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
101 to 125 of 226 Research Studies DisplayedZhang T, Lary CW, Zullo AR
Post-hip fracture mortality in nursing home residents by obesity status.
This research letter discusses a study that examined whether obesity status affected mortality in post-hip fracture patients who were nursing home residents. A national cohort of nursing home (NH) residents was examined from national Medicare fee-for-service claims linked to the Minimum Data Set (MDS) from January 2008 through the end of 2009. A total of 33, 622 long-stay residents were identified who had been hospitalized for a hip fracture. They excluded 6918 patients due to a number of factors. They classified residents based on their BMI: normal BMI, overweight, mild obesity, or moderate/severe obesity. They found that being moderate/severely obese did not increase mortality.
AHRQ-funded; HS022998.
Citation: Zhang T, Lary CW, Zullo AR .
Post-hip fracture mortality in nursing home residents by obesity status.
J Am Geriatr Soc 2019 Sep;67(9):1983-85. doi: 10.1111/jgs.16028..
Keywords: Injuries and Wounds, Surgery, Nursing Homes, Obesity, Mortality, Elderly, Long-Term Care, Patient-Centered Outcomes Research
Libertucci J, Bassis CM, Cassone M
Bacteria detected in both urine and open wounds in nursing home residents: a pilot study.
Researchers sought to determine if bacterial species colonizing open wounds are also found in the urine. Their pilot study of nursing home residents provided evidence that bacterial species identified within the urine can also be identified in open wounds in the same patient at one point in time. They recommended further studies to investigate if these species are of the same lineage and if the urinary microbiota are able to seed colonization of open wounds below the umbilicus.
AHRQ-funded; HS019767.
Citation: Libertucci J, Bassis CM, Cassone M .
Bacteria detected in both urine and open wounds in nursing home residents: a pilot study.
mSphere 2019 Aug 28;4(4). doi: 10.1128/mSphere.00463-19..
Keywords: Elderly, Nursing Homes, Long-Term Care, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Patient Safety
Orth J, Li Y, Simning A
Providing behavioral health services in nursing homes is difficult: findings from a national survey.
This study evaluated access to behavioral health services in nursing homes (NHs). A random sample of 2996 NHs in the United States was identified. Two structured surveys were developed with questions on service availability, quality, satisfaction, staffing, staff education, turnover and service barriers. The surveys were mailed to administrators and directors of nursing in NHs between July and December 2017. The results showed that over 30% reported having inadequate coordination of care between NHs and community providers, and 26.2% had inadequate infrastructure for resident referrals or transport. Staff education was the most important factor associated with subpar provision of behavioral health services in nursing homes.
AHRQ-funded; HS024923.
Citation: Orth J, Li Y, Simning A .
Providing behavioral health services in nursing homes is difficult: findings from a national survey.
J Am Geriatr Soc 2019 Aug;67(8):1713-17. doi: 10.1111/jgs.16017..
Keywords: Elderly, Nursing Homes, Behavioral Health, Access to Care, Long-Term Care, Healthcare Delivery
Perraillon MC, Brauner DJ, Konetzka RT
Nursing home response to Nursing Home Compare: the provider perspective.
This paper examined the validity of quality ratings of nursing homes with Nursing Home Compare (NHC) and assessed the views of nursing home administrators and staff. There was a conflict found between improving ratings and competing goals of maximizing profits and avoidance of litigation. Since the NHC is self-reported there is controversy on its validity due to self-reporting bias.
AHRQ-funded; HS018718.
Citation: Perraillon MC, Brauner DJ, Konetzka RT .
Nursing home response to Nursing Home Compare: the provider perspective.
Med Care Res Rev 2019 Aug;76(4):425-43. doi: 10.1177/1077558717725165..
Keywords: Long-Term Care, Nursing Homes, Provider Performance, Quality of Care, Quality Improvement
Gorges RJ, Sanghavi P, Konetzka RT
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
The authors investigated the outcomes of expanding Medicaid funding for long-term care home and community-based services (HCBS). Using national Medicaid claims data on older adults enrolled in both Medicare and Medicaid, they found that overall hospitalization rates were similar for HCBS and nursing facility users. They concluded that home and community-based services need to be carefully targeted to avoid adverse outcomes and that the racial/ethnic disparities in access to high-quality institutional long-term care are also present in HCBS.
