National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (4)
- Brain Injury (1)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (2)
- Dementia (1)
- Diagnostic Safety and Quality (1)
- Elderly (11)
- Emergency Department (2)
- Evidence-Based Practice (1)
- Eye Disease and Health (1)
- (-) Falls (18)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (3)
- Hospitals (2)
- Imaging (1)
- Injuries and Wounds (3)
- Medical Errors (1)
- Medication (2)
- Medication: Safety (2)
- Mortality (1)
- Neurological Disorders (2)
- Nursing Homes (3)
- Opioids (1)
- Outcomes (1)
- Pain (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (10)
- Prevention (3)
- Research Methodologies (1)
- Risk (5)
- Shared Decision Making (3)
- Trauma (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
1 to 18 of 18 Research Studies DisplayedLeland NE, Lekovitch C, Martínez J
Optimizing post-acute care patient safety: a scoping review of multifactorial fall prevention interventions for older adults.
The purpose of this scoping review was to describe the evidence for multifactorial post-acute care (PAC) fall prevention interventions for older patients. The researchers included 33 studies and characterized common intervention domains including: evaluating patient-specific fall risk factors, developing an individualized risk profile and treatment plan that targets each patient's fall risk factors, and implementing facility-based strategies such as staff education. There was not consensus across studies in how the domains were addressed and to what extent. The researchers concluded that health system efforts to prevent accidental falls in PAC should consider a patient-centered multifactorial approach.
AHRQ-funded; HS022907.
Citation: Leland NE, Lekovitch C, Martínez J .
Optimizing post-acute care patient safety: a scoping review of multifactorial fall prevention interventions for older adults.
J Appl Gerontol 2022 Oct;41(10):2187-96. doi: 10.1177/07334648221104375..
Keywords: Elderly, Falls, Prevention, Patient Safety, Evidence-Based Practice
Newgard CD, Lin A, Caughey AB
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
The purpose of this study was to assess the prognoses, healthcare use, transitions to skilled nursing or hospice, and mortality of older, community-living adults after a fall. The researchers conducted a secondary analysis of all adults in 7 Northwest U.S. counties greater than or equal to 65 years of age who had been transported to one of 51 hospitals after a fall. The study analyzed Medicare claims, state trauma registry data, state inpatient data, and death records for outcomes which included healthcare use, new claims for skilled nursing and hospice for one year, and mortality. The researchers found that in 3,159 older adults there were 147 deaths within 30 days and 665 deaths within one year, and the following predictors of mortality: respiratory diagnosis, serious brain injury, having a baseline disability, or a score of greater than or equal to 2 on the Charlson Comorbidity Index. The study concluded that in the year after experiencing a fall, community-living older adults who require ambulance transport to the hospital have increases in institutionalized living, the utilization of health care, and mortality.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Caughey AB .
Falls in older adults requiring emergency services: mortality, use of healthcare resources, and prognostication to one year.
West J Emerg Med 2022 May 14;23(3):375-85. doi: 10.5811/westjem.2021.11.54327..
Keywords: Elderly, Falls, Emergency Department, Mortality, Healthcare Utilization
Rice H, Garabedian PM, Shear K
Clinical decision support for fall prevention: defining end-user needs.
The purpose of this study was to identify patient and primary care staff needs for development of a tool that will generate clinical decision support (CDS) to prevent falls and injuries in older adults. Community-dwelling patients aged 60 and over and primary care clinic staff were eligible to participate in the study; all were affiliated with the University of Florida Health Archer Family Health Care primary care clinic and the Brigham & Women's Hospital-affiliated primary care clinics. Through qualitative interviews with patients (n=18) and primary care clinic staff (n=24) user needs were identified and then categorized into the following themes: evidence-based safe exercises; expert guidance; individualized resources; in-person assessment of patient condition; motivational tools; patient understanding of fall risk; personal support networks; systematic communication and workload burden. The study concluded that personalized, actionable, and evidence-based clinical decision support may be able to address some of the many gaps that exist in fall prevention management in older adults.
AHRQ-funded; HS027557.
Citation: Rice H, Garabedian PM, Shear K .
Clinical decision support for fall prevention: defining end-user needs.
