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
76 to 100 of 208 Research Studies DisplayedColborn KL, Bronsert M, Amioka E
Identification of surgical site infections using electronic health record data.
The objective of this study was to develop an algorithm for identifying surgical site infections (SSIs) using independent variables from electronic health record data and outcomes from the American College of Surgeons National Surgical Quality Improvement Program to supplement manual chart review. The investigators concluded that they identified a model that accurately identified SSIs. They indicated that the framework presented can be easily implemented by other American College of Surgeons National Surgical Quality Improvement Program-participating hospitals to develop models for enhancing surveillance of SSIs.
AHRQ-funded; HS026019.
Citation: Colborn KL, Bronsert M, Amioka E .
Identification of surgical site infections using electronic health record data.
Am J Infect Control 2018 Nov;46(11):1230-35. doi: 10.1016/j.ajic.2018.05.011..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Injuries and Wounds, Patient Safety, Surgery
Yokoe DS, Avery TR, Platt R
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
This study examined how hospitals are ranked based on colon surgery and abdominal surgical site infection (SSI) outcomes. This ranking can impact how financial penalties are determined. Currently SSI surveillance focuses mainly on the operative hospital, but patients sometimes go to a different hospital after an SSI as opposed to readmission in the operative hospital. The authors used data from a California statewide hospital registry to assess for evidence of SSI for surgeries performed from March 2011 through November 2013. This analysis showed show that operational hospital surveillance alone would have missed 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSIs. This leads to an inaccurate assignment or avoidance of financial penalties for approximately 1 in 11-16 hospitals.
AHRQ-funded; HS021424.
Citation: Yokoe DS, Avery TR, Platt R .
Ranking hospitals based on colon surgery and abdominal hysterectomy surgical site infection outcomes: impact of limiting surveillance to the operative hospital.
Clin Infect Dis 2018 Sep 14;67(7):1096-102. doi: 10.1093/cid/ciy223..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Injuries and Wounds, Adverse Events, Hospitals, Payment, Patient Safety, Provider Performance
Wahl TS, Graham LA, Morris MS
Association between preoperative proteinuria and postoperative acute kidney injury and readmission.
This retrospective cohort study investigated whether preoperative proteinuria is associated with surgical outcomes including postoperative acute kidney injury (AKI) and readmission. The cohort used were undergoing elective inpatient surgery at 119 Veterans Affairs facilities from October 2007 to September 2014. The data collected was for a 7-month period in 2016. A higher probability of 30-day unplanned readmission was associated with preoperative proteinuria and postoperative AKI.
AHRQ-funded; HS013852.
Citation: Wahl TS, Graham LA, Morris MS .
Association between preoperative proteinuria and postoperative acute kidney injury and readmission.
JAMA Surg 2018 Sep;153(9):e182009. doi: 10.1001/jamasurg.2018.2009..
Keywords: Kidney Disease and Health, Injuries and Wounds, Adverse Events, Surgery, Risk, Hospital Readmissions, Outcomes
Grundmeier RW, Xiao R, Ross RK
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
The objective of this study was to prospectively derive and validate a prediction rule for detecting cases warranting investigation for surgical site infections (SSI) after ambulatory surgery. The investigators concluded that electronic health record data can facilitate SSI surveillance with adequate sensitivity and positive predictive value.
AHRQ-funded; HS020921.
Citation: Grundmeier RW, Xiao R, Ross RK .
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
J Am Med Inform Assoc 2018 Sep;25(9):1160-66. doi: 10.1093/jamia/ocy075..
Keywords: Healthcare-Associated Infections (HAIs), Injuries and Wounds, Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Risk, Patient Safety, Adverse Events, Ambulatory Care and Surgery
Fan T, Erickson EA
AHRQ Author: Fan T
Interventions to prevent falls and fractures in community-dwelling older adults.
This case study addresses the U.S. Preventive Health Service Task Force recommendations and offers a scenario, questions, and answers related to interventions to prevent falls and fractures in community-dwelling older adults.
AHRQ-authored.
Citation: Fan T, Erickson EA .
Interventions to prevent falls and fractures in community-dwelling older adults.
Am Fam Physician 2018 Aug 15;98(4):253-55..
Keywords: Case Study, Elderly, Falls, Injuries and Wounds, Prevention, U.S. Preventive Services Task Force (USPSTF)
Yun BJ, Borczuk P, Zachrison KS
Utilization of head CT during injury visits to United States emergency departments: 2012-2015.