AHRQ-funded; HS000084.
Citation: Gorges RJ, Sanghavi P, Konetzka RT .
A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.
Health Aff 2019 Jul;38(7):1110-18. doi: 10.1377/hlthaff.2018.05409..
Keywords: Elderly, Medicaid, Medicare, Long-Term Care, Home Healthcare, Disparities, Racial and Ethnic Minorities
Tandan M, Sloane PD, Ward K
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
This study evaluated the impact of a two-year antimicrobial stewardship intervention program at 27 nursing homes. The objective was to identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures. All urine cultures were audited during the time period, and out of 6,718 total urine cultures collected, 68% were positive for potentially antimicrobial resistant bacteria. Most of the bacteria identified were E. coli, Proteus spp, and Klebsiella pneumonia. During the 2-year program there was a significant decrease in nitrofurantoin resistance among E. coli and ciprofloxacin resistant among Proteus spp, but carbanepem resistance increased for Proteus spp. Overall, while there was some reduction in antibiotic resistance, the reductions were too small and scattered to conclude the intervention made a big impact.
AHRQ-funded; HS022846.
Citation: Tandan M, Sloane PD, Ward K .
Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention.
Infect Control Hosp Epidemiol 2019 Jul;40(7):780-86. doi: 10.1017/ice.2019.108..
Keywords: Antibiotics, Antimicrobial Stewardship, Elderly, Long-Term Care, Medication, Nursing Homes
Coe NB, Guo J, Konetzka RT
AHRQ Author: Guo J
What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.
Research on home-based long-term care has centered almost solely on the costs; there has been very little, if any, attention paid to the relative benefits. This study exploited the randomization built into the Cash and Counseling Demonstration and Evaluation program that directly impacted the likelihood of having family involved in home care delivery. The investigators found that some family involvement in home-based care significantly decreased health-care utilization: lower likelihood of emergency room use, Medicaid-financed inpatient days, any Medicaid hospital expenditures, and fewer months with Medicaid-paid inpatient use.
AHRQ-authored.
Citation: Coe NB, Guo J, Konetzka RT .
What is the marginal benefit of payment-induced family care? Impact on Medicaid spending and health of care recipients.
Health Econ 2019 May;28(5):678-92. doi: 10.1002/hec.3873..
Keywords: Home Healthcare, Long-Term Care, Medicaid
Hass Z, Woodhouse M, Grabowski DC
Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.
This study evaluated the Minnesota Return to Community Initiative (RTCI) program which facilitates community discharge of non-Medicaid nursing home residents. It was implemented statewide without a control group. The program assists with discharge planning, transitioning to the community, and postdischarge follow-up. Results showed the program increased discharge rates by an estimated 11 percent. Success increased with time as nursing home facilities increased their participation.
AHRQ-funded; HS020224.
Citation: Hass Z, Woodhouse M, Grabowski DC .
Assessing the impact of Minnesota's return to community initiative for newly admitted nursing home residents.
Health Serv Res 2019 Jun;54(3):555-63. doi: 10.1111/1475-6773.13118..
Keywords: Care Coordination, Long-Term Care, Nursing Homes, Transitions of Care
Alexander GL, Powell K, Deroche CB
Building consensus toward a national nursing home information technology maturity model.
This study describes the development of a nursing home information technology (IT) maturity model in 2 phases. The first phase was to develop a preliminary maturity model. Phase II involved 3 rounds of questionnaires using a Delphi panel of expert nursing home administrators. Three Delphi rounds were done, and this evolved the model from 5-stages (stages 1-5) to a 7-stage model (stages 0-6).
AHRQ-funded; HS022497.
Citation: Alexander GL, Powell K, Deroche CB .
Building consensus toward a national nursing home information technology maturity model.
J Am Med Inform Assoc 2019 Jun;26(6):495-505. doi: 10.1093/jamia/ocz006..