Appl Clin Inform 2022 May;13(3):647-55. doi: 10.1055/s-0042-1750360..
Keywords: Elderly, Falls, Prevention, Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT)
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
AHRQ-funded; HS024558.
Citation: Jacobsohn GC, Leaf M, Liao F .
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Shared Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)
Chen C, Winterstein AG, Lo-Ciganic WH
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
This study compared the risk of fall-related injury in two cohorts who used gabapentinoids concurrently with opioid use and those who used opioids only. The authors created 2 cohorts based on whether concurrent users initiated gabapentinoids on the day of opioid initiation (Cohort 1) or after opioid initiation (Cohort 2). Both cohorts were identified from a sample of older Medicare beneficiaries with chronic non-cancer pain (CNCP). Four concurrent users were matched up with 1 opioid-only user. They identified 6,733 concurrent users and 27,092 matched opioid-only users in Cohort 1 and 5,709 concurrent users and 22,388 matched opioid-only users in Cohort 2. Cohort 1’s incidence rate of fall-related injury was 24.5 per 100 person-users during follow-up and was 18.0 per 100-person-years during follow-up for Cohort 2. Concurrent users had had similar risk of fall-related injury as opioid-only users in Cohort 1 but had higher risk for fall-related injury than opioid-only users in Cohort 2.
AHRQ-funded; HS027230.
Citation: Chen C, Winterstein AG, Lo-Ciganic WH .
Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.
PLoS Med 2022 Mar;19(3):e1003921. doi: 10.1371/journal.pmed.1003921..
Keywords: Elderly, Opioids, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Falls, Patient Safety, Injuries and Wounds, Pain, Chronic Conditions
Dykes PC, Khasnabish S, Burns Z
Development and validation of a fall prevention efficiency scale.
This study examined nurses’ perception of implementing the Fall TIPS (Tailoring Interventions for Patient Safety) tool, which is an evidence-based fall prevention program which was shown to reduce falls in hospitalized adults by 25%. The authors conducted a 3-phase mixed method study at 3 hospitals in Massachusetts and 3 in New York to assess nurses’ perceptions of burdens imposed on them by using Fall TIPS or other fall prevention programs. A 20-item prototype Fall Prevention Efficiency Scale was developed and administered to 383 clinical nurses. This scale was reduced to 13 items. The scale achieved excellent internal consistency values when examined with the test, validation, and paired (both test and retest) samples.
AHRQ-funded; HS025128.
Citation: Dykes PC, Khasnabish S, Burns Z .
Development and validation of a fall prevention efficiency scale.
J Patient Saf 2022 Mar 1;18(2):94-101. doi: 10.1097/pts.0000000000000811..
Keywords: Falls, Prevention, Patient Safety, Hospitals
Rhodes W, Olsho LE, Ward AS
AHRQ Author: Spector WD
https://link.springer.com/article/10.1007/s10742-015-0138-0
Use of Monte Carlo simulation to inform design decisions for pairwise cluster randomization.
This paper demonstrates the utility of the Monte Carlo approach in the context of a planned evaluation of an intervention to reduce falls among nursing home residents and provides recommendations for researchers on key design questions, including the choice between cluster randomization and pairwise cluster randomization, and selection of parametric or nonparametric estimators.
AHRQ-authored; AHRQ-funded; 290201000031I.
Citation: Rhodes W, Olsho LE, Ward AS .
Use of Monte Carlo simulation to inform design decisions for pairwise cluster randomization.
Health Serv Outcomes Res Method (2015) 15: 182-203. https://doi.org/10.1007/s10742-015-0138-0..
Keywords: Nursing Homes, Research Methodologies, Falls
Easter JS, Haukoos JS, Meehan WP
Will neuroimaging reveal a severe intracranial injury in this adult with minor head trauma?: The rational clinical examination systematic review.
The study objective was to assess systematically the accuracy of symptoms and signs in adults with minor head trauma in order to identify those with severe intracranial injuries. It found that combinations of history and physical examination features in clinical decision rules can identify patients with minor head trauma at low risk of severe intracranial injuries.
AHRQ-funded; HS017526.
Citation: Easter JS, Haukoos JS, Meehan WP .