This study examined national trends in utilization of head computed tomography (CT) imaging in emergency department (ED) patients presenting with an injury-related visit. Data from the US National Hospital Ambulatory Medical Care Survey from 2012 to 2015 was used to find ED patients who had at least one head CT. Overall there was an increase (11.7-13.23%) but it was not statistically significant.
AHRQ-funded; HS024561.
Citation: Yun BJ, Borczuk P, Zachrison KS .
Utilization of head CT during injury visits to United States emergency departments: 2012-2015.
Am J Emerg Med 2018 Aug;36(8):1463-66. doi: 10.1016/j.ajem.2018.05.018..
Keywords: Healthcare Utilization, Emergency Department, Imaging, Injuries and Wounds, Practice Patterns
Shi J, Shen J, Caupp S
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality.
The objective of this study was to develop a weighted Injury Severity Score (wISS) system for pediatric blunt trauma patients with better predictive power than ISS. The authors suggest that by weighting the Abbreviated Injury Scale from different body regions, the wISS had significantly better predictive power for mortality than the ISS, especially in critically injured children.
AHRQ-funded; HS024263.
Citation: Shi J, Shen J, Caupp S .
A new weighted injury severity scoring system: Better predictive power for pediatric trauma mortality.
J Trauma Acute Care Surg 2018 Aug;85(2):334-40. doi: 10.1097/ta.0000000000001943..
Keywords: Children/Adolescents, Injuries and Wounds, Mortality, Children/Adolescents, Trauma
Lin DM, Carson KA, Lubomski LH
Statewide collaborative to reduce surgical site infections results of the Hawaii Surgical Unit-based Safety Program.
Surgical Site Infections (SSI) after colorectal surgery are common, lead to patient harm, and are costly to the healthcare system. This study's purpose was to evaluate the effectiveness of the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Surgery in Hawaii. Participation in the program was associated with a 61.7% decrease in colorectal SSI rate and an increase in patient safety culture.
AHRQ-funded.
Citation: Lin DM, Carson KA, Lubomski LH .
Statewide collaborative to reduce surgical site infections results of the Hawaii Surgical Unit-based Safety Program.
J Am Coll Surg 2018 Aug;227(2):189-97.e1. doi: 10.1016/j.jamcollsurg.2018.04.031..
Keywords: Comprehensive Unit-based Safety Program (CUSP), Healthcare-Associated Infections (HAIs), Surgery, Surveys on Patient Safety Culture, Injuries and Wounds
Jarman MP, Haut ER, Curriero FC
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
This study sought to classify injury event locations based on features of the built and social environment at the injury scene, and to examine patterns in individual patient demographics, injury characteristics, and mortality by location class. The investigators concluded identification of location classes may be useful for targeted primary prevention and treatment interventions, both by identifying geographic areas with the highest risk of injury mortality and by identifying patterns of individual risk within location classes.
AHRQ-funded; HS000029.
Citation: Jarman MP, Haut ER, Curriero FC .
Mapping areas with concentrated risk of trauma mortality: a first step toward mitigating geographic and socioeconomic disparities in trauma.
J Trauma Acute Care Surg 2018 Jul;85(1):54-61. doi: 10.1097/ta.0000000000001883..
Keywords: Disparities, Injuries and Wounds, Mortality, Social Determinants of Health, Trauma
Sakran JV, Mehta A, Fransman R
Nationwide trends in mortality following penetrating trauma: are we up for the challenge?
This study analyzed contemporary trends in pre-hospital mortality from penetrating trauma in the past decade using The National Trauma Data Bank. The authors concluded the odds of pre-hospital mortality has increased over 4-fold for gunshot wounds and almost 9-fold for stab wounds. Examining violence intensity, along with improvements in hospital care and data collection, may explain these findings.
AHRQ-funded; HS024547.
Citation: Sakran JV, Mehta A, Fransman R .
Nationwide trends in mortality following penetrating trauma: are we up for the challenge?
J Trauma Acute Care Surg 2018 Jul;85(1):160-66. doi: 10.1097/ta.0000000000001907..
Keywords: Injuries and Wounds, Mortality, Outcomes, Trauma
Wong C, Fagan B, Leland NE
Occupational therapy practitioners' perspectives on occupation-based interventions for clients with hip fracture.