Keywords: Health Information Technology (HIT), Long-Term Care, Nursing Homes
Fabius CD, Thomas KS
Examining black-white disparities among Medicare beneficiaries in assisted living settings in 2014.
The purpose of this study examined racial differences among a national cohort of assisted living (AL) residents and how the racial variation among AL Medicare Fee-For-Service (FFS) beneficiaries compared to differences among community-dwelling and nursing home cohorts. Using the Medicare Master Summary Beneficiary File, researchers found that black patients were disproportionately represented in AL, younger, more likely to be Medicaid eligible, had higher levels of acuity, and more often lived in ALs with fewer whites and more patients with dual eligibility. Further, new black residents entered AL with higher rates of acute care hospitalizations and skilled nursing facility utilization. Further research is recommended.
AHRQ-funded; HS000011.
Citation: Fabius CD, Thomas KS .
Examining black-white disparities among Medicare beneficiaries in assisted living settings in 2014.
J Am Med Dir Assoc 2019 Jun;20(6):703-09. doi: 10.1016/j.jamda.2018.09.032..
Keywords: Disparities, Elderly, Long-Term Care, Medicare, Racial and Ethnic Minorities
Perraillon MC, Konetzka RT, He D
Consumer response to composite ratings of nursing home quality.
Health care report cards are intended to address information asymmetries and enable consumers to choose providers of better quality. This study examined whether the form of the information mattered to consumers. The investigators concluded that the form of quality reporting mattered to consumers, and that the increased use of composite ratings was likely to increase consumer response.
AHRQ-funded; HS021877; HS021861; HS000084.
Citation: Perraillon MC, Konetzka RT, He D .
Consumer response to composite ratings of nursing home quality.
Am J Health Econ 2019 Spring;5(2):165-90. doi: 10.1162/ajhe_a_00115..
Keywords: Nursing Homes, Long-Term Care, Quality of Care, Provider Performance, Quality Measures
Hanlon JT, Perera S, Drinka PJ
The IOU consensus recommendations for empirical therapy of cystitis in nursing home residents.
A 19-member panel of clinical pharmacists was convened for the Improving Outcomes of UTI Management in Long-Term Care Project (IOU) funded by the Agency for Healthcare Research and Quality. The objective is to reach consensus on a set of recommendations for the empirical treatment of cystitis in older nursing home residents with oral anti-infective medications. A comprehensive literature search was conducted and out of that 31 recommendations were created. There were two Delphi Survey rounds conducted and those recommendations were rated on a 5-point Likert scale. In the first round three recommendations reached consensus and in the second round an additional eight recommendations were agreed on.
AHRQ-funded; HS023779.
Citation: Hanlon JT, Perera S, Drinka PJ .
The IOU consensus recommendations for empirical therapy of cystitis in nursing home residents.
J Am Geriatr Soc 2019 Mar;67(3):539-45. doi: 10.1111/jgs.15726..
Keywords: Elderly, Nursing Homes, Long-Term Care, Medication, Quality Improvement, Quality of Care, Evidence-Based Practice
Carnahan RM, Daly JM, Minion S
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
The authors assessed the needs and preferred resources of Iowa physicians to inform the development of educational resources for best practice dementia care and compared the responses of nursing home medical directors with nonmedical directors. They found that medical directors and nonmedical directors had similar preferences for resources used and information needs, with preference for online resources, pocket guides, a handbook, consulting pharmacists, and facility in-services being the most commonly preferred sources of new information. Medical directors were significantly more aware of the FDA warning on antipsychotic use in dementia and treated more nursing home patients. No differences were observed between groups related to confidence in and use of nondrug strategies instead of antipsychotics to manage behavioral symptoms of dementia.
AHRQ-funded; HS019355.
Citation: Carnahan RM, Daly JM, Minion S .
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719840113. doi: 10.1177/2150132719840113..
Keywords: Education: Continuing Medical Education, Medication, Dementia, Neurological Disorders, Elderly, Evidence-Based Practice, Guidelines, Long-Term Care
Olivieri-Mui B, McGuire J, Cahill S
People living with HIV in U.S. nursing homes in the fourth decade of the epidemic.
