with CAP and those who were not.
AHRQ-funded; HS000063.
Citation: Varda BK, Finkelstein JB, Wang HH .
The association between continuous antibiotic prophylaxis and UTI from birth until initial postnatal imaging evaluation among newborns with antenatal hydronephrosis.
J Pediatr Urol 2018 Dec;14(6):539.e1-39.e6. doi: 10.1016/j.jpurol.2018.04.022..
Keywords: Antibiotics, Antimicrobial Stewardship, Urinary Tract Infection (UTI), Newborns/Infants, Imaging, Medication, Prevention
Daniel VT, Ayturk D, Kiefe CI
The current State of the acute care surgery workforce: a boots on the ground perspective.
Acute care surgery (ACS) was proposed to address a general surgery workforce crisis; however, the ACS workforce composition is unknown. A national survey was conducted to determine the differences in the emergency general surgery (EGS) workforce between ACS and non-ACS hospitals. The investigators concluded that ACS and non-ACS hospitals differ in their surgical workforce. It is clear that ACS hospitals have more human capital, which suggests that ACS hospitals may require more dedicated resources compared to non-ACS hospitals.
AHRQ-funded; HS022694.
Citation: Daniel VT, Ayturk D, Kiefe CI .
The current State of the acute care surgery workforce: a boots on the ground perspective.
Am J Surg 2018 Dec;216(6):1076-81. doi: 10.1016/j.amjsurg.2018.08.023..
Keywords: Critical Care, Emergency Department, Hospitals, Workforce
Danilack VA, Brousseau EC, Phipps MG
The effect of gestational weight gain on persistent increase in body mass index in adolescents: a longitudinal study.
Weight retention after pregnancy is a concern for adolescents who may be entering adulthood at unhealthy weights. In this article, the investigators studied associations between each of three measures: pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and post-pregnancy BMI in a longitudinal follow-up of an adolescent pregnancy study cohort. They concluded that teens experienced an increase in BMI from pre-pregnancy to within 4 years after their first delivery, and this increase was related to GWG.
AHRQ-funded; HS025013.
Citation: Danilack VA, Brousseau EC, Phipps MG .
The effect of gestational weight gain on persistent increase in body mass index in adolescents: a longitudinal study.
J Womens Health 2018 Dec;27(12):1456-58. doi: 10.1089/jwh.2017.6635..
Keywords: Children/Adolescents, Pregnancy, Obesity: Weight Management, Obesity, Women
Cohen JFW, Gorski Findling MT, Rosenfeld L
The impact of 1 year of healthier school food policies on students' diets during and outside of the school day.
In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. The investigators concluded that with the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school.
AHRQ-funded; HS000055.
Citation: Cohen JFW, Gorski Findling MT, Rosenfeld L .
The impact of 1 year of healthier school food policies on students' diets during and outside of the school day.
J Acad Nutr Diet 2018 Dec;118(12):2296-301. doi: 10.1016/j.jand.2018.07.009..
Keywords: Children/Adolescents, Education, Nutrition, Policy
D'Agata EMC, Lindberg CC, Lindberg CM
The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities.
The purpose of this study was to quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing. Implementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The investigators found that within 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.
AHRQ-funded; HS021666.
Citation: D'Agata EMC, Lindberg CC, Lindberg CM .
The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1400-05. doi: 10.1017/ice.2018.237..
Keywords: Antibiotics, Antimicrobial Stewardship, Prevention, Medication, Medication
Blanco N, Johnson JK, Sorkin JD
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities.
The purpose of this study was to estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission. The investigators found that RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission.
AHRQ-funded; HS019979.
Citation: Blanco N, Johnson JK, Sorkin JD .
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1425-30. doi: 10.1017/ice.2018.247.
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Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Prevention, Provider, Provider: Health Personnel
Kranz AM, Dalton S, Damberg C
Using health IT to coordinate care and improve quality in safety-net clinics.
Health centers provide care to vulnerable and high-need populations. Recent investments have promoted use of health information technology (HIT) capabilities for improving care coordination and quality of care in health centers. This study examined factors associated with use of these HIT capabilities and the association between these capabilities and quality of care in a census of health centers in the United States.
AHRQ-funded; HS024067.
Citation: Kranz AM, Dalton S, Damberg C .
Using health IT to coordinate care and improve quality in safety-net clinics.