This study identified perspectives of 18 occupational therapy practitioners on integrating occupation-based interventions during postacute care (PAC) rehabilitation for persons with hip fracture to identify occupational therapy's distinct contribution. The study concluded that identifying practitioners' perspectives on integrating occupation into rehabilitation may inform strategies to facilitate occupation-based interventions in PAC and define occupational therapy's role in this setting.
AHRQ-funded; HS022907.
Citation: Wong C, Fagan B, Leland NE .
Occupational therapy practitioners' perspectives on occupation-based interventions for clients with hip fracture.
Am J Occup Ther 2018 Jul/Aug;72(4):7204205050p1-50p7. doi: 10.5014/ajot.2018.026492..
Keywords: Injuries and Wounds, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Rehabilitation
Jarman MP, Curriero FC, Haut ER
Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality.
The purpose of this study was to examine the association of injury scene characteristics with injury mortality. The study concluded that injury scene characteristics are associated with injury mortality. The authors found that odds of death are highest for patients injured in communities with higher median age or lower per capita income and at locations farthest from level 1 or 2 trauma centers.
AHRQ-funded; HS000029.
Citation: Jarman MP, Curriero FC, Haut ER .
Associations of distance to trauma care, community income, and neighborhood median age with rates of injury mortality.
JAMA Surg 2018 Jun;153(6):535-43. doi: 10.1001/jamasurg.2017.6133..
Keywords: Access to Care, Mortality, Social Determinants of Health, Trauma, Injuries and Wounds
Berry SD, Zullo AR, Lee Y
Fracture Risk Assessment in Long-term Care (FRAiL): development and validation of a prediction model.
This paper’s objective was to develop and validate a model, Fracture Risk Assessment in Long-term Care (FRAiL) to predict the 2-year risk of hip fracture in nursing home (NH) residents using readily available clinical characteristics. The FRAiL model was developed specifically to identify NH residents at greatest risk for hip fracture, and results identified a different pattern of risk factors compared with community models. This practical model could be used to screen NH residents for fracture risk and to target intervention strategies.
AHRQ-funded; HS022998.
Citation: Berry SD, Zullo AR, Lee Y .
Fracture Risk Assessment in Long-term Care (FRAiL): development and validation of a prediction model.
J Gerontol A Biol Sci Med Sci 2018 May 9;73(6):763-69. doi: 10.1093/gerona/glx147.
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Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Risk
Agimi Y, Albert SM, Youk AO
AHRQ Author: Steiner CA
Mandatory physician reporting of at-risk drivers: the older driver example.
The hypothesis that mandatory physician reporting laws reduce the rate of crash-related hospitalizations among older adult drivers was tested. Mandatory physician reporting failed to explain any significant variation in crash hospitalization rates, when adjusting for other state-specific laws and characteristics. Vision testing at in-person license renewal was a significant predictor of lower crash hospitalization rate.
AHRQ-authored.
Citation: Agimi Y, Albert SM, Youk AO .
Mandatory physician reporting of at-risk drivers: the older driver example.
Gerontologist 2018 May 8;58(3):578-87. doi: 10.1093/geront/gnw209.
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Keywords: Elderly, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Injuries and Wounds
Allegranzi B, Aiken AM, Zeynep Kubilay N
A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study.
The researchers aimed to establish the effect of a multimodal intervention on surgical site infections (SSIs) in Africa. SSI cumulative incidence significantly decreased post intervention, from 8.0 percent to 3.8 percent and this decrease persisted in the sustainability period. A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods.
AHRQ-funded; 290201000027.
Citation: Allegranzi B, Aiken AM, Zeynep Kubilay N .
A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study.
Lancet Infect Dis 2018 May;18(5):507-15. doi: 10.1016/s1473-3099(18)30107-5.
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Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Surgery, Injuries and Wounds, Prevention
Dore DD, Zullo AR, Mor V
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
This study examined the rate of hip fracture in nursing home residents prescribed nonbenzodiazepine hypnotics. A sample of nursing home residents was used and linked to Medicare and Minimum Data Set (2007-2008) data. The rate of hip fracture was higher in residents aged 90 and above, and lower in residents 70 or below. There was no different by sex.
AHRQ-funded; HS022998.
Citation: Dore DD, Zullo AR, Mor V .
Age, sex, and dose effects of nonbenzodiazepine hypnotics on hip fracture in nursing home residents.
