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 208 Research Studies DisplayedGawel M, Emerson B, Giuliano JS, Jr.,
A qualitative study of multidisciplinary providers' experiences with the transfer process for injured children and ideas for improvement.
The purpose of this study was 1) to explore multidisciplinary providers' experiences with the process of transferring injured children and 2) to describe proposed ideas for process improvement. The authors concluded that efforts to improve the transfer process for injured children should be guided by the experiences of and input from multidisciplinary frontline emergency providers.
AHRQ-funded; HS023554.
Citation: Gawel M, Emerson B, Giuliano JS, Jr., .
A qualitative study of multidisciplinary providers' experiences with the transfer process for injured children and ideas for improvement.
Pediatr Emerg Care 2018 Feb;34(2):125-31. doi: 10.1097/pec.0000000000001405..
Keywords: Children/Adolescents, Patient Safety, Provider, Quality Improvement, Injuries and Wounds
Wong C, Leland NE
Clinicians' perspectives of patient engagement in post-acute care: a social ecological approach.
The purpose of this study was to identify rehabilitation providers' perspectives on barriers and facilitators of patient engagement in hip fracture patients in skilled nursing facilities (SNFs) within the social ecological model. Clinicians identified barriers and facilitators of patient engagement across all levels of the social ecological model: public policy (e.g., insurance), organizational (e.g., facility culture), interpersonal (e.g., clinicians fostering self-reflection), and intrapersonal (e.g., patients' anxiety).
AHRQ-funded; HS022907.
Citation: Wong C, Leland NE .
Clinicians' perspectives of patient engagement in post-acute care: a social ecological approach.
Phys Occup Ther Geriatr 2018;36(1):29-42. doi: 10.1080/02703181.2017.1407859..
Keywords: Injuries and Wounds, Patient and Family Engagement, Rehabilitation
Santos P, Hefele JG, Ritter G
Population-based risk factors for shoulder dystocia.
This retrospective observational study examined population-based risk factors for infant shoulder dystocia during labor. Five hospitals in 5 states were used and over 19,000 births evaluated between April 2011 and July 2013. An increased risk for dystocia was found for women who were prescribed insulin, indicating gestational diabetes. However this was not true of women with gestational diabetes who were not prescribed insulin. Other risk factors included being Black, Hispanic, covered by Medicaid or no insurance, infant gestational age of 41 weeks or greater, and chronic diabetes.
AHRQ-funded; HS019608.
Citation: Santos P, Hefele JG, Ritter G .
Population-based risk factors for shoulder dystocia.
J Obstet Gynecol Neonatal Nurs 2018 Jan;47(1):32-42. doi: 10.1016/j.jogn.2017.11.011..
Keywords: Labor and Delivery, Newborns/Infants, Risk, Pregnancy, Injuries and Wounds, Adverse Events
Wheeler KK, Shi J, Nordin AB
U.S. pediatric burn patient 30-day readmissions.
The objectives of the study were to determine unscheduled 30-day readmission rates for pediatric burn patients and to identify readmission reasons. The investigators used the 2013-2014 National Readmission Database to produce 30-day all-cause unscheduled readmission rates by patient and hospital characteristics.
AHRQ-funded; HS024263.
Citation: Wheeler KK, Shi J, Nordin AB .
U.S. pediatric burn patient 30-day readmissions.
J Burn Care Res 2018 Jan;39(1):73-81. doi: 10.1097/bcr.0000000000000596..
Keywords: Children/Adolescents, Healthcare Cost and Utilization Project (HCUP), Injuries and Wounds, Children/Adolescents, Hospital Readmissions
Skube SJ, Hu Z, Arsoniadis EG
Characterizing surgical site infection signals in clinical notes.
Building off of previous work for automated and semi-automated surgical site infections (SSIs) detection using expert-derived "strong features" from clinical notes, researchers hypothesized that additional SSI phrases may be contained in clinical notes. They systematically characterized phrases and expressions associated with SSIs. While 83 percent of expert-derived original terms overlapped with new terms and modifiers, an additional 362 modifiers associated with both positive and negative SSI signals were identified.
AHRQ-funded; HS024532.
Citation: Skube SJ, Hu Z, Arsoniadis EG .
Characterizing surgical site infection signals in clinical notes.
Stud Health Technol Inform 2017;245:955-59.
