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
1 to 25 of 129 Research Studies DisplayedVenema DM, Skinner AM, Nailon R
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
Unassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals.
AHRQ-funded; HS021429.
Citation: Venema DM, Skinner AM, Nailon R .
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
BMC Geriatr 2019 Dec 11;19(1):348. doi: 10.1186/s12877-019-1368-8..
Keywords: Falls, Injuries and Wounds, Patient Safety, Elderly, Risk, Hospitals, Adverse Events
CE Kranz, AM DeYoreo, M
AHRQ Author: O'Hanlon
Access, quality, and financial performance of rural hospitals following health system affiliation.
This study examined the effect of a rural hospital affiliating itself with a health system. The comparison study used data from 2008 to 2017. A propensity score-weighted set of twelve measures were used on structure, utilization, financial performance, and quality. The rural hospitals that affiliated themselves with a health system experienced a significant reduction in on-site diagnostic imaging technologies, the availability of obstetric and primary care services, and outpatient nonemergency visits as well as a significant increase in operating margins. While these affiliations may help to keep a rural hospital open, it may also reduce access to services in these rural areas.
AHRQ-funded; HS024067.
Citation: CE Kranz, AM DeYoreo, M .
Access, quality, and financial performance of rural hospitals following health system affiliation.
Health Aff 2019 Dec;38(12):2095-104. doi: 10.1377/hlthaff.2019.00918..
Keywords: Provider Performance, Quality of Care, Hospitals, Rural Health
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
Williams CN, Eriksson CO, Kirby A
Hospital mortality and functional outcomes in pediatric neurocritical care.
Pediatric neurocritical care (PNCC) outcomes research is scarce. In this study, the investigators aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. The investigators concluded that PNCC patients had high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability were affected, underscoring the ongoing multidisciplinary health care needs of survivors.
AHRQ-funded; HS022981.
Citation: Williams CN, Eriksson CO, Kirby A .
Hospital mortality and functional outcomes in pediatric neurocritical care.
Hosp Pediatr 2019 Dec;9(12):958-66. doi: 10.1542/hpeds.2019-0173..
Keywords: Children/Adolescents, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Neurological Disorders, Mortality, Hospitals, Inpatient Care, Outcomes, Patient-Centered Outcomes Research
Saluja S, Hochman M, Bourgoin A
Primary care: the new frontier for reducing readmissions.
To date, efforts to reduce hospital readmissions have centered largely on hospitals. In a recently published environmental scan, the investigators examined the literature focusing on primary care-based efforts to reduce readmissions. They found that multi-component care transitions programs that are initiated early in the hospitalization and are part of broader primary care practice transformation appear most promising.
AHRQ-funded; 233201500019I.
Citation: Saluja S, Hochman M, Bourgoin A .
Primary care: the new frontier for reducing readmissions.
J Gen Intern Med 2019 Dec;34(12):2894-97. doi: 10.1007/s11606-019-05428-2.
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Keywords: Primary Care, Hospital Readmissions, Hospitals, Transitions of Care, Primary Care: Models of Care, Healthcare Delivery
Zachrison KS, Aaronson E, Mahmood S
Resource utilisation among patients transferred for intracerebral haemorrhage.
Patients with intracerebral haemorrhage (ICH) are frequently transferred between hospitals for higher level of care. The investigators aimed to identify factors associated with resource utilisation among patients with ICH admitted to a single academic hospital. They used a prospectively collected registry of consecutive patients with primary ICH at an urban academic hospital between 1 January 2005 and 31 December 2015.
hospital between 1 January 2005 and 31 December 2015.
AHRQ-funded; HS024561.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Aaronson E, Mahmood S .
Resource utilisation among patients transferred for intracerebral haemorrhage.
Stroke Vasc Neurol 2019 Dec;4(4):223-26. doi: 10.1136/svn-2019-000255..
Keywords: Stroke, Cardiovascular Conditions, Healthcare Utilization, Hospitals
Barbash IJ, Kahn JM
Sepsis quality in safety-net hospitals: an analysis of Medicare's SEP-1 performance measure.