Will neuroimaging reveal a severe intracranial injury in this adult with minor head trauma?: The rational clinical examination systematic review.
JAMA 2015 Dec 22-29;314(24):2672-81. doi: 10.1001/jama.2015.16316..
Keywords: Falls, Brain Injury, Imaging, Trauma, Diagnostic Safety and Quality
Hignett S, Wolf L, Taylor E
Firefighting to innovation: using human factors and ergonomics to tackle slip, trip, and fall risks in hospitals.
The aim of this study was to use a theoretical model (bench) for human factors and ergonomics (HFE) and a comparison with occupational slips, trips, and falls (STFs) risk management to discuss patient STF interventions (bedside). : Three case studies are used to discuss how HFE has been, or could be, applied to STF risk management.
AHRQ-funded; HS021824.
Citation: Hignett S, Wolf L, Taylor E .
Firefighting to innovation: using human factors and ergonomics to tackle slip, trip, and fall risks in hospitals.
Hum Factors 2015 Nov;57(7):1195-207. doi: 10.1177/0018720815593642.
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Keywords: Patient Safety, Risk, Falls, Hospitals
Leland NE, Gozalo P, Bynum J
What happens to patients when they fracture their hip during a skilled nursing facility stay?
This study characterized outcomes of patients experiencing a fall and subsequent hip fracture while in a nursing home receiving skilled nursing facility (SNF) services. In the first 90 days following hospitalization for surgical repair of the hip fracture, 24.1 percent of patients died, 7.3 percent were discharged to the community but remained fewer than 30 days, and 14.0 percent achieved successful community discharge.
AHRQ-funded; HS000011.
Citation: Leland NE, Gozalo P, Bynum J .
What happens to patients when they fracture their hip during a skilled nursing facility stay?
J Am Med Dir Assoc 2015 Sep;16(9):767-74. doi: 10.1016/j.jamda.2015.03.026..
Keywords: Nursing Homes, Falls, Injuries and Wounds, Outcomes
Callaghan B, Kerber K, Langa KM
Longitudinal patient-oriented outcomes in neuropathy: importance of early detection and falls.
This study evaluated longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis. It concluded that, in older persons, differences in falls, pain, and self-rated health can be detected 3–5 years prior to peripheral neuropathy diagnosis, but only falls deteriorate more rapidly over time in neuropathy cases compared to controls.
AHRQ-funded; HS017690; HS022258.
Citation: Callaghan B, Kerber K, Langa KM .
Longitudinal patient-oriented outcomes in neuropathy: importance of early detection and falls.
Neurology 2015 Jul 7;85(1):71-9. doi: 10.1212/wnl.0000000000001714..
Keywords: Patient-Centered Outcomes Research, Neurological Disorders, Falls, Elderly, Patient Safety
Reiter-Palmon R, Kennel V, Allen JA
Naturalistic decision making in after-action review meetings: the implementation of and learning from post-fall huddles.
In this study, the authors added to our understanding of Naturalistic Decision Making (NDM) in healthcare and how After Action Reviews (AARs) can be utilized as a learning tool to reduce errors. They found that the use of self-guided post-fall huddles increased over the time of the project, the types of errors identified as contributing to the patient fall changed, and the proportion of falls with less adverse effects increased during the project time period. They concluded that , over time, self-guided AARs can be useful for some aspects of learning from errors.
AHRQ-funded; HS021429.
Citation: Reiter-Palmon R, Kennel V, Allen JA .
Naturalistic decision making in after-action review meetings: the implementation of and learning from post-fall huddles.
J Occup Organ Psychol 2015 Jun;88(2):322-40. doi: 10.1111/joop.12084.
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Keywords: Adverse Events, Falls, Shared Decision Making, Medical Errors, Patient Safety
Su BY, Ho KC, Rantz MJ
Doppler radar fall activity detection using the wavelet transform.
The authors propose the use of Wavelet transform (WT) to detect human falls using a ceiling mounted Doppler range control radar. Evaluations based on the data collected in the lab, in the bathrooms, and in the senior residence apartment validate the promising and robust performance of the proposed WT fall activity detector.
AHRQ-funded; HS018477.
Citation: Su BY, Ho KC, Rantz MJ .
Doppler radar fall activity detection using the wavelet transform.
