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
26 to 50 of 217 Research Studies DisplayedMeddings J, Greene MT, Ratz D
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates.
AHRQ’s Safety Program for ICUs aimed to reduce central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) in intensive care units with elevated rates. Included hospitals had at least one adult intensive care unit with elevated CLABSI or CAUTI rates. The investigators targeted intensive care units with elevated catheter infection rates but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilization in the first two of six planned cohorts. Improvements in the interventions based on lessons learned from these initial cohorts are being applied to subsequent cohorts.
AHRQ-funded; 233201500016I.
Citation: Meddings J, Greene MT, Ratz D .
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates.
BMJ Qual Saf 2020 May;29(5):418-29. doi: 10.1136/bmjqs-2019-009330..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Urinary Tract Infection (UTI), Intensive Care Unit (ICU), Hospitals, Evidence-Based Practice, Patient-Centered Outcomes Research, Inpatient Care, Critical Care
Alfred M, Catchpole K, Huffer E
Work systems analysis of sterile processing: decontamination.
This study examined the work of sterile processing departments (SPDs) from a systems perspective. This paper reports the results of a work systems analysis that sought to identify the complex multilevel interdependencies that create performance variation and identify potential improvement interactions. The analysis was conducted at a 700-bed academic hospital with two reprocessing facilities decontaminating approximately 23,000 units each month. Mixed methods, including 56 hours of observations of work was done, as well as formal and informal interviews with relevant stakeholders and analysis of data collected about the system. The authors identified 21 different performance shaping factors, 30 potential failures, 16 types of process variance, and 10 outcome variances in decontamination. Approximately 2% of trays were returned to decontamination from assembly with 1% of surgical cases having decontamination problems.
AHRQ-funded; HS025538.
Citation: Alfred M, Catchpole K, Huffer E .
Work systems analysis of sterile processing: decontamination.
BMJ Qual Saf 2020 Apr;29(4):320-28. doi: 10.1136/bmjqs-2019-009422..
Keywords: Patient Safety, Quality Improvement, Quality of Care, Prevention, Surgery, Healthcare-Associated Infections (HAIs)
Ilies I, Benneyan JC, Jabur TBC
Impact of molecular testing on reported Clostridoides difficile infection rates.
This study examined the impact of changing from the enzyme immunoassay (EIA) method to nucleic acid amplification tests (NAATs) to detect incidence of Cloistridoides difficile infection (CDI) in hospitals. The authors analyzed retrospective data from 2009-2017 from 47 hospitals in the southeastern United States. During that time period 37 hospitals switched to NAAT, including 24 with good pre- and post-switch data for statistical analysis. The incidence of CDI detection did go up in hospitals that had transitioned from 10.9 to 23.9 per 10,000 patient days, an average increase of 75%.
AHRQ-funded; HS023821.
Citation: Ilies I, Benneyan JC, Jabur TBC .
Impact of molecular testing on reported Clostridoides difficile infection rates.
Infect Control Hosp Epidemiol 2020 Mar;41(3):306-12. doi: 10.1017/ice.2019.327..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety, Hospitals
Lee BY, Bartsch SM, Hayden MK
How introducing a registry with automated alerts for carbapenem-resistant Enterobacteriaceae (CRE) may help control CRE spread in a region.
This study examined the effectiveness of implementing a registry which tracks patients that carry antibiotic-resistant bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). The researchers developed an agent-based model of all inpatient healthcare facilities in the Chicago metropolitan area and surrounding areas. They used their Regional Healthcare Ecosystem Analyst software platform to study patient flow. They created scenarios where all, 75%, 50%, and 25% of Chicago-area facilities participated. Even at 25% participation there was a 9.1% relative reduction in incident carriers and 2.8% relative reduction of prevalence. At 100% there was an 11.6% relative reduction in new carrier and CRE prevalence by 7.6%.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Hayden MK .
How introducing a registry with automated alerts for carbapenem-resistant Enterobacteriaceae (CRE) may help control CRE spread in a region.
Clin Infect Dis 2020 Feb 14;70(5):843-49. doi: 10.1093/cid/ciz300..