Jt Comm J Qual Patient Saf 2018 Dec;44(12):731-40. doi: 10.1016/j.jcjq.2018.03.006..
Keywords: Health Information Technology (HIT), Care Coordination, Patient-Centered Healthcare, Quality Improvement, Quality of Care, Vulnerable Populations, Care Management
Kelsall AC, Cassidy R, Ghaferi AA
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
The authors described hospital-level variation in roux-en-Y gastric bypass and sleeve gastrectomy in Michigan. Their findings suggested that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. The authors also suggested that sleeve gastrectomy may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and post-discharge payments.
AHRQ-funded; HS023621; HS024403.
Citation: Kelsall AC, Cassidy R, Ghaferi AA .
Variation in bariatric surgery episode costs in the commercially insured: implications for bundled payments in the private sector.
Ann Surg 2018 Dec;268(6):1014-18. doi: 10.1097/sla.0000000000002462..
Keywords: Surgery, Obesity: Weight Management, Obesity, Payment, Health Insurance, Healthcare Costs
Grossman LV, Mitchell EG, Hripcsak G
A method for harmonization of clinical abbreviation and acronym sense inventories.
Previous research has developed methods to construct acronym sense inventories from a single institutional corpus. Although beneficial, a sense inventory constructed from a single institutional corpus is not generalizable, because acronyms from different geographic regions and medical specialties vary greatly. The purpose of this study was to develop an automated method to harmonize sense inventories from different regions and specialties towards the development of a comprehensive inventory.
AHRQ-funded; HS021816.
Citation: Grossman LV, Mitchell EG, Hripcsak G .
A method for harmonization of clinical abbreviation and acronym sense inventories.
J Biomed Inform 2018 Dec;88:62-69. doi: 10.1016/j.jbi.2018.11.004..
Keywords: Health Information Technology (HIT)
Horwood CR, Moffatt-Bruce SD, Fitzgerald M
A qualitative analysis of clinical decompensation in the surgical patient: perceptions of nurses and physicians.
This study is a quantitative analysis of nurse and physician perception of clinical decompensation in postsurgical patients. The study aims to assess how nurses and physicians perceive early warning signs that predict clinical decompensation, changes in clinical acuity, and the need for escalation of care. Many areas showed strong agreement, but there were differences between nurses and physicians in primary indicators of patient stability. There were also differences in the methods and frequency used to monitor medically unstable patients.
AHRQ-funded; HS024379.
Citation: Horwood CR, Moffatt-Bruce SD, Fitzgerald M .
A qualitative analysis of clinical decompensation in the surgical patient: perceptions of nurses and physicians.
Surgery 2018 Dec;164(6):1311-15. doi: 10.1016/j.surg.2018.06.006..
Keywords: Adverse Events, Health Status, Provider: Clinician, Provider: Nurse, Provider: Physician, Surgery
Sampson UKA, McGlynn EA, Perlin JB
AHRQ Author: Arnold SB
Advancing the science of healthcare service delivery: the NHLBI Corporate Healthcare Leaders' Panel.
The National Heart, Lung, and Blood Institute convened a panel made up of leaders of corporate health care entities, including academic health centers, and government agency representatives to inform contemporary strategic partnerships with health care companies. This article provides insights from the meeting on how to execute a transformative innovation research agenda that will foster improvements in health care service delivery by leveraging the translation of biomedical research evidence in real-world settings.
AHRQ-authored.
Citation: Sampson UKA, McGlynn EA, Perlin JB .
Advancing the science of healthcare service delivery: the NHLBI Corporate Healthcare Leaders' Panel.
Glob Heart 2018 Dec;13(4):339-45. doi: 10.1016/j.gheart.2018.09.508..
Keywords: Cardiovascular Conditions, Healthcare Delivery
Vermandere M, Kuijpers T, Burgers JS
Alpha-Blockers for uncomplicated ureteric stones: a clinical practice guideline.
This paper develops an evidence-based recommendation for the use of alpha-blockers for treating uncomplicated ureteric stones. It is based on an up-to-date Cochran review and applies the Rapid Recommendations approach to guideline development. An international panel of clinicians, researchers, methodologists and patient representatives was created and a recommendation was created. There is only low-quality evidence for using alpha-blockers and the net benefit was found to be small.
AHRQ-funded; HS025701.
Citation: Vermandere M, Kuijpers T, Burgers JS .
Alpha-Blockers for uncomplicated ureteric stones: a clinical practice guideline.