J Am Med Dir Assoc 2018 Apr;19(4):328-32.e2. doi: 10.1016/j.jamda.2017.09.015..
Keywords: Injuries and Wounds, Medication, Nursing Homes, Long-Term Care, Adverse Drug Events (ADE), Adverse Events, Falls, Risk, Patient Safety
Hefele JG, Santos P, Ritter G
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
The purpose of this observational study was to examine shoulder dystocia risk factors by race and ethnicity using a 19,236 sample of pregnant women who presented for labor and delivery. Results found that, for White non-Hispanic mothers, the strongest risk factors were delivering past 40 weeks' gestation and use of epidural anesthesia during delivery. Among Black non-Hispanic mothers, the risk factors with the greatest impact were use of epidural and having gestational diabetes and controlling the condition with insulin. Additionally, among Hispanic mothers, having Spanish as the primary language increased shoulder dystocia likelihood compared to those who did not cite it as their primary language. This study provides evidence that risk factors for a labor and delivery condition can vary significantly across racial and ethnic subgroups.
AHRQ-funded; HS019608.
Citation: Hefele JG, Santos P, Ritter G .
Risk factors for shoulder dystocia: the impact of mother's race and ethnicity.
J Racial Ethn Health Disparities 2018 Apr;5(2):333-41. doi: 10.1007/s40615-017-0374-9..
Keywords: Adverse Events, Labor and Delivery, Injuries and Wounds, Newborns/Infants, Pregnancy, Risk
Yarbrough CK, Bommarito KM, Gamble PG
Population-based approaches to treatment and readmission after spinal cord injury.
Recent studies in surgical and non-surgical specialties have suggested that patients admitted on the weekend may have worse outcomes. It is unclear whether this extends to patients with spinal cord injury (SCI). This study was designed to evaluate factors for readmission after index hospitalization for spinal cord injury. The study’s results suggested that the weekend effect, described previously in other patient populations, may not play as important a role in patients with SCI.
AHRQ-funded; HS019455.
Citation: Yarbrough CK, Bommarito KM, Gamble PG .
Population-based approaches to treatment and readmission after spinal cord injury.
J Neurosurg Sci 2018 Apr;62(2):107-15. doi: 10.23736/s0390-5616.16.03617-1..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Outcomes, Injuries and Wounds
Wright NC, Hooker ER, Nielson CM
The epidemiology of wrist fractures in older men: the Osteoporotic Fractures in Men (MrOS) study.
The goal of this study was to calculate the frequency of and to identify risk factors for wrist fracture in the Osteoporotic Fractures in Men (MrOS) study. The researchers identified incident wrist fractures in men aged 65 or older. Potential risk factors included demographics, lifestyle, bone mineral density, selected medications, biomarkers, and physical function and performance measures. The researcher confirmed that fracture history and certain medications are predictors, and also identified novel predictors such as markers of kidney function and an inability to perform the grip strength test. They did not find associations with factors commonly associated with wrist and other osteoporosis fractures such as falls, diabetes, calcium and vitamin D intake, or alcohol intake.
AHRQ-funded; HS023009.
Citation: Wright NC, Hooker ER, Nielson CM .
The epidemiology of wrist fractures in older men: the Osteoporotic Fractures in Men (MrOS) study.
Osteoporos Int 2018 Apr;29(4):859-70. doi: 10.1007/s00198-017-4349-9..
Keywords: Arthritis, Elderly, Injuries and Wounds, Men's Health, Risk
Taaffe K, Lee B, Ferrand Y
The influence of traffic, area location, and other factors on operating room microbial load.
The researchers sought to determine how the movement of patients, equipment, materials, staff, and door openings within the operating room (OR) affect microbial loads at various locations within the OR. They found that the microbial load was affected by the time of year that the samples were taken. Both microbial load measured by the air samplers and by settle plates in 1 area of the OR was correlated with the physical movement of people in the same area.
AHRQ-funded; HS024380.
Citation: Taaffe K, Lee B, Ferrand Y .
The influence of traffic, area location, and other factors on operating room microbial load.
Infect Control Hosp Epidemiol 2018 Apr;39(4):391-97. doi: 10.1017/ice.2017.323.
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Keywords: Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Prevention, Patient Safety
Zullo AR, Zhang T, Banerjee G
Facility and state variation in hip fracture in U.S. nursing home residents.