Keywords: Registries, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety
Quinn M, Ameling JM, Forman J
Persistent barriers to timely catheter removal identified from clinical observations and interviews.
Indwelling urinary and vascular catheters are valuable devices in patient care, but prolonged or unnecessary use increases the risk of infectious and noninfectious catheter harms. To understand persistent barriers to detecting and removing unnecessary catheters, the researchers conducted a multimethod qualitative study that included observations and in-person interviews with clinicians working on a progressive care unit of a large hospital.
AHRQ-funded; HS024385; HS019767.
Citation: Quinn M, Ameling JM, Forman J .
Persistent barriers to timely catheter removal identified from clinical observations and interviews.
Jt Comm J Qual Patient Saf 2020 Feb;46(2):99-108. doi: 10.1016/j.jcjq.2019.10.004..
Keywords: Patient Safety, Quality of Care, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI)
Hoffman GJ, Min LC, Liu H
Role of post-acute care in readmissions for preexisting healthcare-associated infections.
Researchers examined the risk of preexisting healthcare-associated infections (HAIs) readmissions according to patient discharge disposition and comorbidity level. They found that skilled nursing facility discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. They recommended further research to identify modifiable mechanisms to improve posthospital infection care at home.
AHRQ-funded; HS025838; HS025451.
Citation: Hoffman GJ, Min LC, Liu H .
Role of post-acute care in readmissions for preexisting healthcare-associated infections.
J Am Geriatr Soc 2020 Feb;68(2):370-78. doi: 10.1111/jgs.16208..
Keywords: Healthcare-Associated Infections (HAIs), Hospital Readmissions, Hospital Discharge, Hospitals, Patient Safety, Elderly
Milstone AM, Voskertchian A, Koontz DW
Effect of treating parents colonized with Staphylococcus aureus on transmission to neonates in the intensive care unit: a randomized clinical trial.
This study examined the effect of treating parents of neonates in the intensive care unit (NICUs) with intranasal mupirocin and topical chlorhexidine compared with a placebo treatment and whether it reduces transmission of Staphlyococcus aureus to their babies. A double-blind randomized trial was conducted at 2 tertiary NICUs in Baltimore, MD from November 2014 to December 2018. Parents were given intranasal treatments for 5 days. Of the intervention group 13 of 89 neonates acquired S aureus, and in the control group 29 of 101 neonates acquired S aureus with the same strain as their parents. The results showed a significant reduction in transmission.
AHRQ-funded; HS022872.
Citation: Milstone AM, Voskertchian A, Koontz DW .
Effect of treating parents colonized with Staphylococcus aureus on transmission to neonates in the intensive care unit: a randomized clinical trial.
JAMA 2020 Jan;323(4):295-386. doi: 10.1001/jama.2019.20785..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention
Gohil SK, Yim J, Quan K
Impact of a Central-Line Insertion Site Assessment (CLISA) score on localized insertion site infection to prevent central-line-associated bloodstream infection (CLABSI).
This study assessed the impact of a newly developed Central-Line Insertion Site Assessment (CLISA) score on the incidence of site inflammation or infection for CLABSI prevention. A cohort of adult inpatients with central venous catheters (CVCs) hospitalized in an intensive care unit or oncology ward at a large academic medical center participated. CLISA score impacts were evaluated with a CLISA score of 2 or 3 indicating insertion site inflammation and infection. The baseline study period was June 2014 through January 2015 and the intervention period April 2015 through October 2017. During that time CLISA scores of 2 or 3 in the baseline and intervention periods decreased by 78.2%. Days to removal of lines on patients with a CLISA score of 2 or 3 was 3.19 days faster after the intervention. Line dwell time also decreased by 37.1% from a mean of 14 days to 8.8 days.
AHRQ-funded; HS024424.
Citation: Gohil SK, Yim J, Quan K .
Impact of a Central-Line Insertion Site Assessment (CLISA) score on localized insertion site infection to prevent central-line-associated bloodstream infection (CLABSI).