IEEE Trans Biomed Eng 2015 Mar;62(3):865-75. doi: 10.1109/tbme.2014.2367038..
Keywords: Falls, Patient Safety, Adverse Events
Steinman BA, Allen SM, Chen J
Functional limitations as potential mediators of the effects of self-reported vision status on fall risk of older adults.
The purpose of this study was to examine mediating effects of two indices of physical functioning (mobility and large-muscle functioning) on self-reported vision status, as it relates to falls in older adults. Limited evidence was found for a mediating effect among women; however, large-muscle groups were implicated as partially mediating risk factors for falls among men with fair self-reported vision status.
AHRQ-funded; HS000011.
Citation: Steinman BA, Allen SM, Chen J .
Functional limitations as potential mediators of the effects of self-reported vision status on fall risk of older adults.
J Aging Health 2015 Feb;27(1):158-76. doi: 10.1177/0898264314543473..
Keywords: Elderly, Falls, Eye Disease and Health, Risk
Stone E, Skubic M, Rantz M
Average in-home gait speed: investigation of a new metric for mobility and fall risk assessment of elders.
This study assessed how a new metric, average in-home gait speed (AIGS), measured using a low-cost, continuous, environmentally mounted monitoring system, compares to a set of traditional physical performance instruments used for mobility and fall risk assessment of elderly adults. It found that, using the ability of an instrument to predict how an individual would score on all the instruments as a metric, AIGS performs best, having better predictive ability than the traditional instruments.
AHRQ-funded; HS018477.
Citation: Stone E, Skubic M, Rantz M .
Average in-home gait speed: investigation of a new metric for mobility and fall risk assessment of elders.
Gait Posture 2015 Jan;41(1):57-62. doi: 10.1016/j.gaitpost.2014.08.019..
Keywords: Patient Safety, Falls, Elderly, Risk
Aspinall SL, Zhao X, Semia TP
Epidemiology of drug-disease interactions in older veteran nursing home residents.
The objective of this study was to assess the prevalence of and factors associated with potentially inappropriate drug– disease combinations according to the AGS 2012 Beers criteria that are clinically important in elderly adults residing in Veterans Affairs Community Living Centers. It found that drug-disease interactions were common in older residents with dementia or cognitive impairment or a history of falls or hip fracture.
AHRQ-funded; HS018721.
Citation: Aspinall SL, Zhao X, Semia TP .
Epidemiology of drug-disease interactions in older veteran nursing home residents.
J Am Geriatr Soc 2015 Jan;63(1):77-84. doi: 10.1111/jgs.13197..
Keywords: Adverse Drug Events (ADE), Adverse Events, Dementia, Elderly, Falls, Injuries and Wounds, Medication, Medication: Safety, Neurological Disorders, Nursing Homes, Patient Safety
Stone EE, Skubic M
Fall detection in homes of older adults using the Microsoft Kinect.
The researchers present a method for detecting falls in the homes of older adults using the Microsoft Kinect and a two-stage fall detection system. The method is compared against five state-of-the-art fall detection algorithms and significantly better results are achieved.
AHRQ-funded; HS018477.
Citation: Stone EE, Skubic M .
Fall detection in homes of older adults using the Microsoft Kinect.
IEEE J Biomed Health Inform 2015 Jan;19(1):290-301. doi: 10.1109/jbhi.2014.2312180..
Keywords: Patient Safety, Falls, Elderly, Health Information Technology (HIT)
Nilsagard Y, Gunn H, Freeman J
Falls in people with MS--an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States.
The objectives of this paper are to compile fall rates across a broad range of ages and disease severity and to definitively assess the extent to which multiple sclerosis (MS)-associated and demographic factors influence fall rates. It found that persons with MS are at high risk of falls and there are important associations between falls and MS-associated disability, gender and age.
AHRQ-funded; HS017582.
Citation: Nilsagard Y, Gunn H, Freeman J .
Falls in people with MS--an individual data meta-analysis from studies from Australia, Sweden, United Kingdom and the United States.
Mult Scler 2015 Jan;21(1):92-100. doi: 10.1177/1352458514538884..
Keywords: Falls, Risk, Elderly, Chronic Conditions