Researchers studied the relationship between hospital safety-net status and performance on Medicare's SEP-1 quality measure. Data from 2827 hospitals were analyzed. They found that existing sepsis policies may harm safety-net hospitals and widen health disparities. They suggest that strategies to promote collaboration among hospitals may be an avenue for sepsis performance improvement in these hospitals.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Kahn JM .
Sepsis quality in safety-net hospitals: an analysis of Medicare's SEP-1 performance measure.
J Crit Care 2019 Dec;54:88-93. doi: 10.1016/j.jcrc.2019.08.009.
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Keywords: Sepsis, Quality Measures, Quality of Care, Hospitals, Provider Performance, Quality Improvement
Krein SL, Kuhn L, Ratz D
Use of designated nurse PICC teams and CLABSI prevention practices among U.S. hospitals: a survey-based study.
The authors identified the prevalence of and factors associated with having a designated nurse peripherally inserted central catheter (PICC) team among U.S. acute care hospitals. They found that nurse PICC teams inserted PICCs in more than 60% of U.S. hospitals during the study period. Moreover, certain practices to prevent central line-associated bloodstream infection, including maximum sterile barrier precautions, chlorhexidine gluconate for insertion site antisepsis, and facility-wide insertion checklists were regularly used by a higher percentage of hospitals with nurse PICC teams compared with those without. They concluded that nurse PICC teams play an integral role in PICC use at many hospitals and that use of such teams may promote key practices to prevent complications.
AHRQ-funded; HS022835.
Citation: Krein SL, Kuhn L, Ratz D .
Use of designated nurse PICC teams and CLABSI prevention practices among U.S. hospitals: a survey-based study.
J Patient Saf 2019 Dec;15(4):293-95. doi: 10.1097/pts.0000000000000246..
Keywords: Nursing, Teams, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Inpatient Care, Hospitals, Patient Safety, Prevention, Provider: Nurse, Provider
Germack HD, Kandrack R, Martsolf GR
When rural hospitals close, the physician workforce goes.
Researchers examined the relationship between rural hospital closures and the supply of physicians across different specialties in the years leading up to and after a closure. They observed significant annual reductions in the supply of general surgeons in the years leading up to a closure. They also found that rural hospital closures were associated with immediate and persistent decreases in the supply of surgical specialists and long-term decreases in the supply of physicians across multiple specialties. Because this decrease could lead to reduced access to care for rural residents, they recommended that future policy efforts focus on supporting and maintaining health care delivery models that do not depend on hospitals.
AHRQ-funded; HS000032.
Citation: Germack HD, Kandrack R, Martsolf GR .
When rural hospitals close, the physician workforce goes.
Health Aff 2019 Dec;38(12):2086-94. doi: 10.1377/hlthaff.2019.00916..
Keywords: Rural Health, Hospitals, Workforce, Provider: Physician, Provider
Kundi H, Strom JB, Valsdottir LR
Trends in isolated surgical aortic valve replacement according to hospital-based transcatheter aortic valve replacement volumes.
This research analyzed trends in isolated surgical aortic valve replacement (SAVR) procedures with the advent of the transcatheter aortic valve replacement (TAVR) procedure. Hospitalizations of adults from January 2011 through December 2014 was analyzed with data from the Medicare Provider Analysis and Review database using ICD-9 Revision-Clinical Modification procedure codes. The annual value of isolated SAVR went down as TAVR volumes increased which also decreased short- and long-term mortality over the study period.
AHRQ-funded; HS024520.
Citation: Kundi H, Strom JB, Valsdottir LR .
Trends in isolated surgical aortic valve replacement according to hospital-based transcatheter aortic valve replacement volumes.
JACC Cardiovasc Interv 2018 Nov 12;11(21):2148-56. doi: 10.1016/j.jcin.2018.07.002..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Hospitals
Sun EC, Mello MM, Moshfegh J
Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals.
This retrospective analysis used data from the Clinformatics Data Mart database (Optum) to examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals. The investigators found that out-of-network billing appeared to have become common for privately insured patients even when they soughttreatment at in-network hospitals. They indicated that the mean amounts billed appeared to be sufficiently large that they may create financial strain for a substantial proportion of patients.
AHRQ-funded; HS026128.
Citation: Sun EC, Mello MM, Moshfegh J .
Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals.
JAMA Intern Med 2019 Nov;179(11):1453-612. doi: 10.1001/jamainternmed.2019.3451..