Infect Control Hosp Epidemiol 2020 Jan;41(1):59-66. doi: 10.1017/ice.2019.291..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Prevention, Patient Safety
Woods-Hill CZ, Srinivasan L, Schriver E
Novel risk factors for central-line associated bloodstream infections in critically ill children.
Central-line-associated bloodstream infections (CLABSI) cause morbidity and mortality in critically ill children. In this study the investigators examined novel and/or modifiable risk factors for CLABSI to identify new potential targets for infection prevention strategies. They found that novel risk factors for CLABSI in PICU patients included acute behavioral health needs and >80 CVC accessed in the 3 days before CLABSI. They suggest that interventions focused on these factors may reduce CLABSIs in this high-risk population.
AHRQ-funded; HS025642.
Citation: Woods-Hill CZ, Srinivasan L, Schriver E .
Novel risk factors for central-line associated bloodstream infections in critically ill children.
Infect Control Hosp Epidemiol 2020 Jan;41(1):67-72. doi: 10.1017/ice.2019.302..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Children/Adolescents, Intensive Care Unit (ICU), Risk, Patient Safety
Patel SA, Araujo T, Rodriguez LP
Long peripheral catheters: a retrospective review of major complications.
The risk of infectious and noninfectious complications associated with long peripheral catheters (LPCs) is unknown. In this retrospective study of 539 catheters, the investigators did a retrospective review of major complications. Among other discoveries, they found LPCs were often placed for the indications of difficult access and long-term antibiotics.
AHRQ-funded; HS025891.
Citation: Patel SA, Araujo T, Rodriguez LP .
Long peripheral catheters: a retrospective review of major complications.
J Hosp Med 2019 Dec;14(12):758-60. doi: 10.12788/jhm.3313..
Keywords: Healthcare-Associated Infections (HAIs), Adverse Events, Patient Safety, Central Line-Associated Bloodstream Infections (CLABSI), Blood Clots, Infectious Diseases, Risk
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
McKinnell JA, Singh RD, Miller LG
The SHIELD Orange County project: multidrug-resistant organism prevalence in 21 nursing homes and long-term acute care facilities in Southern California.
The authors reported baseline multidrug-resistant organism (MDRO) prevalence in 21 nursing homes (NHs) and long-term acute care facilities (LTACs). They found that prevalence of MDROs was 65% in NHs and 80% in LTACs. They concluded that the majority of NH residents and LTAC patients harbor MDROs, and that MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.
AHRQ-funded; HS023317.
Citation: McKinnell JA, Singh RD, Miller LG .
The SHIELD Orange County project: multidrug-resistant organism prevalence in 21 nursing homes and long-term acute care facilities in Southern California.
Clin Infect Dis 2019 Oct 15;69(9):1566-73. doi: 10.1093/cid/ciz119.
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Keywords: Nursing Homes, Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Patient Safety
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
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)
Caroff DA, Chan C, Kleinman K
Association of open approach vs laparoscopic approach with risk of surgical site infection after colon surgery.
The authors assessed whether laparoscopic colon surgery is associated with a lower surgical site infection rate than open-approach laparoscopy. They found that policy changes that promote surgical education and resources for laparoscopy, especially at low-adoption hospitals, may be associated with reduced colon surgical site infection rates. They recommend support of the development of innovative educational policies to help achieve improvement in patient outcomes and decreased health care use in colon surgery.
AHRQ-funded; HS021424.
Citation: Caroff DA, Chan C, Kleinman K .
Association of open approach vs laparoscopic approach with risk of surgical site infection after colon surgery.
JAMA Netw Open 2019 Oct 2;2(10):e1913570. doi: 10.1001/jamanetworkopen.2019.13570..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Patient Safety, Risk
McGee MF, Kreutzer L, Quinn CM
Leveraging a comprehensive program to implement a colorectal surgical site infection reduction bundle in a statewide quality improvement collaborative.
This study’s objective was examine the implementation and associated clinical outcomes of a comprehensive colorectal surgical site infection (SSI) reduction bundle in a large statewide quality improvement collaborative. This multifaceted bundle includes guided implementation, data feedback, mentorship, process improvement training/coaching, and targeted-implementation toolkits. Bundle adherence outcomes were examined pre- and post-implementation. Among 32 hospitals, there was a 2.4-fold relative increase in patients completing at least 75% of bundle elements. The largest gains were in wound closure re-gowning/re-gloving, use of clean closing instruments, and preoperative chlorhexidine bathing. Adherence showed a significant decrease in superficial SSI rates.