BJU Int 2018 Dec;122(6):924-31. doi: 10.1111/bju.14457..
Keywords: Evidence-Based Practice, Guidelines, Medication
Neal JL, Lowe NK, Caughey AB
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
The aims of this study were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. The authors suggest that adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Caughey AB .
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
Birth 2018 Dec;45(4):358-67. doi: 10.1111/birt.12358..
Keywords: Labor and Delivery, Pregnancy, Women
Abu HO, Anatchkova MD, Erskine NA
Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization.
The objective of this qualitative study was to explore the factors that negatively/positively influence care transitions following an unplanned hospitalization from the perspective of healthcare providers. The study identified factors within and outside the discharging healthcare facility that influence care transitions and ultimately affect patient-centered outcomes and provider satisfaction with delivered care.
AHRQ-funded; HS022694.
Citation: Abu HO, Anatchkova MD, Erskine NA .
Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization.
Appl Nurs Res 2018 Dec;44:60-66. doi: 10.1016/j.apnr.2018.09.006..
Keywords: Hospital Discharge, Hospitalization, Transitions of Care, Clinician-Patient Communication
Burgermaster M, Murray M, Saiman L
Associations between enteral nutrition and acute respiratory infection among patients in New York metropolitan region pediatric long-term care facilities.
This study investigated the outcomes of children and a subsample of infants in pediatric long-term care facilities are need enteral nutrition (EN). Those patients who need EN had a higher risk of acute pediatric infection (ARI) and a lower odds of discharge than those who did not. Infants had a particular higher risk of comorbidities and infections when they were fed using percutaneous feeding tubes.
AHRQ-funded; HS021470.
Citation: Burgermaster M, Murray M, Saiman L .
Associations between enteral nutrition and acute respiratory infection among patients in New York metropolitan region pediatric long-term care facilities.
Nutr Clin Pract 2018 Dec;33(6):865-71. doi: 10.1002/ncp.10017..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Nutrition, Outcomes, Patient-Centered Outcomes Research, Patient Safety, Respiratory Conditions, Long-Term Care
Fink JT, Magnan EM, Johnson HM
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
In this observational population-based cohort study, the investigators sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. The investigators suggest that although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, they found that patients with obesity are even further behind in achieving blood pressure control.
AHRQ-funded; HS021899.
Citation: Fink JT, Magnan EM, Johnson HM .
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
High Blood Press Cardiovasc Prev 2018 Dec;25(4):391-99. doi: 10.1007/s40292-018-0284-x..
Keywords: Blood Pressure, Diabetes, Quality of Care, Obesity
Federman A, Sarzynski E, Brach C
AHRQ Author: Brach C
Challenges optimizing the after visit summary.
The purpose of this study was to describe experiences of health systems implementing a redesigned outpatient after visit summary (AVS) in commercially available electronic health record (EHR) systems to inform future optimization. The authors noted limitations to AVS modifications in EHR systems present challenges to optimizing the tool. They recommended that EHR vendors should incorporate learning from healthcare systems innovation efforts and consider building more flexibility into their product development.
AHRQ-authored; AHRQ-funded; HS023844.
Citation: Federman A, Sarzynski E, Brach C .
Challenges optimizing the after visit summary.
Int J Med Inform 2018 Dec;120:14-19. doi: 10.1016/j.ijmedinf.2018.09.009..
Keywords: Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), System Design
Mundkur ML, Franklin J, Huybrechts KF
Changes in outpatient use of antibiotics by adults in the United States, 2006-2015.
The two goals of this observational study were to describe general trends in outpatient antibiotic use among adults from 2006 to 2015, and to identify rapid shifts in use during this time period as potential indicators for key events. Patients aged 18 years and older were selected from the Optum Clinformatics Datamart, a commercial insurance claims database; linear regression was used to identify trends in use over multiple years, and change-point regression was used to identify rapid shifts in use within individual years. Outpatient use of antibiotics from 2006 to 2015 decreased substantially among adults. Rapid shifts in use occurring in 2008 and 2013 may reflect the presence of key drivers of change.
AHRQ-funded; HS024930; 233201500020I.
Citation: Mundkur ML, Franklin J, Huybrechts KF .
Changes in outpatient use of antibiotics by adults in the United States, 2006-2015.
Drug Saf 2018 Dec;41(12):1333-42. doi: 10.1007/s40264-018-0697-4..