Keywords: Health Insurance, Healthcare Costs, Payment, Hospitals, Emergency Department
Turner NA, Grambow SC, Woods CW
Epidemiologic trends in Clostridioides difficile infections in a regional community hospital network.
Clostridioides difficile infection (CDI) remains a leading cause of health care facility-associated infection. A greater understanding of the regional epidemiologic profile of CDI could inform targeted prevention strategies. The objectives of this study was to assess trends in incidence of health care facility-associated and community-acquired CDI among hospitalized patients over time and to conduct a subanalysis of trends in the NAP1 strain of CDI over time.
AHRQ-funded; HS023866.
Citation: Turner NA, Grambow SC, Woods CW .
Epidemiologic trends in Clostridioides difficile infections in a regional community hospital network.
JAMA Netw Open 2019 Oct 2;2(10):e1914149. doi: 10.1001/jamanetworkopen.2019.14149..
Keywords: Clostridium difficile Infections, Community-Acquired Infections, Infectious Diseases, Hospitals
Leary JC, Walsh KE, Morin RA
Quality and safety of pediatric inpatient care in community hospitals: a scoping review.
This study’s aim was to conduct a scoping review and synthesize literature on the quality and safety of pediatric inpatient care in nonpediatric hospitals in the United States. A systematic literature review was performed in October 2016 to identify pediatric studies that reported on safety, effectiveness, efficiency, timeliness, patient-centeredness, or equity set. A total of 44 articles were included using inclusion criteria. There was a moderate or high risk of bias for 72% of the studies. This study shows there is very limited research currently and would benefit from more multicenter collaborations.
AHRQ-funded; HS024133.
Citation: Leary JC, Walsh KE, Morin RA .
Quality and safety of pediatric inpatient care in community hospitals: a scoping review.
J Hosp Med 2019 Nov 1;14(10):694-703. doi: 10.12788/jhm.3268..
Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Children/Adolescents, Inpatient Care, Hospitals, Patient Safety, Quality of Care
Haldar S, Mishra SR, Kim Y
Use and impact of an online community for hospital patients.
This study examined the impact of a technology resembling an online health community for hospitalized patients to exchange advice and provide each other support during their hospitalization. It was deployed at 1 pediatric and 1 adult hospital. Thirty participants were recruited and were interviewed bedside and were observed how they used the technology, along with follow-up phone interviews. It was found to be helpful to patients and that most (64%) of the shared advice was positive in nature. They also reported positive impacts to their quality, safety, and hospital experience due to the inpatient peer support community.
AHRQ-funded; HS022894.
Citation: Haldar S, Mishra SR, Kim Y .
Use and impact of an online community for hospital patients.
J Am Med Inform Assoc 2020 Apr;27(4):549-57. doi: 10.1093/jamia/ocz212..
Keywords: Health Information Technology (HIT), Hospitals, Patient and Family Engagement, Patient Experience
Ellis RJ, Zhang LM, Ko CY
Variation in hospital utilization of minimally invasive distal pancreatectomy for localized pancreatic neoplasms.
The objectives of this study were to identify factors associated with use of minimally invasive distal pancreatectomy (MIDP) for localized neoplasms and to assess hospital variation in MIDP utilization. Results showed that utilization of MIDP for localized pancreatic neoplasms is highly variable; while some patient-level factors are associated with MIDP use, hospital adoption of MIDP appears to be the primary driver of utilization. Monitoring hospital-level use of MIDP may be a useful quality measure to monitor uptake of emerging techniques in pancreatic surgery.
AHRQ-funded; HS026385; HS000078.
Citation: Ellis RJ, Zhang LM, Ko CY .
Variation in hospital utilization of minimally invasive distal pancreatectomy for localized pancreatic neoplasms.
J Gastrointest Surg 2020 Dec;24(12):2780-88. doi: 10.1007/s11605-019-04414-7..
Keywords: Cancer, Surgery, Hospitals, Quality of Care
Stolldorf DP, Schnipper JL, Mixon AS
Organisational context of hospitals that participated in a multi-site mentored medication reconciliation quality improvement project (MARQUIS2): a cross-sectional observational study.
