National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
Topics
- Case Study (1)
- COVID-19 (8)
- Elderly (2)
- Emergency Department (1)
- Emergency Preparedness (1)
- Evidence-Based Practice (4)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (4)
- Healthcare Costs (2)
- Hospitals (2)
- Human Immunodeficiency Virus (HIV) (1)
- (-) Infectious Diseases (19)
- Long-Term Care (1)
- Nursing Homes (2)
- Patient Safety (1)
- Policy (1)
- (-) Prevention (19)
- Provider (1)
- Provider: Health Personnel (1)
- (-) Public Health (19)
- Public Reporting (1)
- Respiratory Conditions (2)
- Screening (1)
- Sexual Health (1)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Vaccination (2)
- Vulnerable Populations (2)
- Women (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 19 of 19 Research Studies DisplayedJenkins JL, Hsu EB, Zhang A
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
This study’s aim was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. A database search was conducted for literature published January 2006 through March 15, 2022 to search for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing and less frequent hand hygiene after glove use were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity and virus 2 (SARS-CoV-2) seropositivity. Workers were more likely to be vaccinated against influenza if their employer offered the vaccine. Vaccination rates for H1N1 influenza increased with the use of active, targeted education modules.
AHRQ-funded; 75Q80120D00003.
Citation: Jenkins JL, Hsu EB, Zhang A .
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
Prehosp Disaster Med 2023 Jun; 38(3):371-77. doi: 10.1017/s1049023x23000389..
Keywords: COVID-19, Emergency Department, Evidence-Based Practice, Prevention, Public Health, Infectious Diseases
Crnich CJ
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
This paper provides an overview of nursing home (NH) infection and control, reviews the 2016 CMS changes to federal regulations, and proposes recommendations to sustain improvements. COVID-19 put further pressure on nursing homes who were already strained by rising numbers of infections from C. difficile and multidrug-resistant organisms. The author puts out a call for reimagining infection prevention and control using the Systems Engineering Initiative for Patient Safety framework. Additional recommendations are made to enhance NH infection prevention and control programs in the areas of people, tasks, tools, organization, built environment, and external environment.
AHRQ-funded; HS022465.
Citation: Crnich CJ .
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc 2022 Dec;23(12):1909-15. doi: 10.1016/j.jamda.2022.10.022..
Keywords: Elderly, COVID-19, Public Health, Infectious Diseases, Nursing Homes, Healthcare-Associated Infections (HAIs), Prevention
Adams C, Peterson SR, Hall AJ
Associations of infection control measures and norovirus outbreak outcomes in healthcare settings: a systematic review and meta-analysis.
This systematic review/meta-analysis’ goal was to assess associations between norovirus outbreak control measures and outcomes in hospitals and long-term care facilities (LTCFs), globally. The authors identified 102 papers describing 162 norovirus outbreaks. Control measures were reportedly implemented in 118 (73%) outbreaks and were associated with 0.6 times smaller patient case counts and 0.7 times shorter durations in hospitals but 1.5, 1.5 and 1.6 times larger overall, resident and staff case counts, respectively, and 1.4 times longer durations in LTCFs. The paper concluded that control measures were likely implemented in response to larger/longer outbreaks in LTCFs rather than causing them, while hospitals’ preemptive control measures resulted in smaller/shorter outbreaks.
AHRQ-funded; HS025987.
Citation: Adams C, Peterson SR, Hall AJ .
Associations of infection control measures and norovirus outbreak outcomes in healthcare settings: a systematic review and meta-analysis.
Expert Rev Anti Infect Ther 2022 Feb;20(2):279-90. doi: 10.1080/14787210.2021.1949985..
Keywords: Infectious Diseases, Prevention, Public Health, Evidence-Based Practice
Malloy GSP, Puglisi L, Brandeau ML
Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis.
The authors sought to estimate the impact of various mitigation strategies on COVID-19 transmission in a US jail beyond those offered in national guidelines. They found that depopulation, single celling, and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. They recommended that decision makers prioritize reductions in the jail population, single celling, and testing asymptomatic populations as additional measures to manage COVID-19 within correctional settings.
AHRQ-funded; HS026128.
Citation: Malloy GSP, Puglisi L, Brandeau ML .
Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis.
BMJ Open 2021 Feb 17;11(2):e042898. doi: 10.1136/bmjopen-2020-042898..
Keywords: COVID-19, Public Health, Vulnerable Populations, Prevention, Infectious Diseases
Puglisi LB, Malloy GSP, Harvey TD
Estimation of COVID-19 basic reproduction ratio in a large urban jail in the United States.