AHRQ-funded; HS024516.
Citation: McGee MF, Kreutzer L, Quinn CM .
Leveraging a comprehensive program to implement a colorectal surgical site infection reduction bundle in a statewide quality improvement collaborative.
Ann Surg 2019 Oct;270(4):701-11. doi: 10.1097/sla.0000000000003524..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Quality Improvement, Quality of Care
Manojlovich M, Ameling JM, Forman J
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
This study identified contextual barriers to communication between physicians and nurses that contribute to inappropriate use of catheters and increased risk of health care-associated infections. The researchers conducted individual and small-group semistructured interviewed with physicians and nurses in a progressive care unit of an academic hospital. Common barriers included workflow misalignment between clinicians, issues with electronic medical records and pagers, and strained relationships between clinicians.
AHRQ-funded; HS024385.
Citation: Manojlovich M, Ameling JM, Forman J .
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
Am J Crit Care 2019 Jul;28(4):290-98. doi: 10.4037/ajcc2019372..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Communication, Healthcare-Associated Infections (HAIs), Patient Safety, Provider, Provider: Nurse, Provider: Physician, Urinary Tract Infection (UTI), Workflow
Chopra V, Kaatz S, Swaminathan L
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
This study examined complication rates from placement of midline vascular catheters. They have become more common in use recently. Complications were analyzed using medical records from hospitalized patients in 12 hospitals from January 2017 to February 2018. Most midline catheters were placed in general ward settings for difficult intravenous access. About half were removed within 5 days of insertion. Major or minor complications occurred in 10.3% of midlines with minor complications accounting for 71% of all adverse events. These minor complications included dislodgement, leaking, and infiltration. Major complications included occlusion, upper-extremity DVT and BSI. Use of midlines and outcomes varied widely across hospitals.
AHRQ-funded; HS025891.
Citation: Chopra V, Kaatz S, Swaminathan L .
Variation in use and outcomes related to midline catheters: results from a multicentre pilot study.
BMJ Qual Saf 2019 Sep;28(9):714-20. doi: 10.1136/bmjqs-2018-008554..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Infectious Diseases, Adverse Events, Practice Patterns, Outcomes, Hospitals
Anderson DJ, Watson S, Moehring RW
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy.
AHRQ-funded; HS023866.
Citation: Anderson DJ, Watson S, Moehring RW .
Feasibility of core antimicrobial stewardship interventions in community hospitals.
The purpose of this study was to determine the feasibility and results of implementing 2 core stewardship intervention strategies in community hospitals. The two antimicrobial stewardship strategies targeted vancomycin hydrochloride, piperacillin-tazobactam, and the antipseudomonal carbapenems on formulary at the study hospitals: (1) modified preauthorization (PA), in which the prescriber had to receive pharmacist approval for continued use of the antibiotic after the first dose, and (2) postprescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness after 72 hours of therapy..
Keywords: Antibiotics, Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Hospitals, Infectious Diseases, Medication, Patient Safety
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
Hefner JL, Fareed N, Walker DM
Central line infections in United States hospitals: an exploration of variation in central line device days and infection rates across hospitals that serve highly complex patient populations.
Am J Infect Control 2019 Aug;47(8):1032-34. doi: 10.1016/j.ajic.2018.12.001.
The authors’ descriptive analyses show a wide distribution in rates of central line device days and central line-associated bloodstream infections for a given standardized infection ratio among 215 US hospitals serving highly complex patient populations. They established that the standardized infection ratio masks hospital-level variation in device use and associated patient safety.
The authors’ descriptive analyses show a wide distribution in rates of central line device days and central line-associated bloodstream infections for a given standardized infection ratio among 215 US hospitals serving highly complex patient populations. They established that the standardized infection ratio masks hospital-level variation in device use and associated patient safety.
AHRQ-funded; HS024958.