Medication reconciliation (MedRec) is an important patient safety strategy and is widespread in US hospitals and globally. Nevertheless, high quality MedRec has been difficult to implement. As part of a larger study investigating MedRec interventions, the investigators evaluated and compared organisational contextual factors and team cohesion by hospital characteristics and implementation team members' profession to better understand the environmental context and its correlates during a multi-site quality improvement (QI) initiative.
AHRQ-funded; HS025486.
Citation: Stolldorf DP, Schnipper JL, Mixon AS .
Organisational context of hospitals that participated in a multi-site mentored medication reconciliation quality improvement project (MARQUIS2): a cross-sectional observational study.
BMJ Open 2019 Nov 2;9(11):e030834. doi: 10.1136/bmjopen-2019-030834.
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Keywords: Medication, Quality Improvement, Hospitals, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Implementation
Sheetz KH, Chhabra KR, Smith ME
Association of discretionary hospital volume standards for high-risk cancer surgery with patient outcomes and access, 2005-2016.
Various clinical societies and patient advocacy organizations continue to encourage minimum volume standards at hospitals that perform certain high-risk operations. Although many clinicians and quality and safety experts believe this can improve outcomes, the extent to which hospitals have responded to these discretionary standards remains unclear. The purpose of this study was to evaluate the association between short-term clinical outcomes and hospitals' adherence to the Leapfrog Group's minimum volume standards for high-risk cancer surgery.
AHRQ-funded; HS000053; HS023597; HS024763.
Citation: Sheetz KH, Chhabra KR, Smith ME .
Association of discretionary hospital volume standards for high-risk cancer surgery with patient outcomes and access, 2005-2016.
JAMA Surg 2019 Nov;154(11):1005-12. doi: 10.1001/jamasurg.2019.3017..
Keywords: Patient Safety, Hospitals, Outcomes, Surgery, Cancer
McWilliams JM, Barnett ML, Roberts ET
Did hospital readmissions fall because per capita admission rates fell?
In this study examining the cause of falling hospital readmission rates, the investigators found that the probability of an admission occurring soon after another was lower when there were fewer admissions per patient. The authors indicate that the reduction in admission rates may explain much of the reduction in readmission rates.
AHRQ-funded; HS026727.
Citation: McWilliams JM, Barnett ML, Roberts ET .
Did hospital readmissions fall because per capita admission rates fell?
Health Aff 2019 Nov;38(11):1840-44. doi: 10.1377/hlthaff.2019.00411..
Keywords: Hospital Readmissions, Hospitals, Hospitalization, Quality of Care, Medicare
Sheetz KH, Dimick JB, Englesbe MJ
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
In 2013 the Centers for Medicare and Medicaid Services announced that it would begin levying penalties against hospitals with the highest rates of hospital-acquired conditions through the Hospital-Acquired Condition Reduction Program. This study evaluates whether the program has been successful in improving patient safety or not. The investigators concluded that the program did not improve patient safety in Michigan beyond existing trends.
AHRQ-funded; HS000053; HS026244.
Citation: Sheetz KH, Dimick JB, Englesbe MJ .
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
Health Aff 2019 Nov;38(11):1858-65. doi: 10.1377/hlthaff.2018.05504..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Provider Performance, Quality Improvement, Quality of Care, Infectious Diseases, Payment
Yarrington ME, Anderson DJ, Dodds Ashley E
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
This study’s objective was the quantify the effect of the 2016 FDA “black box” update on the use of fluoroquinolone antibiotics among a cohort of southeastern US hospitals. Fluoroquinolone was given a black box warning after many serious adverse events were reported. Antibiotic use data from 29 southeastern US hospitals over a 5-year period was analyzed. Fluoroquinolone use declined both and before after the FDA advisory update in 2016.
AHRQ-funded; HS023866.
Citation: Yarrington ME, Anderson DJ, Dodds Ashley E .
Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals.
Infect Control Hosp Epidemiol 2019 Nov;40(11):1297-300. doi: 10.1017/ice.2019.247..
Keywords: Antibiotics, Medication, Practice Patterns, Healthcare Utilization, Hospitals, Adverse Drug Events (ADE), Adverse Events
Keshvani N, Berger K, Gupta A
Improving respiratory rate accuracy in the hospital: a quality improvement initiative.