The purpose of this study was to quantify the variation in hip fracture incidence across U.S. nursing home (NH) facilities and states and examine how hip fracture incidence varies according to facility- and state-level characteristics. The investigators concluded that much of the variation in hip fracture incidence remained unexplained. They suggested that their findings indicated that potentially modifiable state and facility characteristics such as psychoactive drug prescribing and minimum staffing requirements could be addressed to help reduce the rate of hip fracture in U.S. NHs.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Banerjee G .
Facility and state variation in hip fracture in U.S. nursing home residents.
J Am Geriatr Soc 2018 Mar;66(3):539-45. doi: 10.1111/jgs.15264..
Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Patient Safety
McArdle J, Sorensen A, Fowler CI
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
The purpose of this study using TeamSTEPPS was to assess the implementation of safety strategies to improve management of births complicated by shoulder dystocia in labor and delivery units. Results suggested that successful management of shoulder dystocia requires a rapid, standardized, and coordinated response. The Safety Program for Perinatal Care strategies to increase safety of shoulder dystocia management are scalable, replicable, and adaptable to unit needs and circumstances.
AHRQ-funded; 2902010000241.
Citation: McArdle J, Sorensen A, Fowler CI .
Strategies to improve management of shoulder dystocia under the AHRQ Safety Program for Perinatal Care.
J Obstet Gynecol Neonatal Nurs 2018 Mar;47(2):191-201. doi: 10.1016/j.jogn.2017.11.014.
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Keywords: Labor and Delivery, Newborns/Infants, Pregnancy, Adverse Events, TeamSTEPPS, Injuries and Wounds, Care Management, Education: Continuing Medical Education, Training, Tools & Toolkits, Patient Safety, Nursing, Communication, Quality of Care
Leland NE, Lepore M, Wong C
Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners.
This study aimed to identify rehabilitation practitioners' perspectives on the practices that constitute high quality hip fracture rehabilitation. The investigators suggest that guidelines are critical tools to facilitate clinical decision-making and achieve desired patient outcomes. The authors suggest that future research is needed to verify the findings from other stakeholders (e.g., patients), ensure the alignment of our findings with current evidence, and develop measures for evaluating their delivery and relationship to desired outcomes.
AHRQ-funded; HS022907.
Citation: Leland NE, Lepore M, Wong C .
Delivering high quality hip fracture rehabilitation: the perspective of occupational and physical therapy practitioners.
Disabil Rehabil 2018 Mar;40(6):646-54. doi: 10.1080/09638288.2016.1273973..
Keywords: Healthcare Delivery, Injuries and Wounds, Quality of Care, Quality Improvement, Rehabilitation
Gunter RL, Fernandes-Taylor S, Rahman S
Feasibility of an image-based mobile health protocol for postoperative wound monitoring.
Many surgical site infections (SSIs) develop in the postdischarge period and are inadequately recognized by patients. To address this, the authors developed a mobile health protocol of remote wound monitoring using smartphone technology. The current study aims to establish its feasibility among patients and providers. It found that participant and provider satisfaction was universally high.
AHRQ-funded; HS023395.
Citation: Gunter RL, Fernandes-Taylor S, Rahman S .
Feasibility of an image-based mobile health protocol for postoperative wound monitoring.
J Am Coll Surg 2018 Mar;226(3):277-86. doi: 10.1016/j.jamcollsurg.2017.12.013.
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Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Telehealth, Patient Safety, Health Information Technology (HIT)
Zullo AR, Zhang T, Beudoin FL
Pain treatments after hip fracture among older nursing home residents.
In this retrospective cohort study the investigators examined the association between use of opioids versus other analgesics with death and functioning after hip fracture in older nursing home (NH) residents. The investigators concluded that a rigorous study addressing the limitations of their study is critical to validate their preliminary findings and provide evidence about the effect of using opioid versus nonopioid analgesics to optimize acute pain in NH residents with a hip fracture.
AHRQ-funded; HS022998.
Citation: Zullo AR, Zhang T, Beudoin FL .
Pain treatments after hip fracture among older nursing home residents.
J Am Med Dir Assoc 2018 Feb;19(2):174-76. doi: 10.1016/j.jamda.2017.11.008..
Keywords: Opioids, Pain, Nursing Homes, Long-Term Care, Elderly, Medication, Injuries and Wounds, Patient-Centered Outcomes Research, Healthcare Utilization