National Healthcare Quality and Disparities Report
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- Adverse Events (5)
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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 17 of 17 Research Studies DisplayedRay M, Zhao S, Wang S
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
This study’s goal was to see if using hierarchical group lasso regularization (HGLR) improved hospital quality risk adjustment (RA) models. The authors analyzed patient discharge de-identified data from 14 State Inpatient Databases, AHRQ Healthcare Cost and Utilization Project, California Department of Health Care Access and Information, and New York State Department of Health. They used HGLR to identify first-order interactions in several AHRQ inpatient quality indicators (IQI) - IQI 09 (Pancreatic Resection Mortality Rate), IQI 11 (Abdominal Aortic Aneurysm Repair Mortality Rate), and Patient Safety Indicator 14 (Postoperative Wound Dehiscence Rate). These RA models were compared with stratum-specific and composite main effects models with covariates selected by least absolute shrinkage and selection operator (LASSO). HGLR identified clinical meaning interactions for all models, with model performance similar or superior for composite models with HGLR-selected features, compared to those with LASSO-selected features. HGLR was found to be scalable to handle a large number of covariates and their interactions and is customizable to use multiple CPU cores to reduce analysis time.
AHRQ-funded; 290201200003I.
Citation: Ray M, Zhao S, Wang S .
Improving hospital quality risk-adjustment models using interactions identified by hierarchical group lasso regularisation.
BMC Health Serv Res 2023 Dec 15; 23(1):1419. doi: 10.1186/s12913-023-10423-9..
Keywords: Quality of Care, Hospitals, Risk
Liao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
AHRQ-funded; HS027595.
Citation: Liao JM, Wang E, Isidro U .
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Bucholz EM, Toomey SL, McCulloch CE EM, Toomey SL, McCulloch CE
Adjusting for social risk factors in pediatric quality measures: adding to the evidence base.
The purpose of this study was to evaluate a method for incorporating social risk variables into a pediatric measure of utilization from the Pediatric Quality Measures Program (PQMP). The researchers utilized data from California Medicaid claims (2015-16) and Massachusetts All Payer Claims Database (2014-2015) to assess health plan performance using the Pediatric Asthma Emergency Department Use measure. The study found that of 133 health plans serving 404,649 pediatric patients with asthma, 7% to 13% changed performance categories after social risk adjustment. Health plans that shifted to higher performance categories cared for lower socioeconomic status (SES) patients, while those that shifted to lower performance categories cared for higher SES patients. The study concluded that adjustment for social risk factors shifted performance rankings on the PQMP Pediatric Asthma Emergency Department Use measure for a large number of health plans.
AHRQ-funded; HS025297; HS025299.
Citation: Bucholz EM, Toomey SL, McCulloch CE EM, Toomey SL, McCulloch CE .
Adjusting for social risk factors in pediatric quality measures: adding to the evidence base.
Acad Pediatr 2022 Apr;22(3s):S108-s14. doi: 10.1016/j.acap.2021.09.023..
Keywords: Children/Adolescents, Quality Measures, Quality of Care, Risk, Social Determinants of Health
Delaney LD, Howard R, Palazzolo K
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
The authors evaluated the feasibility of evidence-based patient optimization before surgery by implementing a low-cost preoperative optimization clinic. They found that a hernia optimization clinic safely improved management of high-risk patients and increased operative yield for the institution. They concluded that their results represented an opportunity to create sustainable and scalable models that provide longitudinal care and optimize patients to improve outcomes of hernia repair.
AHRQ-funded; HS025778.
Citation: Delaney LD, Howard R, Palazzolo K .
Outcomes of a presurgical optimization program for elective hernia repairs among high-risk patients.
JAMA Netw Open 2021 Nov;4(11):e2130016. doi: 10.1001/jamanetworkopen.2021.30016..
Keywords: Surgery, Risk, Evidence-Based Practice, Quality Improvement, Quality of Care, Outcomes
Wilson BL, Butler RJ
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. In this study the investigators examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing.
AHRQ-funded; HS024607.
Citation: Wilson BL, Butler RJ .
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Nurs Outlook 2021 Jan-Feb;69(1):84-95. doi: 10.1016/j.outlook.2020.07.003..
Keywords: Provider: Nurse, Provider, Workforce, Labor and Delivery, Pregnancy, Quality of Care, Risk, Women
Brajcich BC, Bentrem DJ, Yang AD
Short-term risk of performing concurrent procedures with hepatic artery infusion pump placement.
This study’s objective was to characterize the short-term outcomes of concurrent surgery with hepatic artery infusion pump (HAIP) placement using data from the 2005-2017 ACS NSQIP dataset. Findings showed that HAIP placement is not associated with additional morbidity when performed with hepatic and/or colorectal surgery. Decisions regarding HAIP placement should consider the risks of concurrent operations as well as patient- and disease-specific factors.
AHRQ-funded; HS026385.