Researchers initiated a quality improvement (QI) initiative in hospitals to improve respiratory rate measurement accuracy. Time-keeping devices were added to vital sign carts and patient care assistants were retrained on a newly modified workflow that included concomitant respiratory rate (RR) measurement during automated blood pressure measurement. The median RR measurement rate increased postintervention. This intervention was associated with a 7.8% reduced incidence of tachypnea-specific systemic inflammatory response syndrome. This QI initiative was interdisciplinary, low-cost, and low-tech.
AHRQ-funded; HS022418.
Citation: Keshvani N, Berger K, Gupta A .
Improving respiratory rate accuracy in the hospital: a quality improvement initiative.
J Hosp Med 2019 Nov 1;14(10):673-77. doi: 10.12788/jhm.3232..
Keywords: Patient-Centered Outcomes Research, Quality Improvement, Inpatient Care, Diagnostic Safety and Quality, Hospitals, Quality of Care, Outcomes
Mueller S, Zheng J, Orav EJ
Inter-hospital transfer and patient outcomes: a retrospective cohort study.
Inter-hospital transfer (IHT, the transfer of patients between hospitals) occurs regularly and exposes patients to risks of discontinuity of care, though outcomes of transferred patients remains largely understudied. The purpose of this retrospective cohort study was to evaluate the association between IHT and healthcare utilisation and clinical outcomes. The investigators concluded that IHT was associated with higher costs, longer LOS and lower odds of discharge home, but was differentially associated with odds of early death and 30 -day mortality depending on patients' disease category.
AHRQ-funded; HS023331.
Citation: Mueller S, Zheng J, Orav EJ .
Inter-hospital transfer and patient outcomes: a retrospective cohort study.
BMJ Qual Saf 2019 Nov;28(11):e1. doi: 10.1136/bmjqs-2018-008087..
Keywords: Transitions of Care, Hospitals, Patient Safety, Elderly, Outcomes, Chronic Conditions, Mortality, Medicare
Law AC, Stevens JP, Walkey AJ
National trends in timing of death among patients with septic shock, 1994-2014.
Investigators sought to assess trends in the timing of mortality among patients with septic shock. Using HCUP data, they found that septic shock 48-hour, 3-14-day, and greater than 14-day mortality declined markedly over two decades; in contrast, patients with acute respiratory failure only experienced marked decreases in greater than 14-day in-hospital mortality rates.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Walkey AJ .
National trends in timing of death among patients with septic shock, 1994-2014.
Crit Care Med 2019 Nov;47(11):1493-96. doi: 10.1097/ccm.0000000000003956..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sepsis, Mortality, Hospitals
Lauerman MH, Herrera AV, Albrecht JS
Percentage of mortal encounters transferred in emergency general surgery.
The purpose of this study was to describe individual hospital transfer rates of mortal encounters. Using data from the Maryland Health Services Cost Review Commission database, results showed broad variability in individual hospital practices for mortality transferred to other institutions. Application of this knowledge of percentage of mortal encounters transferred includes consideration in hospital quality metrics.
AHRQ-funded; HS024560.
Citation: Lauerman MH, Herrera AV, Albrecht JS .
Percentage of mortal encounters transferred in emergency general surgery.
J Surg Res 2019 Nov;243:391-98. doi: 10.1016/j.jss.2019.05.040.
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Keywords: Emergency Department, Surgery, Mortality, Hospitals
Hsu HE, Wang R, Jentzsch MS
The impact of measurement changes on evaluating hospital performance: the case of catheter-associated urinary tract infections.
Researchers observed that catheter-associated urinary tract infections in 592 hospitals immediately declined after federal value-based incentive program implementation, but found that this was fully attributable to a concurrent surveillance case definition revision. They found that post revision, more hospitals had favorable standardized infection ratios, likely leading to artificial inflation of their performance scores unrelated to changes in patient safety.
AHRQ-funded; HS000063; HS025008; HS018414.
Citation: Hsu HE, Wang R, Jentzsch MS .
The impact of measurement changes on evaluating hospital performance: the case of catheter-associated urinary tract infections.
Infect Control Hosp Epidemiol 2019 Nov;40(11):1269-71. doi: 10.1017/ice.2019.240..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Provider Performance, Quality Measures, Urinary Tract Infection (UTI)