This study described the sociodemographic characteristics as well as the antiretroviral therapy treatment and physical and mental health among Medicare-eligible persons living with HIV (PLWH) in nursing homes (NHs). Of the newer admissions, results showed that they were older, had higher prevalence of viral hepatitis and anemia, but had less pneumonia and dementia. NH nurses can better anticipate health care needs of PLWH using these health profiles, understanding that there have been changes in the health of PLWH at admission over time.
AHRQ-funded; HS025662.
Citation: Olivieri-Mui B, McGuire J, Cahill S .
People living with HIV in U.S. nursing homes in the fourth decade of the epidemic.
J Assoc Nurses AIDS Care 2019 Jan-Feb;30(1):20-34. doi: 10.1097/jnc.0000000000000033..
Keywords: Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Elderly, Infectious Diseases, Medicare
Aspinall SL, Springer SP, Zhao X
Central nervous system medication burden and risk of recurrent serious falls and hip fractures in Veterans Affairs nursing home residents.
This study investigated the association between taking central nervous system (CNS) medications with the risk of serious falls and hip fractures. Study participants were residents at a Veterans Health Administration (VHA) Community Living Center (CLC) between July 1, 2005 and June 30, 2009. This was a nested case-control study. The investigators concluded that there was a higher risk in those residents receiving 3.0 or more daily CNS medications.
AHRQ-funded; HS023779.
Citation: Aspinall SL, Springer SP, Zhao X .
Central nervous system medication burden and risk of recurrent serious falls and hip fractures in Veterans Affairs nursing home residents.
J Am Geriatr Soc 2019 Jan;67(1):74-80. doi: 10.1111/jgs.15603..
Keywords: Elderly, Falls, Injuries and Wounds, Long-Term Care, Medication, Nursing Homes, Patient Safety, Risk
Jackson SS, Lydecker AD, Magder LS
Development and validation of a clinical prediction rule to predict transmission of methicillin-resistant Staphylococcus aureus in nursing homes.
This study’s goal was to develop and validate a clinical prediction rule that can predict transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes. The researchers wanted to identify residents who were most likely to transmit MRSA to health-care workers (HCWs) on their hands or clothing during clinical care. Demographic and clinical characteristic data was used from residents of community nursing homes in Maryland and Michigan from 2012 to 2014. The clinical prediction rule that was developed was then externally validated in a cohort of Department of Veterans Affairs nursing home residents from 7 states between 2012 and 2016. Variables in the prediction model included sex, race, resident dependency on care, the presence of any medical device, diabetes mellitus, and chronic skin breakdown. The prediction model showed good performance although it showed less utility in the validation cohort.
AHRQ-funded; HS019979.
Citation: Jackson SS, Lydecker AD, Magder LS .
Development and validation of a clinical prediction rule to predict transmission of methicillin-resistant Staphylococcus aureus in nursing homes.
Am J Epidemiol 2019 Jan;188(1):214-21. doi: 10.1093/aje/kwy220..
Keywords: Elderly, Healthcare-Associated Infections (HAIs), Infectious Diseases, Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Nursing Homes, Patient Safety
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
Felix HC, Bradway C, Bird TM
Safety of obese persons in nursing homes.
This paper discusses the emergence of obese persons as a vulnerable group in the nursing home community. The authors discuss the special needs of this population including that obese residents require special protocols, trained staff, and appropriately sized equipment to prevent and treat skin breakdown.
AHRQ-funded; HS025703.
Citation: Felix HC, Bradway C, Bird TM .
Safety of obese persons in nursing homes.
Med Care 2018 Dec;56(12):1032-34. doi: 10.1097/mlr.0000000000000997..
Keywords: Long-Term Care, Obesity, Nursing Homes, Patient Safety, Skin Conditions
McConeghy KW, Lee Y, Zullo AR
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
In this retrospective cohort study, the investigators evaluated the association between influenza and hip fracture hospitalizations in long-stay (LS) nursing home (NH) residents. The study authors found that influenza like illness (ILI) hospitalizations were associated with a 13% average increase in hip fracture hospitalization risk. In a given NH week, an increase in the number ILI hospitalizations from none to two was associated with an approximate one percentage point increase in hip fracture hospitalization risk.