Citation: Brajcich BC, Bentrem DJ, Yang AD .
Short-term risk of performing concurrent procedures with hepatic artery infusion pump placement.
Ann Surg Oncol 2020 Dec;27(13):5098-106. doi: 10.1245/s10434-020-08938-0..
Keywords: Quality Improvement, Quality of Care, Surgery, Risk, Cancer, Outcomes
Mangrum R, Stewart MD, Gifford DR
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
The goal of this study was to create a uniform definition of omission of care in US nursing homes. Lack of a uniform definition has made efforts to prevent them challenging. Subject matter experts and a broad range of nursing home stakeholders were brought together in iterative rounds of engagement to identify key concepts and aspects of omissions of care and develop a consensus-based definition. The concise definition decided on was: “Omissions of care in nursing homes encompass situations when care–either clinical or nonclinical–is not provided for a resident and results in additional monitoring or intervention or increases the risk of an undesirable or adverse physical, emotional, or psychosocial outcome for the resident."
AHRQ-funded; 233201500014I.
Citation: Mangrum R, Stewart MD, Gifford DR .
Omissions of care in nursing homes: a uniform definition for research and quality improvement.
J Am Med Dir Assoc 2020 Nov;21(11):1587-91.e2. doi: 10.1016/j.jamda.2020.08.016..
Keywords: Elderly, Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Medical Errors, Adverse Events, Patient Safety, Risk, Patient-Centered Outcomes Research
Griffey RT, Schneider RM, Todorov AA
The emergency department trigger tool: a novel approach to screening for quality and safety events.
The goal of this study was to develop an automated version of a previously developed emergency department (ED) trigger tool to track the likelihood of an adverse event. Thirty triggers were associated with risk of harm. The authors identified 1,726 records out of 76,894 ED visits with greater than or equal to 1 trigger. They compared the results of the automated tool to the previous version and found it performed well. They began with a broad set of candidate triggers and validated a computerized query that eliminates the need for manual screening of triggers and also identified a refined set of triggers associated with adverse events in the ED.
AHRQ-funded; HS025052.
Citation: Griffey RT, Schneider RM, Todorov AA .
The emergency department trigger tool: a novel approach to screening for quality and safety events.
Ann Emerg Med 2020 Aug;76(2):230-40. doi: 10.1016/j.annemergmed.2019.07.032..
Keywords: Emergency Department, Patient Safety, Adverse Events, Medical Errors, Quality of Care, Risk
De la Garza Ramos R, Gelfand Y, Benton JA
Rates, risk factors, and complications of red blood cell transfusion in metastatic spinal tumor surgery: an analysis of a prospective multicenter surgical database.
The goal of this study was to identify rates, risks, and complications of red blood cell (RBC) transfusion in metastatic spinal tumor surgery. The multicenter prospective American College of Surgeons National Quality Improvement Program database was used to identify adult patients with disseminated cancer who underwent metastatic spinal tumor surgery from 2012-2016. A patient was included if at least 1 intraoperative/postoperative RBC transfusion was received within the first 72 hours of surgery start time. Out of 1601 patients included, 623 (38.9%) received a RBC transfusion. There was an overall higher complication rate in patients who received a transfusion compared to those who didn’t. These complications included sepsis (3.5% vs. 1.9%), deep vein thrombosis (6.1% vs. 3.3%), and prolonged ventilation (3.9% vs. 1.3%). Future research into complication prevention was recommended.
https://www.pubmed.ncbi.nlm.nih.gov/32298819
Citation: De la Garza Ramos R, Gelfand Y, Benton JA .
Rates, risk factors, and complications of red blood cell transfusion in metastatic spinal tumor surgery: an analysis of a prospective multicenter surgical database.
World Neurosurg 2020 Jul;139:e308-e15. doi: 10.1016/j.wneu.2020.03.202..
Keywords: Quality Improvement, Quality of Care, Surgery, Risk, Cancer
Khaneki S, Bronsert MR, Henderson WG
Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.
The purpose of this study was to compare the accuracy of the Surgical Risk Preoperative Assessment System (SURPAS) to that of the American College of Surgeons Surgical Risk Calculator (ACS-SRC). Data from 1006 selected ACS National Surgical Quality Improvement Program (NSQIP) patients with known outcomes were used to calculate predicted risk of postoperative mortality and morbidity. Findings showed that the SURPAS risk predictions were more accurate than the ACS-SRC's for overall morbidity, particularly for high risk patients.
AHRQ-funded; HS024124.
Citation: Khaneki S, Bronsert MR, Henderson WG .
Comparison of accuracy of prediction of postoperative mortality and morbidity between a new, parsimonious risk calculator (SURPAS) and the ACS Surgical Risk Calculator.
Am J Surg 2020 Jun;219(6):1065-72. doi: 10.1016/j.amjsurg.2019.07.036..