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Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Adverse Events, Quality Improvement, Quality of Care
Juriga LL, Murray DJ, Boulet JR
Simulation and the diagnostic process: a pilot study of trauma and rapid response teams.
Simulation can be used to recreate conditions that engage teams in the diagnostic process. In contrast to most instruction about diagnostic error, teams learn through realistic experiences and receive timely feedback about their decision-making skills. The purpose of this study was to assess how trauma teams (TrT) and pediatric rapid response teams (RRT) managed scenarios that included a diagnostic error.
AHRQ-funded; HS022265; HS018731.
Citation: Juriga LL, Murray DJ, Boulet JR .
Simulation and the diagnostic process: a pilot study of trauma and rapid response teams.
Diagnosis 2017 Nov 27;4(4):241-49. doi: 10.1515/dx-2017-0010..
Keywords: Diagnostic Safety and Quality, Emergency Medical Services (EMS), Injuries and Wounds, Training, Trauma
Teppala S, Ottenbacher KJ, Eschbach K
Variation in functional status after hip fracture: facility and regional influence on mobility and self-care.
Little is known about variation in functional outcomes after postacute rehabilitation for patients with hip fracture. The researchers examined variation in mobility and self-care after hip fracture rehabilitation across inpatient rehabilitation facilities (IRFs), hospital referral regions (HRRs) and states. Variation in functional status following postacute hip fracture rehabilitation appears to occur primarily at the level of facilities rather than geographic location.
AHRQ-funded; HS022134.
Citation: Teppala S, Ottenbacher KJ, Eschbach K .
Variation in functional status after hip fracture: facility and regional influence on mobility and self-care.
J Gerontol A Biol Sci Med Sci 2017 Oct;72(10):1376-82. doi: 10.1093/gerona/glw249.
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Keywords: Injuries and Wounds, Quality of Care, Health Status, Rehabilitation, Patient Self-Management
Jackson SS, Leekha S, Magder LS
Electronically available comorbidities should be used in surgical site infection risk adjustment.
A multicenter retrospective cohort study of patients undergoing surgical procedures at 28 US hospitals was performed. The authors developed a well-performing risk adjustment model for surgical site infections (SSI) using electronically available comorbidities. Healthcare-associated infections, such as SSIs, are used by the Centers for Medicare and Medicaid Services (CMS) as pay-for-performance metrics. The authors recommended that comorbidity-based risk adjustment should be strongly considered by the Centers for Disease Control and Prevention and CMS to adequately compare SSI rates across hospitals.
AHRQ-funded; HS022291.
Citation: Jackson SS, Leekha S, Magder LS .
Electronically available comorbidities should be used in surgical site infection risk adjustment.
Clin Infect Dis 2017 Sep 1;65(5):803-10. doi: 10.1093/cid/cix431..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Risk, Injuries and Wounds, Adverse Events
Olsen MA, Nickel KB, Fraser VJ
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
This study determined utilization, predictors, and outcomes of postdischarge prophylactic antibiotics after mastectomy with or without immediate breast reconstruction. The study conclude that prophylactic postdischarge antibiotics are commonly prescribed after mastectomy; immediate reconstruction is the strongest predictor. The authors recommended stewardship efforts in this population to limit continuation of prophylactic antibiotics after discharge are needed to limit antimicrobial resistance.
AHRQ-funded; HS019455.
Citation: Olsen MA, Nickel KB, Fraser VJ .
Prevalence and predictors of postdischarge antibiotic use following mastectomy.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1048-54. doi: 10.1017/ice.2017.128.
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Keywords: Antibiotics, Healthcare-Associated Infections (HAIs), Medication, Patient Safety, Surgery, Injuries and Wounds, Prevention, Adverse Events, Risk
Calderwood MS, Huang SS, Keller V
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
This study assesses hospital surgical-site infection (SSI) identification and reporting following colon surgery and abdominal hysterectomy via a statewide external validation. The authors concluded that claims-based surveillance is a standardized approach that hospitals can use to augment traditional surveillance methods and health departments can use for external validation.
AHRQ-funded; HS021424.
Citation: Calderwood MS, Huang SS, Keller V .
Variable case detection and many unreported cases of surgical-site infection following colon surgery and abdominal hysterectomy in a statewide validation.