The purpose of this study was to estimate the basic reproduction ratio () of SARS-CoV-2 inside a correctional facility early in the COVID-19 pandemic. The investigators concluded that the high of SARS-CoV-2 in a large urban jail highlighted the importance of including correctional facilities in public health strategies for COVID-19. The investigators suggested that in the absence of more aggressive mitigation strategies, correctional facilities will continue to contribute to community infections.
AHRQ-funded; HS026128.
Citation: Puglisi LB, Malloy GSP, Harvey TD .
Estimation of COVID-19 basic reproduction ratio in a large urban jail in the United States.
Ann Epidemiol 2021 Jan;53:103-05. doi: 10.1016/j.annepidem.2020.09.002..
Keywords: COVID-19, Public Health, Vulnerable Populations, Prevention, Infectious Diseases
Lee BY, Bartsch SM, Ferguson MC
The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Researchers developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. They reported that their study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Ferguson MC .
The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
PLoS Comput Biol 2021 Jan;17(1):e1008470. doi: 10.1371/journal.pcbi.1008470..
Keywords: COVID-19, Respiratory Conditions, Public Health, Prevention, Infectious Diseases
Fan T, Palma M
AHRQ Author: Fan T
Behavioral counseling interventions to prevent sexually transmitted infections.
This case study of a 24-year-old cisgender woman presents three questions with answers concerning USPSTF recommendations about sexually transmitted infections and counseling.
AHRQ-authored.
Citation: Fan T, Palma M .
Behavioral counseling interventions to prevent sexually transmitted infections.
Am Fam Physician 2020 Nov 15;102(10):623-24..
Keywords: U.S. Preventive Services Task Force (USPSTF), Sexual Health, Infectious Diseases, Public Health, Prevention, Case Study, Guidelines
Chou R, Dana T, Jungbauer R
Masks for prevention of respiratory virus infections, including SARS-CoV-2, in health care and community settings : a living rapid review.
This study examined the effectiveness of N95, surgical, and cloth masks in community and health care settings for preventing respiratory virus infections, including coronavirus. The effects of reuse or extended use of N95 masks was also studied. The authors used multiple electronic databases, including the World Health Organization COVID-19 database and medRxiv preprint server (2003 through 2020), and reference lists. Randomized trials of masks and risks for respiratory virus infection were included. The studies were abstracted and methodological limitations were assessed by one reviewer, with a second reviewer providing verification. Thirty-nine studies with 33,867 participants were included. No studies were found that evaluated reuse or extended use of N95 masks. The studies showed that COVID-19 and MERS probably decreased with use versus nonuse and possibly decreased with N95 versus surgical mask use. Random trials in community settings found not much difference between N95 versus surgical masks. The studies’ findings were not definitive.
AHRQ-funded; 290201500009I.
Citation: Chou R, Dana T, Jungbauer R .
Masks for prevention of respiratory virus infections, including SARS-CoV-2, in health care and community settings : a living rapid review.
Ann Intern Med 2020 Oct 6;173(7):542-55. doi: 10.7326/m20-3213..
Keywords: COVID-19, Respiratory Conditions, Infectious Diseases, Prevention, Public Health, Evidence-Based Practice
Bartsch SM, O'Shea KJ, Ferguson MC
Vaccine efficacy needed for a COVID-19 coronavirus vaccine to prevent or stop an epidemic as the sole intervention.
This study examined the needed efficacy and coverage of a COVID-19 vaccine to prevent or stop the pandemic. Simulation experiments were conducted at 60-80% efficacy rates. At 60% efficacy, vaccination coverage needs to be 100%. If the coverage rate is reduced to 75%, the efficacy needs to be 70% and up to 80% when coverage drops to 60%. These findings show that the vaccine needs to have at least an efficacy rate of 70% to prevent an epidemic and at least 80% to extinguish an epidemic without any other measures such as social distancing.
AHRQ-funded; HS023317.
Citation: Bartsch SM, O'Shea KJ, Ferguson MC .
Vaccine efficacy needed for a COVID-19 coronavirus vaccine to prevent or stop an epidemic as the sole intervention.
Am J Prev Med 2020 Oct;59(4):493-503. doi: 10.1016/j.amepre.2020.06.011..
Keywords: Vaccination, COVID-19, Public Health, Prevention, Evidence-Based Practice, Infectious Diseases
Cho HJ, Feldman LS, Keller S
Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers.
This paper highlights the 5 top recommendations developed for hospitals in the COVID-19 era as part of the Choosing Wisely® campaign. This top 5 list of overuse practices in hospital medicine can lead to harm of both patients and healthcare workers. The recommendations include: 1) Do not obtain nonurgent labs in separate blood draws if they can be batched together; 2) Do not use bronchodilators unless there is active obstructive airway disease; 3) Do not use posteroanterior and lateral chest X-ray (CXR) as initial imaging, use a portable CXR instead; 4) Avoid in-person evaluations in favor of virtual communication unless necessary; and 5) Do not delay goals of care conversations for hospitalized patients who are unlikely to benefit from life-sustaining treatments.
AHRQ-funded; HS025782.
Citation: Cho HJ, Feldman LS, Keller S .
Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers.
J Hosp Med 2020 Jun;15(6):360-62. doi: 10.12788/jhm.3457..
Keywords: COVID-19, Infectious Diseases, Hospitals, Prevention, Public Health, Provider: Health Personnel
Adams C, Young D, Gastanaduy PA
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
Norovirus transmissibility is poorly understood and the goal of this study was to examine transmission via vomiting, diarrhea, and patient exposures. Six nursing home outbreaks in South Carolina were examined from 2014 to 2016. Vomiting infected 2.12 times the number of individuals as non-vomiters, diarrhea 1.39 times, and resident cases infected 1.53 times the number of individuals as staff cases. This finding is important for not just nursing homes, but other sites of norovirus outbreaks such as cruise ships.
AHRQ-funded; HS025987.
Citation: Adams C, Young D, Gastanaduy PA .
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
PLoS Comput Biol 2020 Mar;16(3):e1007271. doi: 10.1371/journal.pcbi.1007271..
Keywords: Elderly, Nursing Homes, Long-Term Care, Infectious Diseases, Healthcare-Associated Infections (HAIs), Prevention, Public Health
Bartsch SM, Asti L, Stokes-Cawley OJ
The potential economic value of a Zika vaccine for a woman of childbearing age.
The authors mapped the Zika vaccine and vaccination characteristic thresholds at which vaccination becomes cost effective, highly cost effective, and cost saving. They developed a Markov model to simulate a woman of childbearing age to follow the potential risk and clinical course of a Zika infection. They found that, in some cases, the vaccine was cost effective when the risk was as low as 0.015%, the cost was as high as $7,500, the efficacy was as low as 25%, and the duration of protection was 1 year. They concluded that the thresholds at which vaccination becomes cost effective and cost saving can provide targets for Zika vaccine development and implementation.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Asti L, Stokes-Cawley OJ .
The potential economic value of a Zika vaccine for a woman of childbearing age.
Am J Prev Med 2020 Mar;58(3):370-77. doi: 10.1016/j.amepre.2019.10.023..
Keywords: Vaccination, Women, Infectious Diseases, Public Health, Healthcare Costs, Prevention
Brault MA, Spiegelman D, Hargreaves J
Treatment as prevention: concepts and challenges for reducing HIV incidence.
This paper reviews the results and lessons learned from four large-scale HIV antiretroviral therapy (ART) clinical trials that were held in sub-Saharan Africa to reduce HIV transmission. These trials used treatment as prevention (TasP) to improve overall health and protect HIV-uninfected sexual partners from infection. There were seemingly inconsistent findings in the major TasP trials held in South African, Kenya, Uganda, Botswana, and Zambia. The review highlighted implementation challenges and identified approaches to optimize programs and incentivize uptake and engagement in HIV testing and ART-based care.
AHRQ-funded; HS023000.
Citation: Brault MA, Spiegelman D, Hargreaves J .
Treatment as prevention: concepts and challenges for reducing HIV incidence.
J Acquir Immune Defic Syndr 2019 Dec 1;82 Suppl 2:S104-s12. doi: 10.1097/qai.0000000000002168..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Infectious Diseases, Public Health, Screening
Malloy GSP, Brandeau ML, Goldhaber-Fiebert JD
Modeling the cost-effectiveness of interventions to prevent plague in Madagascar.
The authors assessed the cost-effectiveness of plague (Yersinia pestis) control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. They calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios from a healthcare perspective. The preferred intervention, using a cost-effectiveness threshold of $1350/QALY, was expanded access to antibiotic treatment with doxycycline with 100% coverage starting immediately after the first reported case, gaining 543 QALYs at an incremental cost of $1023/QALY gained. Sensitivity analyses support expanded access to antibiotic treatment and leave open the possibility that mass distribution of doxycycline prophylaxis or mass distribution of malathion could be cost-effective.
AHRQ-funded; HS026128.
Citation: Malloy GSP, Brandeau ML, Goldhaber-Fiebert JD .
Modeling the cost-effectiveness of interventions to prevent plague in Madagascar.
Trop Med Infect Dis 2021 Jun 11;6(2). doi: 10.3390/tropicalmed6020101..
Keywords: Infectious Diseases, Healthcare Costs, Public Health, Prevention
Lee BY, Bartsch SM, Wong KF
Tracking the spread of carbapenem-resistant Enterobacteriaceae (CRE) through clinical cultures alone underestimates the spread of CRE even more than anticipated.
Clinical testing detects only a fraction of carbapenem-resistant Enterobacteriaceae (CRE) carriers, an estimated 1 of every 9 carriers; therefore, it may underestimate true CRE burden. Because targeted interventions to prevent spread are applied only to known cases, the unseen part of the “iceberg” of CRE carriers can exacerbate pathogen spread through lack of applied contact precautions and other infection prevention strategies. In this study, the investigators estimate the size of the iceberg in a large US metropolitan area.
Citation: Lee BY, Bartsch SM, Wong KF .
Tracking the spread of carbapenem-resistant Enterobacteriaceae (CRE) through clinical cultures alone underestimates the spread of CRE even more than anticipated.
.
Keywords: Infectious Diseases, Public Health, Prevention
Woodard JA, Leekha S, Jackson SS
Beyond entry and exit: Hand hygiene at the bedside.
This study assessed compliance with, knowledge of, and attitudes toward the World Health Organization (WHO) 5 moments for hand hygiene (HH) using a modified WHO HH observation form and a survey that assessed health care personnel (HCP) knowledge, opinions, and barriers to HH. Of the 218 HCPs who completed the survey, less than one-third were familiar with the WHO 5 moments and only 21& of that group could recall the 5 moments. 302 HH opportunities in 104 unique HCP-patient interactions were observed, but with infrequent compliance. The researchers conclude that lack of recognition of opportunities at the bedside and for glove use may contribute to low compliance.
AHRQ-funded; HS024108.
Citation: Woodard JA, Leekha S, Jackson SS .
Beyond entry and exit: Hand hygiene at the bedside.
Am J Infect Control 2019 May;47(5):487-91. doi: 10.1016/j.ajic.2018.10.026..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Provider, Public Health
Pogorzelska-Maziarz M, de Cordova PB, Herzig M, de Cordova PB, Herzig CTA
Perceived impact of state-mandated reporting on infection prevention and control departments.
Currently, most US states have adopted legislation requiring hospitals to submit health care-associated infection (HAI) data. In this study, the authors evaluated the perceived impact of state HAI laws on infection prevention and control (IPC) departments. They concluded that respondents in states with laws reported negative effects on their IPC department, beyond what was required by federal mandates.
AHRQ-funded; HS024339.
Citation: Pogorzelska-Maziarz M, de Cordova PB, Herzig M, de Cordova PB, Herzig CTA .
Perceived impact of state-mandated reporting on infection prevention and control departments.
Am J Infect Control 2019 Feb;47(2):118-22. doi: 10.1016/j.ajic.2018.08.012..
Keywords: Public Reporting, Policy, Public Health, Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Hospitals
Marx FM, Yaesoubi R, Menzies NA
Tuberculosis control interventions targeted to previously treated people in a high-incidence setting: a modelling study.
In high-incidence settings, recurrent disease among previously treated individuals contributes substantially to the burden of incident and prevalent tuberculosis. The authors developed a transmission-dynamic model of tuberculosis and HIV in a high-incidence setting. And concluded that in the high-incidence setting, the use of targeted active case finding in combination with secondary isoniazid preventive therapy in previously treated individuals could accelerate decreases in tuberculosis morbidity and mortality.
AHRQ-funded; HS000055.
Citation: Marx FM, Yaesoubi R, Menzies NA .
Tuberculosis control interventions targeted to previously treated people in a high-incidence setting: a modelling study.
Lancet Glob Health 2018 Apr;6(4):e426-e35. doi: 10.1016/s2214-109x(18)30022-6..
Keywords: Infectious Diseases, Prevention, Public Health
Matthews Pillemer F, Blendon RJ, Zaslavsky AM
Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis.
Non-pharmaceutical interventions (NPIs) such as quarantines and face masks are socially and economically disruptive, and usually require compliance by a significant proportion of the population to be effective. The researchers investigated the predictors of NPI support in Hong Kong, Singapore, Taiwan, and the United States. They found NPI support varies widely by region, possibly because of cultural variation and prior experience.
AHRQ-funded; HS000055; HS017587.
Citation: Matthews Pillemer F, Blendon RJ, Zaslavsky AM .
Predicting support for non-pharmaceutical interventions during infectious outbreaks: a four region analysis.
Disasters 2015 Jan;39(1):125-45. doi: 10.1111/disa.12089..
Keywords: Public Health, Prevention, Infectious Diseases, Emergency Preparedness