Keywords: Surgery, Risk, Adverse Events, Quality Improvement, Quality of Care
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
Jones KJ, Skinner A, Venema D
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Researchers evaluated the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. They found that multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.
AHRQ-funded; HS024630; HS021429.
Citation: Jones KJ, Skinner A, Venema D .
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Health Serv Res 2019 Oct;54(5):994-1006. doi: 10.1111/1475-6773.13186..
Keywords: Falls, Hospitals, Inpatient Care, Quality of Care, Quality Improvement, Patient Safety, Prevention, Risk
Parchman ML, Anderson ML, Dorr DA
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Researchers conducted a randomized controlled trial to compare the effectiveness of adding various forms of enhanced external support to practice facilitation on primary care practices' clinical quality measure (CQM) performance. They concluded that, although they found no significant differences in CQM performance across study arms, the ability of a practice to reach a target level of performance may be enhanced by adding both educational outreach visits and shared learning to practice facilitation.
AHRQ-funded; HS023908.
Citation: Parchman ML, Anderson ML, Dorr DA .
A randomized trial of external practice support to improve cardiovascular risk factors in primary care.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S40-s49. doi: 10.1370/afm.2407..
Keywords: Cardiovascular Conditions, Primary Care, Quality Improvement, Provider Performance, Quality Measures, Quality of Care, Risk, Evidence-Based Practice, Patient-Centered Healthcare, Chronic Conditions
Nakamura MM, Toomey SL, Zaslavsky AM
Potential impact of initial clinical data on adjustment of pediatric readmission rates.
This study investigated whether the addition of adding initial clinical data to adjust for case-mix (differences in patient populations) improved prediction of pediatric readmissions. Thirty-day readmissions were examined using claims and electronic records for patients aged 18 and younger who were admitted to 3 children’s hospitals from February 2011 to February 2014. The Pediatric All-Condition Readmission Measure was used and started with a model including age, gender, chronic conditions, and primary diagnosis. Initial vital sign and laboratory data was added to see if it improved model performance. Greater readmission risk was found if there was a low red blood cell count and mean corpuscular hemoglobin concentration and high red cell distribution risk. However, it did not provide more than minimal improvement in performance.
AHRQ-funded; HS020513; HS025299.
Citation: Nakamura MM, Toomey SL, Zaslavsky AM .
Potential impact of initial clinical data on adjustment of pediatric readmission rates.
Acad Pediatr 2019 Jul;19(5):589-98. doi: 10.1016/j.acap.2018.09.006..
Keywords: Children/Adolescents, Hospital Readmissions, Risk, Quality Indicators (QIs), Quality Measures, Quality of Care
Horwitz LI, Bernheim SM, Ross JS
Hospital characteristics associated with risk-standardized readmission rates.
This national study using Medicare data examined the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR). Overall, larger, urban, academic facilities had modestly higher RSRRs than smaller, suburban, community hospitals, although there was a wide range of performance. The strong regional effect suggests that local practice patterns are an important influence.
AHRQ-funded; HS022882.
Citation: Horwitz LI, Bernheim SM, Ross JS .
Hospital characteristics associated with risk-standardized readmission rates.
Med Care 2017 May;55(5):528-34. doi: 10.1097/mlr.0000000000000713.
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Keywords: Hospitals, Hospital Readmissions, Medicaid, Risk, Quality of Care
Hernandez-Boussard TM, McDonald KM, Morrison DE
Risks of adverse events in colorectal patients: population-based study.
The authors sought to assess adverse events in colorectal surgical patients. They found important differential rates of adverse events by diagnostic category, with the highest odds ratio occurring in patients undergoing surgery for ischemic colitis.
AHRQ-funded; HS018558.
Citation: Hernandez-Boussard TM, McDonald KM, Morrison DE .
Risks of adverse events in colorectal patients: population-based study.
J Surg Res 2016 May 15;202(2):328-34. doi: 10.1016/j.jss.2016.01.013.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Events, Surgery, Patient Safety, Risk, Quality Indicators (QIs), Quality of Care, Quality Measures
Arkin N, Lee PH, McDonald K
Association of Nurse-to-Patient Ratio with mortality and preventable complications following aortic valve replacement.
The purpose of this study was to examine hospital resources associated with patient outcomes for aortic valve replacement (AVR), including inpatient adverse events and mortality. The investigators found that the hospital volume-outcomes relationship was associated with mortality outcomes but not postoperative complications. They identified structural differences in hospital size, nurses-to-patient ratio, and nursing skill level indicative of high quality outcomes.
AHRQ-funded; HS018558.
Citation: Arkin N, Lee PH, McDonald K .
Association of Nurse-to-Patient Ratio with mortality and preventable complications following aortic valve replacement.
J Card Surg 2014 Mar;29(2):141-8. doi: 10.1111/jocs.12284..
Keywords: Adverse Events, Cardiovascular Conditions, Quality of Care, Mortality, Risk