Infect Control Hosp Epidemiol 2017 Sep;38(9):1091-97. doi: 10.1017/ice.2017.134..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Injuries and Wounds, Patient Safety, Women, Adverse Events, Diagnostic Safety and Quality, Hospitals
Sears ED, Momoh AO, Chung KC
A national study of the impact of delayed flap timing for treatment of patients with deep sternal wound infection.
This study aimed to evaluate the impact of delayed flap closure on mortality and resource use for treatment of deep sternal wound infection. The timing of flap closure was delayed more than 7 days after diagnosis in 39 percent of patients. The study concluded that delay in flap closure was associated with greater mortality and resource use.
AHRQ-funded; HS023313.
Citation: Sears ED, Momoh AO, Chung KC .
A national study of the impact of delayed flap timing for treatment of patients with deep sternal wound infection.
Plast Reconstr Surg 2017 Aug;140(2):390-400. doi: 10.1097/prs.0000000000003514.
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Keywords: Injuries and Wounds, Surgery, Healthcare-Associated Infections (HAIs), Adverse Events, Patient-Centered Outcomes Research
Newgard CD, Platts-Mills TF
Can an out-of-hospital medication history save lives for injured older adults?
In this issue of Annals, Nishijima et al present a much-needed study evaluating the use of anticoagulation and antiplatelet medications as an additional triage criterion to aid in the identification of older adults with intracranial hemorrhage. The authors believe that the new study helps fill a critical void in suggesting that a targeted medication history, formally integrated as a field triage criterion, may be useful in identifying high-risk older adults.
AHRQ-funded; HS023796.
Citation: Newgard CD, Platts-Mills TF .
Can an out-of-hospital medication history save lives for injured older adults?
Ann Emerg Med 2017 Aug;70(2):139-41. doi: 10.1016/j.annemergmed.2017.02.005.
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Keywords: Blood Thinners, Elderly, Emergency Medical Services (EMS), Injuries and Wounds, Medication
Dykes PC, Duckworth M, Cunningham S
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Patient falls during an acute hospitalization cause injury, reduced mobility, and increased costs. The laminated paper Fall TIPS Toolkit (Fall TIPS) provides clinical decision support at the bedside by linking each patient's fall risk assessment with evidence-based interventions. The investigators examined strategies to integrate this evidence into clinical practice. They concluded that engaging hospital and clinical leadership is critical in translating evidence-based care into clinical practice. They address and detail barriers to adoption of the protocol to provide guidance for spread to other institutions.
AHRQ-funded; HS025128.
Citation: Dykes PC, Duckworth M, Cunningham S .
Pilot testing Fall TIPS (Tailoring Interventions for Patient Safety): a patient-centered fall prevention toolkit.
Jt Comm J Qual Patient Saf 2017 Aug;43(8):403-13. doi: 10.1016/j.jcjq.2017.05.002..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Evidence-Based Practice, Falls, Hospitals, Injuries and Wounds, Inpatient Care, Patient Safety, Prevention, Risk, Tools & Toolkits
Berry SD, Zullo AR, McConeghy K
Defining hip fracture with claims data: outpatient and provider claims matter.
Medicare claims are commonly used to identify hip fractures, but there is no universally accepted definition. The authors of this study found that a definition using inpatient claims identified fewer fractures than a definition including outpatient and provider claims. Few additional fractures were identified by including inconsistent diagnostic and procedural codes at contiguous sites. The authors recommend that future studies publish their definition of fracture and specify if diagnostic codes from contiguous fracture sites were used.
AHRQ-funded; HS022998.
Citation: Berry SD, Zullo AR, McConeghy K .
Defining hip fracture with claims data: outpatient and provider claims matter.
Osteoporos Int 2017 Jul;28(7):2233-37. doi: 10.1007/s00198-017-4008-1..
Keywords: Elderly, Injuries and Wounds, Payment
Gandek B, Ware JE, Jr.
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
The researchers evaluated validity and responsiveness of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in relation to other patient-reported outcome measures before and after total knee replacement (TKR). They concluded that KOOS scales were valid and responsive in a cohort of 1,143 US TKR patients. KOOS QOL performed particularly well in capturing aggregate knee-specific outcomes.
AHRQ-funded; HS018910; HS024632.
Citation: Gandek B, Ware JE, Jr. .
Validity and responsiveness of the knee injury and osteoarthritis outcome score: a comparative study among total knee replacement patients.
Arthritis Care Res 2017 Jun;69(6):817-25. doi: 10.1002/acr.23193.
