National Healthcare Quality and Disparities Report
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Topics
- Blood Pressure (2)
- Cardiovascular Conditions (2)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (1)
- Communication (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Cultural Competence (1)
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- Diagnostic Safety and Quality (1)
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- Healthcare-Associated Infections (HAIs) (2)
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- Health Services Research (HSR) (3)
- Heart Disease and Health (3)
- (-) Home Healthcare (19)
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- Patient Experience (1)
- Patient Safety (2)
- Policy (1)
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- Provider: Health Personnel (1)
- Provider Performance (2)
- Public Health (1)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
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- Quality of Care (1)
- Respiratory Conditions (1)
- Risk (2)
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- Transitions of Care (3)
- Vulnerable Populations (2)
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
1 to 19 of 19 Research Studies DisplayedDuan KI, Wong ES, Liao JM
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
The purpose of this study was to explore how respiratory durable medical equipment (DME) supply has changed since Medicare implemented the Competitive Bidding Program (CBP) in 2011and increased the scale of the program nationally in 2013 and 2016. The researchers analyzed all publicly available nationwide Medicare DME data from 2013 to 2019 and analyzed all respiratory DME included in the CBP (excluding accessories such as masks, tubing, and filters). The researchers found that the three highest-volume respiratory DME products were stationary oxygen concentrators, continuous positive airway pressure (CPAP) devices, and gaseous portable oxygen. Decreases in suppliers across all items and increases in claims per supplier for the majority of items suggest greater market concentration of respiratory DME suppliers for Medicare beneficiaries. Even as the Medicare population expanded by 2.6% between 2013 and 2019, the number of patients receiving home oxygen decreased, results that could represent reduced access to home oxygen DME. Finally, in contrast to declines in use for most home oxygen items, the percentage of Medicare beneficiaries using portable oxygen concentrators and CPAP devices increased significantly. The researchers conclude that this analysis addresses a critical knowledge gap and highlights the need for future work evaluating how policies such as the CBP affect respiratory DME access and outcomes.
AHRQ-funded; HS026369.
Citation: Duan KI, Wong ES, Liao JM .
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
Am J Respir Crit Care Med 2022 Aug 15;206(4):509-11. doi: 10.1164/rccm.202202-0238LE..
Keywords: Home Healthcare, Medicare, Respiratory Conditions
Lee JL, Gustavson AM, Kian L
Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations.
This research letter discusses the development process for cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations. These collaborations are proposed between health, social, and academic research systems. The authors collaborated with their local Houston Meals on Wheels (MOW) program, the University of Texas Health Science Center at Houston, and the Harris County Health System. These organizations formed a Healthy Aging Committee with several healthcare professionals from different healthcare systems participating as volunteers. The goal of the Committee was to identify ways to highlight the potential benefits of nutritious meal delivery. The three institutions worked together through all stages of research, from grant writing to recruiting participants, establishing trust in their relationships, and leveraging their connections and expertise in different areas. In their first research project, they investigated the addition of a home-based exercise program with enhanced meal deliveries to improve frailty status in older adults who were frail and homebound. This pilot study had been stopped during the pandemic. The restarted study was revised so that the MOW drivers delivering frozen and shelf-stable meals in person once a week would now also provide exercise handouts for those in the treatment group to minimize face-to-face contact. Their current second research project is evaluating whether the combination of a virtual assistant device such as Amazon Alexa with meal delivery can improve mental health for homebound older adults with cognitive impairment.
AHRQ-funded; HS026379.
Citation: Lee JL, Gustavson AM, Kian L .
Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations.
J Am Geriatr Soc 2022 Jul; 70(7):1939-41. doi: 10.1111/jgs.17813..
Keywords: Elderly, Home Healthcare, Vulnerable Populations, Public Health
Hobensack M, Ojo M, Barrón Y
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians.
The objectives of this study were to identify risk factors that home healthcare clinicians associate with patient deterioration and to understand clinicians’ response to and documentation of these risk factors. The authors interviewed multidisciplinary home healthcare clinicians and used directed content analysis to identify risk factors for deterioration. A total of 79 risk factors were identified by the clinicians, who responded most often by communicating with the prescribing provider or following up with patients and caregivers. Clinicians also acknowledged that social factors played a role in deterioration risk. The authors noted that, since most risk factors were documented in clinical notes, methods such as natural language processing are needed to extract them. They concluded that by providing a comprehensive list of risk factors grounded in clinician expertise and mapped to standardized terminologies, the results of their study supported the development of an early warning system for patient deterioration.
AHRQ-funded; HS027742.
Citation: Hobensack M, Ojo M, Barrón Y .
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians.
J Am Med Inform Assoc 2022 Apr 13;29(5):805-12. doi: 10.1093/jamia/ocac023..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Home Healthcare, Risk, Hospitalization
Wang J, Ying M, Li Y
Home health agencies with more socially vulnerable patients have poorer experience of care ratings.
The purpose of this study was to evaluate the relationship between Medicare dual eligibility and race/ ethnicity when exploring Medicare-certified Home Health Agencies (CHHAs) and experience of care ratings. The researchers analyzed the 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs and found that CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings. In addition, CHHAs with higher proportions of racial/ ethnic minorities were less likely to have high experience of care ratings in the domains of care delivery, communication, and specific care issues.
AHRQ-funded; HS026893.
Citation: Wang J, Ying M, Li Y .
Home health agencies with more socially vulnerable patients have poorer experience of care ratings.
J Appl Gerontol 2022 Mar;41(3):661-70. doi: 10.1177/07334648211053859..
Keywords: Elderly, Home Healthcare, Vulnerable Populations, Provider Performance
Schwartz ML, Rahman M, Thomas KS
Consumer selection and home health agency quality and patient experience stars.
The objective of this study was to compare the impact of the introduction of two distinct sets of star ratings, quality of care, and patient experience, on home health agency (HHA) selection. The investigators concluded that the introduction of quality of care and patient experience stars were associated with changes in HHA selection; however, the strength of these relationships was weaker than observed in other health care settings where a single star rating was reported.
AHRQ-funded; HS026440.
Citation: Schwartz ML, Rahman M, Thomas KS .
Consumer selection and home health agency quality and patient experience stars.
Health Serv Res 2022 Feb;57(1):113-24. doi: 10.1111/1475-6773.13867..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Home Healthcare, Patient Experience, Quality Measures, Quality of Care, Provider Performance, Quality Indicators (QIs)
Bryant KB, Green MB, Shimbo D
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
This analysis examined how historical use of home blood pressure monitoring (HBPM) aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis and how HBPM use varies by patient characteristics. A cohort of 7185 adults aged 20 years or older without a diagnosis of hypertension or antihypertensive medication use and a high office BP (≥130/80 mm Hg) who participated in the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014 cycle were included. Participants who answered as having self-initiated or physician recommended HBPM were categorized as having used or having been told to use HBPM. The authors estimate that 31.4 million US adults did not have diagnosed hypertension, were not taking antihypertensive medications, and had an office BP ≥130/80 mm Hg. Out of that population, 95.3% would have met criteria to undergo out-of-office BP monitoring by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Only 3.6% (1.1 million) were told to use HBPM, and 15.7% had used HPBM. There were no differences in use by race/ethnicity, sex, health insurance status, or source of routine healthcare. The authors suggest the use of a telemonitoring system to improve ease of HBPM.
AHRQ-funded; HS024262.
Citation: Bryant KB, Green MB, Shimbo D .
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
Hypertension 2022 Feb;79(2):e15-e17. doi: 10.1161/hypertensionaha.121.18463..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Home Healthcare, Guidelines, Evidence-Based Practice
Squires A, Ma C, Miner S
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. The objective of this retrospective cross-sectional study was to determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge.
AHRQ-funded; HS023593.
Citation: Squires A, Ma C, Miner S .
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
Int J Nurs Stud 2022 Jan;125:104093. doi: 10.1016/j.ijnurstu.2021.104093..
Keywords: Cultural Competence, Home Healthcare, Hospital Readmissions, Risk, Communication
Yang Y, Bass EJ, Sockolow PS
Knowledge elicitation of homecare admission decision making processes via focus group, member checking and data visualization.
Researchers elicit knowledge related to expert decision-making processes to inform information technology design and related interventions. In this study, the investigators examine knowledge elicitation of homecare admission decision making processes via focus group, member checking and data visualization. The investigators concluded that the data collection and validation methodology showed promise for knowledge elicitation in time-constrained situations.
AHRQ-funded; HS024537.
Citation: Yang Y, Bass EJ, Sockolow PS .
Knowledge elicitation of homecare admission decision making processes via focus group, member checking and data visualization.
AMIA Annu Symp Proc 2018 Dec 5;2018:1127-36..
Keywords: Home Healthcare, Shared Decision Making, Health Information Technology (HIT), Data
Sterling MR, Silva AF, Leung PBK
"It's like they forget that the word 'health' is in 'home health aide'": Understanding the perspectives of home care workers who care for adults with heart failure.
Home care workers (HCWs) were interviewed about their role and perspectives in caring for community-dwelling adults with heart failure (HF) posthospitalization. Researchers conducted a total of 8 focus groups in partnership with the Home Care Industry Education Fund. A total of 46 English- and Spanish-speaking HCWs employed by 21 unique home care agencies participated. Generally they felt overworked and unappreciated but care about their clients and families and still love their job. The majority of HCWs have not received HF training, so do not feel supported when their clients’ symptoms worsened.
AHRQ-funded; HS024569.
Citation: Sterling MR, Silva AF, Leung PBK .
"It's like they forget that the word 'health' is in 'home health aide'": Understanding the perspectives of home care workers who care for adults with heart failure.
J Am Heart Assoc 2018 Dec 4;7(23):e010134. doi: 10.1161/jaha.118.010134..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Home Healthcare, Provider: Health Personnel
Keller SC, Williams D, Rock C
A new frontier: central line-associated bloodstream infection surveillance in home infusion therapy.
As more home infusion agencies consider ways to perform surveillance for central line–associated bloodstream infection (CLABSI), an understanding of the assorted challenges is necessary. The authors discussed these challenges, which include a lack of a widely accepted standard definition of CLABSIs in home infusion therapy, the lack of a reporting platform, the absence of a reporting requirement, and barriers in obtaining the needed information to identify the presence of a potential CLABSI and adjudicate whether it meets a CLABSI definition. The 21st Century Cures Act will expand Medicare coverage for home infusion therapy services by 2021, likely leading to increased pressure for home infusion therapy CLABSI surveillance. Benchmarking of CLABSI data can usher in informed work to reduce CLABSIs and enhance patient safety in home infusion therapy.
AHRQ-funded; HS025782.
Citation: Keller SC, Williams D, Rock C .
A new frontier: central line-associated bloodstream infection surveillance in home infusion therapy.
Am J Infect Control 2018 Dec;46(12):1419-21. doi: 10.1016/j.ajic.2018.05.016..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Home Healthcare, Patient Safety, Sepsis, Infectious Diseases, Prevention
Russell D, Dowding DW, McDonald MV
Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control.
This study analyzed survey responses from nurses at 2 large, certified home healthcare agencies to explore levels of compliance with infection control practices and identify associated demographic, knowledge, and attitudinal correlates. The findings suggested that efforts to improve compliance with infection control practices in home healthcare should focus on strategies to alter perceptions about infection risk and other attitudinal factors.
AHRQ-funded; HS024723.
Citation: Russell D, Dowding DW, McDonald MV .
Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses' knowledge and attitudes toward infection control.
Am J Infect Control 2018 Nov;46(11):1211-17. doi: 10.1016/j.ajic.2018.05.005..
Keywords: Healthcare-Associated Infections (HAIs), Home Healthcare, Prevention, Patient Safety
Sterling MR, Shaw AL, Leung PB
Home care workers in heart failure: a systematic review.
This systematic review aimed to 1) describe utilization patterns of home care workers (HCWs) by adults with heart failure (HF), 2) examine the effect of HCWs on HF outcomes, and 3) review HF interventions that involve HCWs. The investigators concluded that the literature on these HCWs in HF is limited. They suggest that additional research is warranted on the potential role of HCWs in HF self-care and on outcomes among adults with HF.
AHRQ-funded; HS024569; T32 HS000066.
Citation: Sterling MR, Shaw AL, Leung PB .
Home care workers in heart failure: a systematic review.
J Multidiscip Healthc 2018 Sep 25;11:481-92. doi: 10.2147/jmdh.s175512..
Keywords: Health Services Research (HSR), Heart Disease and Health, Home Healthcare
Auger KA, Simmons JM, Tubbs-Cooley HL
Postdischarge Nurse Home Visits and Reuse: the Hospital to Home Outcomes (H2O) Trial.
In this study, the investigators evaluated the effects of a pediatric transition intervention, specifically a single nurse home visit, on postdischarge outcomes in a randomized controlled trial. The investigators concluded that children randomly assigned to the intervention had higher rates of 30-day postdischarge unplanned health care reuse. They also noted that parents in the intervention group recalled more clinical warning signs 2 weeks after discharge.
AHRQ-funded; HS024735.
Citation: Auger KA, Simmons JM, Tubbs-Cooley HL .
Postdischarge Nurse Home Visits and Reuse: the Hospital to Home Outcomes (H2O) Trial.
Pediatrics 2018 Jul;142(1). doi: 10.1542/peds.2017-3919..
Keywords: Children/Adolescents, Home Healthcare, Hospital Discharge, Nursing, Transitions of Care
Dowding DW, Russell D, Onorato N
Technology solutions to support care continuity in home care: a focus group study.
The purpose of this study was to explore perceptions among home care clinicians of the barriers they face and the information they need to improve care continuity for patients with heart failure. The study highlighted areas of improvement for health information technology solutions that could support care delivery for patients with heart failure in a home care setting.
AHRQ-funded; HS023855.
Citation: Dowding DW, Russell D, Onorato N .
Technology solutions to support care continuity in home care: a focus group study.
J Healthc Qual 2018 Jul/Aug;40(4):236-46. doi: 10.1097/jhq.0000000000000104..
Keywords: Healthcare Delivery, Health Information Technology (HIT), Heart Disease and Health, Home Healthcare, Quality Improvement
Myerson RM, Colantonio LD, Safford MM
Does identification of previously undiagnosed conditions change care-seeking behavior?
The purpose of the study was to determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries. The study concluded that in-home assessment of cholesterol, blood pressure, and blood glucose can increase doctor visits for individuals with previously undiagnosed conditions. However, biomarker assessment may have more limited impact among individuals with low access to care.
AHRQ-funded; HS000084.
Citation: Myerson RM, Colantonio LD, Safford MM .
Does identification of previously undiagnosed conditions change care-seeking behavior?
Health Serv Res 2018 Jun;53(3):1517-38. doi: 10.1111/1475-6773.12644..
Keywords: Blood Pressure, Diabetes, Home Healthcare, Cardiovascular Conditions
Jones CD, Burke RE
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
The care provided after hospital discharge in skilled-nursing facilities and home health care is collectively termed postacute care (PAC). In this article, the authors outline 3 key problems with postacute care transitions and offer potential solutions.
AHRQ-funded; HS024569.
Citation: Jones CD, Burke RE .
Inpatient notes - getting past the "black box"-opportunities for hospitalists to improve postacute care transitions.
Ann Intern Med 2018 May 15;168(10):HO2-HO3. doi: 10.7326/m18-0940..
Keywords: Health Services Research (HSR), Home Healthcare, Hospital Discharge, Long-Term Care, Transitions of Care
Ma C, Shang J, Miner S
The prevalence, reasons, and risk factors for hospital readmissions among home health care patients: a systematic review.
This systematic review examined the current evidence about hospital readmissions from home health care (HHC). Among 18 reviewed articles, they found that reported readmission rates and risk factors varied dramatically between studies; reasons for readmissions were understudied; and findings were limited by small sample sizes, single data source, and methodological flaws. They recommended that future studies use multiple national data sources across patients’ care spectrum and advanced statistical models to identify who among HHC patients are most likely to be readmitted to hospital and for what reason.
AHRQ-funded; HS023593.
Citation: Ma C, Shang J, Miner S .
The prevalence, reasons, and risk factors for hospital readmissions among home health care patients: a systematic review.
Home Health Care Manag Pract 2018 May;30(2):83-92.
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Keywords: Evidence-Based Practice, Health Services Research (HSR), Home Healthcare, Hospital Readmissions
Sockolow PS, Yang Y, Bass EJ
Data visualization of home care admission nurses' decision-making.
This study investigated nurses’ decision making regarding hospital to home care admissions. They conducted a focus group case study with six admitting home health nurses at a rural agency in Pennsylvania and analyzed the data using thematic analysis.
AHRQ-funded; HS024537.
Citation: Sockolow PS, Yang Y, Bass EJ .
Data visualization of home care admission nurses' decision-making.
AMIA Annu Symp Proc 2018 Apr 16;2017:1597-606..
Keywords: Data, Shared Decision Making, Home Healthcare, Nursing, Transitions of Care
Berridge C
Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: policy analysis.
This study examined passive remote monitoring technologies in state Medicaid programs. Its goals were to identify which states allowed location tracking, sensor systems, and cameras, what policies were in place to track usage, what implementation processes and program monitoring mechanisms were in place, and what related insights Medicaid program stakeholders would like to learn. Interviews were conducted with state, federal, and managed care organization (MCO) Medicaid program stakeholders about the use of these technologies in state waivers that served community-dwelling older adults in 15 states. While two-thirds of the states covered location tracking and activity-monitoring sensors and one-third covered cameras, only 3 states had specific service categories that allowed tracking of when they pay for these technologies. The authors conclude that technologies that have great potential to alter the way older adults receive supportive services are often used without research on their use, social or ethical implications, or outcomes. New service categories are needed to enable oversight, and more interaction between policymakers and researchers in this field would aid in the prioritization of research aims to inform practice.
AHRQ-funded; HS000011.
Citation: Berridge C .
Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: policy analysis.
J Med Internet Res 2018 Feb 21;20(2):e66. doi: 10.2196/jmir.9650..
Keywords: Elderly, Health Information Technology (HIT), Health Insurance, Healthcare Delivery, Home Healthcare, Medicaid, Policy