Keywords: Antibiotics, Healthcare Utilization, Medication, Practice Patterns
Fredericksen RJ, Walcott M, Yang FM
Circumstances surrounding high-risk sexual experiences among primary care patients living with and without HIV.
In this study, the investigators interviewed primary care patients living with and without HIV, regarding circumstances surrounding sexual risk behavior, to identify opportunities for providers to address and reduce STI risk. The investigators found that circumstances surrounding perceived STI exposure risk were diverse, often overlapping, and dependent on internal, environmental, and partner-related factors and inadequate communication. They suggest that meaningful care-based interventions regarding HIV/STI transmission behavior must address the diversity and interplay of these factors.
AHRQ-funded; HS022242.
Citation: Fredericksen RJ, Walcott M, Yang FM .
Circumstances surrounding high-risk sexual experiences among primary care patients living with and without HIV.
J Gen Intern Med 2018 Dec;33(12):2163-70. doi: 10.1007/s11606-018-4675-4..
Keywords: Human Immunodeficiency Virus (HIV), Primary Care, Risk, Sexual Health
Bardossy AC, Williams T, Jones K
Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: the tale of two teaching hospitals.
This study compared 2 teaching hospitals’ intervention programs for preventing catheter-associated urinary tract infections (CAUTI). The comparisons were done in their adult intensive care units.
AHRQ-funded; 290201000025I; 29032001T.
Citation: Bardossy AC, Williams T, Jones K .
Culturing practices and the care of the urinary catheter in reducing NHSN-defined catheter-associated urinary tract infections: the tale of two teaching hospitals.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1494-96. doi: 10.1017/ice.2018.251..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Intensive Care Unit (ICU), Patient-Centered Outcomes Research, Patient Safety, Urinary Tract Infection (UTI)
Oates GR, Phillips JM, Bateman LB
Determinants of obesity in two urban communities: perceptions and community-driven solutions.
Using Photovoice methodology, this study aimed to identify community perceptions of factors associated with obesity in two urban municipalities - one racially mixed and one predominantly African American - and to explore community-driven solutions to the problem of obesity.
AHRQ-funded; HS023009.
Citation: Oates GR, Phillips JM, Bateman LB .
Determinants of obesity in two urban communities: perceptions and community-driven solutions.
Ethn Dis 2018 Winter;28(1):33-42. doi: 10.18865/ed.28.1.33..
Keywords: Obesity, Racial and Ethnic Minorities, Urban Health
Morrow AS, Whiteside SP, Sim LA
Developing tools to enhance the use of systematic reviews for clinical care in health systems.
The researchers’ goal was to develop tools to facilitate the uptake of evidence as summarized in systematic reviews by clinical decisionmakers in health systems. After they conducted a systematic review on the management of anxiety in children, the researchers interviewed health system representatives, clinicians and patients to gain additional information about decisionmaking. Two decision-aid tools - one for the health system and the other for the clinical encounter - were then developed using stakeholders' feedback and literature searches. The health system decision aid provided information on patients who were candidates for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, alternative therapies, remission rates, and prognosis. The encounter decision aid was produced as a set of cards that contained information on the issues that drive treatment decisions. Health system stakeholders found the first decision aid useful, and patients, parents, and clinicians found the second to be helpful.
AHRQ-funded; 290201500013I; 29032001T.
Citation: Morrow AS, Whiteside SP, Sim LA .
Developing tools to enhance the use of systematic reviews for clinical care in health systems.
BMJ Evid Based Med 2018 Dec;23(6):206-09. doi: 10.1136/bmjebm-2018-110995..
Keywords: Children/Adolescents, Shared Decision Making, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Medford-Davis LN, Singh H, Mahajan P
Diagnostic decision-making in the emergency department.
Emergency providers must often diagnose from undifferentiated symptoms, without previous knowledge of the patient. Failure to provide an accurate assessment of the problem or to communicate the problem to the patient is diagnostic error. This article considers methods to monitor diagnostic error in emergency departments.
AHRQ-funded; HS024953.
Citation: Medford-Davis LN, Singh H, Mahajan P .
Diagnostic decision-making in the emergency department.
Pediatr Clin North Am 2018 Dec;65(6):1097-105. doi: 10.1016/j.pcl.2018.07.003..
Keywords: Emergency Department, Diagnostic Safety and Quality, Shared Decision Making, Medical Errors, Patient Safety