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Keywords: Arthritis, Surgery, Patient-Centered Outcomes Research, Outcomes, Injuries and Wounds
Baernholdt M, Hinton ID, Guofen Y
A national comparison of rural/urban pressure ulcer and fall rates.
Despite recent decline in hospital acquired conditions (HACs), rates for pressure ulcers (PURs) and falls (FRs) remain at levels that require improvement. Contextual factors and care processes may impact HACs. Using the National Database of Nursing Quality Indicators (NDNQI®) this study examined differences in care processes and community, hospital, and nursing unit characteristics that influence PURs and FRs in 4238 rural and urban nursing units.
AHRQ-funded; HS023147.
Citation: Baernholdt M, Hinton ID, Guofen Y .
A national comparison of rural/urban pressure ulcer and fall rates.
Online J Issues Nurs 2017 May;22(2):1-12. doi: 10.3912/OJIN.Vol22No02PPT60..
Keywords: Injuries and Wounds, Nursing, Patient Safety, Pressure Ulcers, Quality of Care, Quality Improvement, Quality Indicators (QIs), Quality Measures, Rural Health, Urban Health
Pretz CR, Graham JE, Middleton A
Longitudinal investigation of rehospitalization patterns in spinal cord and traumatic brain injury among Medicare beneficiaries.
The researchers modeled 12-month rehospitalization risk among Medicare beneficiaries receiving inpatient rehabilitation for SCI or TBI in order to create two (SCI- and TBI-specific) interactive tools enabling users to generate monthly projected probabilities for rehospitalization . They found that monthly rehospitalization probabilities for the individual high-risk TBI and SCI cases declined from 33-15% and 41-18%, respectively, over time.
AHRQ-funded; HS022134.
Citation: Pretz CR, Graham JE, Middleton A .
Longitudinal investigation of rehospitalization patterns in spinal cord and traumatic brain injury among Medicare beneficiaries.
Arch Phys Med Rehabil 2017 May;98(5):997-1003. doi: 10.1016/j.apmr.2016.12.012.
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Keywords: Hospital Readmissions, Medicare, Brain Injury, Injuries and Wounds
O'Toole RV, Gary JL, Reider L
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
The FIXIT study is a prospective, multicenter randomized trial comparing 1-year outcomes after treatment of severe open tibial shaft fractures with modern external ring fixation versus internal fixation among men and women of ages 18-64. The primary outcome is rehospitalization for major limb complications. One-year treatment costs and patient satisfaction will be compared between the 2 groups.
AHRQ-funded; HS000029.
Citation: O'Toole RV, Gary JL, Reider L .
A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S10-s17. doi: 10.1097/bot.0000000000000804.
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Keywords: Injuries and Wounds, Surgery, Patient-Centered Outcomes Research, Comparative Effectiveness, Outcomes, Evidence-Based Practice
Obremskey WT, Schmidt AH, O'Toole RV
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
The POvIV study is a prospective, multicenter, randomized trial to compare oral (PO) with intravenous (IV) antibiotic therapy in patients with postoperative wound infections after extremity fractures. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
AHRQ-funded; HS000029.
Citation: Obremskey WT, Schmidt AH, O'Toole RV .
A prospective randomized trial to assess oral versus intravenous antibiotics for the treatment of postoperative wound infection after extremity fractures (POvIV study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S32-s38. doi: 10.1097/bot.0000000000000802.
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Keywords: Antibiotics, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Comparative Effectiveness, Medication, Patient Safety, Adverse Events, Prevention, Patient-Centered Outcomes Research, Outcomes
Fogelberg DJ, Leland NE, Blanchard J
Qualitative experience of sleep in individuals with spinal cord injury.
The objective of this study was to examine the experience of sleep among individuals with spinal cord injury (SCI). Sleep-related data were found in transcripts for 90 percent of the sample. Participants described diminished sleep duration and irregular sleep patterns. Several factors contributing to poor sleep were identified, including SCI-related circumstances and sleep environment. Participants also discussed how poor sleep affected occupational engagement.
AHRQ-funded; HS022907.
Citation: Fogelberg DJ, Leland NE, Blanchard J .
Qualitative experience of sleep in individuals with spinal cord injury.
OTJR 2017 Apr;37(2):89-97. doi: 10.1177/1539449217691978.
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Keywords: Sleep Problems, Quality of Life, Injuries and Wounds
Hu Z, Melton GB, Arsoniadis EG
Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record.
Proper handling of missing data is important for many secondary uses of electronic health record (EHR) data. Data imputation methods can be used to handle missing data, but their use for postoperative complication detection is unclear. Overall, models with missing data imputation almost always outperformed reference models without imputation that included only cases with complete data for detection of SSI overall achieving very good average area under the curve values.
AHRQ-funded; HS024532.
Citation: Hu Z, Melton GB, Arsoniadis EG .
Strategies for handling missing clinical data for automated surgical site infection detection from the electronic health record.
J Biomed Inform 2017 Apr;68:112-20. doi: 10.1016/j.jbi.2017.03.009.
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Keywords: Data, Electronic Health Records (EHRs), Healthcare-Associated Infections (HAIs), Registries, Surgery, Injuries and Wounds, Health Information Technology (HIT), Quality Improvement, Quality of Care, Adverse Events
O'Toole RV, Joshi M, Carlini AR
Supplemental perioperative oxygen to reduce surgical site infection after high-energy fracture surgery (OXYGEN study).
This study is a clinical trial with a primary goal of assessing the efficacy of 2 different concentrations of perioperative oxygen in the prevention of surgical site infection (SSI) in adults with tibial plateau, pilon (tibial plafond), or calcaneus fractures at higher risk of infection and definitively treated with plate and screw fixation.
AHRQ-funded; HS000029.
Citation: O'Toole RV, Joshi M, Carlini AR .
Supplemental perioperative oxygen to reduce surgical site infection after high-energy fracture surgery (OXYGEN study).
J Orthop Trauma 2017 Apr;31 Suppl 1:S25-s31. doi: 10.1097/bot.0000000000000803.
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Keywords: Injuries and Wounds, Surgery, Healthcare-Associated Infections (HAIs), Prevention, Patient Safety, Adverse Events
Wright NC, Saag KG, Dawson-Hughes B
The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA.
This study evaluated the prevalence of osteoporosis using the osteoporosis diagnostic criteria developed by the National Bone Health Alliance (NBHA), which includes qualified fractures, FRAX score in addition to bone mineral density (BMD). The study found that 16% of men and 29.9% of women 50+ have osteoporosis based on the NBHA diagnostic criteria.
AHRQ-funded; HS023009.
Citation: Wright NC, Saag KG, Dawson-Hughes B .
The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA.
Osteoporos Int 2017 Apr;28(4):1225-32. doi: 10.1007/s00198-016-3865-3..
Keywords: Diagnostic Safety and Quality, Injuries and Wounds, Osteoporosis
Wegener ST, Pollak AN, Frey KP
The Trauma Collaborative Care Study (TCCS).
This article describes the Trauma Collaborative Care (TCC) program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers. Compared with standard treatment alone, it is hypothesized that access to the TCC program plus standard treatment will result in lower rates of poor patient-reported function, depression, and posttraumatic stress disorder.
AHRQ-funded; HS000029.
Citation: Wegener ST, Pollak AN, Frey KP .
The Trauma Collaborative Care Study (TCCS).
J Orthop Trauma 2017 Apr;31 Suppl 1:S78-s87. doi: 10.1097/bot.0000000000000792.
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Keywords: Injuries and Wounds, Outcomes, Patient-Centered Outcomes Research, Behavioral Health, Screening, Trauma
Kathuria P, Gordon KB, Silverberg JI
Association of psoriasis and psoriatic arthritis with osteoporosis and pathological fractures.
This study investigated whether psoriasis (Pso) and psoriatic arthritis (PsA) are associated with osteoporosis and fractures in US adults. Using records of 183,725 persons with Pso and 28,765 with PsA from the 2006-2012 National Emergency Department Sample, including 20 percent of the emergency care visits throughout the United States, it found that Pso and PsA were associated with osteopenia, osteoporosis, ankylosing spondylitis, and pathologic fractures.
AHRQ-funded; HS023011.
Citation: Kathuria P, Gordon KB, Silverberg JI .
Association of psoriasis and psoriatic arthritis with osteoporosis and pathological fractures.
J Am Acad Dermatol 2017 Mar 14;76(6):1045-53.e3. doi: 10.1016/j.jaad.2016.11.046.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Osteoporosis, Injuries and Wounds, Arthritis