AHRQ-funded; HS022998.
Citation: McConeghy KW, Lee Y, Zullo AR .
Influenza illness and hip fracture hospitalizations in nursing home residents: are they related?
J Gerontol A Biol Sci Med Sci 2018 Nov 10;73(12):1638-42. doi: 10.1093/gerona/glx200..
Keywords: Elderly, Injuries and Wounds, Hospitalization, Influenza, Long-Term Care, Nursing Homes
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Wilmont S, Hessels AJ, Kelly AM
Family experiences and perspectives on infection prevention in pediatric long-term care.
The aims of this qualitative study were to (a) explore perspectives on infection prevention among families visiting children in pediatric long-term care facilities and (b) identify facilitators of and barriers to optimal hand hygiene using semistructured in-depth interviews with 10 family members visiting two New York City metropolitan area facilities.
AHRQ-funded; HS021470.
Citation: Wilmont S, Hessels AJ, Kelly AM .
Family experiences and perspectives on infection prevention in pediatric long-term care.
Children/Adolescents, Healthcare-Associated Infections, Long-term Care, Pediatrics, Prevention Practices.
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Long-Term Care, Prevention, Patient Safety
Makam AN, Nguyen OK, Xuan L
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
In this observational cohort study, the investigators sought to determine why non-mechanically ventilated hospitalized older adults are transferred to long-term acute care (LTAC) hospitals rather than remaining in the hospital. The authors found that nearly half of the variation in LTAC use is independent of illness severity and is explained by which hospital and what region the individual was hospitalized in.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Xuan L .
Long-term acute care hospital use of non-mechanically ventilated hospitalized older adults.
J Am Geriatr Soc 2018 Nov;66(11):2112-19. doi: 10.1111/jgs.15564..
Keywords: Elderly, Hospitalization, Long-Term Care, Respiratory Conditions
Hessels AJ, Murray MT, Cohen B
Perception of patient safety culture in pediatric long-term care settings.
Patient safety culture (PSC) is an emerging construct in adult long-term care settings. No measures are validated to quantify PSC in pediatric long-term care (pLTC) settings despite the importance of safety for this vulnerable population. The objectives of this study were to (1) describe PSC in pLTC; (2) assess the relationship of PSC to facility recommendation and overall safety rating; and (3) test the stability and reliability of the PSC survey over time.
AHRQ-funded; HS021470.
Citation: Hessels AJ, Murray MT, Cohen B .
Perception of patient safety culture in pediatric long-term care settings.
J Healthc Qual 2018 Nov/Dec;40(6):384-91. doi: 10.1097/jhq.0000000000000134..
Keywords: Children/Adolescents, Long-Term Care, Patient Safety, Children/Adolescents
D'Agata EMC, Varu A, Geffert SF
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
This nested case-control study was conducted among 137 nursing home residents who did not receive antimicrobials, with 44 acquiring a multi-drug resistant organism. Risk factors identified included receiving gastrointestinal medication that affected the gut microbiome, the number of visits from healthcare workers, pressure ulcers, and not residing in a dementia unit.
AHRQ-funded; HS021666.
Citation: D'Agata EMC, Varu A, Geffert SF .
Acquisition of multidrug-resistant organisms in the absence of antimicrobials.
Clin Infect Dis 2018 Oct 15;67(9):1437-40. doi: 10.1093/cid/ciy358..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Elderly, Digestive Disease and Health, Case Study
Goodwin JS, Li S, Middleton A
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
The objective of this study was to determine how the risk of subsequent long-term care (LTC) placement varied between skilled nursing facilities (SNFs) and the SNF characteristics associated with this risk. The investigators concluded that risk of subsequent LTC placement, an important and negatively viewed outcome for older adults, varied substantially between SNFs. Individuals in higher-quality SNFs were at lower risk.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Li S, Middleton A .
Differences between skilled nursing facilities in risk of subsequent long-term care placement.
J Am Geriatr Soc 2018 Oct;66(10):1880-86. doi: 10.1111/jgs.15377..
Keywords: Nursing Homes, Long-Term Care, Elderly, Medicare