Citation: Hefner JL, Fareed N, Walker DM .
Central line infections in United States hospitals: an exploration of variation in central line device days and infection rates across hospitals that serve highly complex patient populations.
Am J Infect Control 2019 Aug;47(8):1032-34. doi: 10.1016/j.ajic.2018.12.001..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety
Kates AE, Zimbric ML, Mitchell K
The impact of chlorhexidine gluconate on the skin microbiota of children and adults: a pilot study.
The authors examined the effect of chlorhexidine gluconate bathing on the skin microbiota of adult and pediatric patients. They observed no differences in pediatric patients, but multiple genera of bacteria were observed to be significantly less abundant in adults. They recommended further research to determine long-term impact.
AHRQ-funded; HS024039.
Citation: Kates AE, Zimbric ML, Mitchell K .
The impact of chlorhexidine gluconate on the skin microbiota of children and adults: a pilot study.
Am J Infect Control 2019 Aug;47(8):1014-16. doi: 10.1016/j.ajic.2019.01.024..
Keywords: Children/Adolescents, Skin Conditions, Healthcare-Associated Infections (HAIs), Prevention, Patient Safety
Musuuza JS, Hundt AS, Carayon P
Implementation of a Clostridioides difficile prevention bundle: understanding common, unique, and conflicting work system barriers and facilitators for subprocess design.
This study assessed the factors that should be considered when designing subprocesses of a Clostridioides difficile (C. difficile) prevention bundle. Three focus groups were conducted with environmental services staff, physicians and nurses to assess their perspectives on the prevention bundle and barriers to implementation. Common barriers included inconsistencies in knowledge and practice of CD management procedures; increased workload; poor setup of aspects of the physical environment; and inconsistencies in CD documentation. There were also unique barriers in different hospital environments. The authors recommend a systems engineering approach to help holistically identify factors that influence successful implementation of subprocesses of the CD infection prevention bundle.
AHRQ-funded; HS023791.
Citation: Musuuza JS, Hundt AS, Carayon P .
Implementation of a Clostridioides difficile prevention bundle: understanding common, unique, and conflicting work system barriers and facilitators for subprocess design.
Infect Control Hosp Epidemiol 2019 Aug;40(8):880-88. doi: 10.1017/ice.2019.150..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety, Prevention
Sankaran R, Sukul D, Nuliyalu U
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
This study evaluated the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and changes in clinical outcomes. Out of the total of 724 hospitals were penalized in fiscal year 2015, 708 were included in the study. The majority of the penalized hospitals were large teaching institutions and have a greater share of low-income patients than non-penalized hospitals. After penalization, there was a non-significant change in hospital acquired conditions, 30-day readmission rates, and 30-day mortality. This might mean that disparities in care could be exacerbated.
AHRQ-funded; HS026244.
Citation: Sankaran R, Sukul D, Nuliyalu U .
Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study.
BMJ 2019 Jul 3;366:l4109. doi: 10.1136/bmj.l4109..
Keywords: Health Insurance, Healthcare-Associated Infections (HAIs), Hospitals, Medicare, Patient Safety, Provider Performance, Payment, Quality of Care, Quality Indicators (QIs)
Paje D, Rogers MAM, Conlon A
Use of peripherally inserted central catheters in patients with advanced chronic kidney disease: a prospective cohort study.
Existing guidelines, including Choosing Wisely recommendations, endorse avoiding placement of peripherally inserted central catheters (PICCs) in patients with chronic kidney disease (CKD). The purpose of this study was to describe the frequency of and characteristics associated with PICC use in hospitalized patients with stage 3b or greater CKD (glomerular filtration rate [GFR] <45 mL/min/1.73 m2).
AHRQ-funded; HS025891.
Citation: Paje D, Rogers MAM, Conlon A .
Use of peripherally inserted central catheters in patients with advanced chronic kidney disease: a prospective cohort study.
Ann Intern Med 2019 Jul 2;171(1):10-18. doi: 10.7326/m18-2937..
Keywords: Kidney Disease and Health, Guidelines, Evidence-Based Practice, Patient Safety, Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs)