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
1 to 18 of 18 Research Studies DisplayedBradford W, Akselrod H, Bassler J
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
This multisite, retrospective cohort study of hospitalized patients with opioid use disorder with infectious complications of injection drug use looked at rates of HIV screening, pre-exposure prophylaxis, and treatment among these patients. The authors included 322 patients, with most (300) now known to have HIV. Of those, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 had a viral load collected during admission of whom all were viremic and 10 were successfully linked to care post-discharge. Both groups had high rates of readmission, Medicaid or uninsured status, and unstable housing.
AHRQ-funded; HS013852.
Citation: Bradford W, Akselrod H, Bassler J .
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
Addict Sci Clin Pract 2024 Mar 26; 19(1):22. doi: 10.1186/s13722-024-00451-z..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Prevention, Inpatient Care
Auerbach AD, Lee TM, Hubbard CC
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
The objective of this retrospective cohort study was to determine the prevalence, underlying causes, and harms of diagnostic errors in hospitalized adults who were transferred to an intensive care unit or who died. Data was taken from 29 academic medical centers in the U.S. in a random sample of adults hospitalized with general medical conditions. Errors were found to have contributed to temporary harm, permanent harm, or death in nearly 18% of patients; among patients who died, diagnostic error was judged to have contributed to death in 6.6% of cases. The researchers noted that problems with choosing and interpreting tests and the processes involved with clinician assessment were a high priority for improvement efforts.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Lee TM, Hubbard CC .
Diagnostic errors in hospitalized adults who died or were transferred to intensive care.
JAMA Intern Med 2024 Feb; 184(2):164-73. doi: 10.1001/jamainternmed.2023.7347..
Keywords: Diagnostic Safety and Quality, Medical Errors, Hospitals, Inpatient Care, Quality of Care, Patient Safety, Adverse Events
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
Quinn M, Horowitz JK, Krein SL
The role of hospital-based vascular access teams and implications for patient safety: a multi-methods study.
The purpose of this study was to examine the roles, functions, and composition of vascular access teams (VATs) related to the use and management of PICC and midline catheters. The researchers administered an online survey of 62 hospitals participating in a quality improvement consortium and qualitative interviews with 74 hospital-based clinicians in 10 sites. The study found that more than 77% of hospitals had an on-site VAT. The average team size was seven nurses; their main function was device insertion. Findings from the interviews revealed variations in team characteristics and functions. Interviewees characterized the broad role that teams play in device insertion, care, and removal, and in educating/training hospital staff. The researchers found that teams' role in decision making, especially related to appropriate device selection, was limited an was met with physician resistance in some cases.
AHRQ-funded; HS025891.
Citation: Quinn M, Horowitz JK, Krein SL .
The role of hospital-based vascular access teams and implications for patient safety: a multi-methods study.
J Hosp Med 2024 Jan; 19(1):13-23. doi: 10.1002/jhm.13253..
Keywords: Patient Safety, Inpatient Care, Cardiovascular Conditions
Huerta TR, McAlearney AS, Rizer MK
Introducing a patient portal and electronic tablets to inpatient care.
The researchers implemented a pilot inpatient portal (MyChart Bedside [Epic Systems]) using Android tablets to provide patients and their families and caregivers with an expected care plan each day, a roster of the care team, the ability to exchange secure messages with the care team, a way to write and save notes, and access to health information. They conducted the 90-day pilot program in 15 rooms on 1 patient unit in each of 2 hospitals and gave tablets to 179 patients. They found that patients wanted immediate access to laboratory results, that patients admitted for 1-2 days found the tablets less important, that those readmitted insisted on having a tablet, and that those with their own electronic devices were less likely to accept the tablet.
AHRQ-funded; HS024091.
Citation: Huerta TR, McAlearney AS, Rizer MK .
Introducing a patient portal and electronic tablets to inpatient care.
Ann Intern Med 2017 Dec 5;167(11):816-17. doi: 10.7326/m17-1766.
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Keywords: Health Information Technology (HIT), Hospitalization, Inpatient Care, Web-Based, Electronic Health Records (EHRs)
Bowen ME, Rumana U, Kilgore EA
A user-centered glucose-insulin data display for the inpatient setting.
Researchers sought to develop a set of user-centered displays of capillary glucose data and insulin dose to improve inpatient management of insulin-dependent diabetes. Their proposed conceptual data display prototype is designed to simplify the presentation and visualization of key information needed for treatment decisions. The goal is also to enhance clinician's ability to identify opportunities to optimize insulin dosing and decrease end users' cognitive load and error rates.
AHRQ-funded; HS022895.
Citation: Bowen ME, Rumana U, Kilgore EA .
A user-centered glucose-insulin data display for the inpatient setting.
Stud Health Technol Inform 2017;245:684-88.
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Keywords: Care Management, Diabetes, Health Information Technology (HIT), Inpatient Care, Patient Safety
Lindenauer PK, Shieh MS, Stefan MS
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
The purpose of this study was to determine the impact of procalcitonin (PCT) testing on antibiotic treatment of patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in routine practice. The study conclude that as currently implemented, PCT testing appears to have had little impact on decisions to initiate antibiotic therapy or on duration of treatment for COPD exacerbations.
AHRQ-funded; HS024596.
Citation: Lindenauer PK, Shieh MS, Stefan MS .
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation
Ann Am Thorac Soc 2017 Dec;14(12):1779-85. doi: 10.1513/AnnalsATS.201702-133OC..
Keywords: Antibiotics, Respiratory Conditions, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research
Badawy J, Nguyen OK, Clark C
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
The researchers sought to assess the potential accuracy of respiratory rate (RR) by analyzing the distribution and variation as a proxy, since RR should be normally distributed if recorded accurately. The observed patterns suggest that RR is inaccurately recorded, even among those with cardiopulmonary compromise, and represents a 'spot' estimate with values of 18 and 20 breaths per minute representing 'normal.’
AHRQ-funded; HS022418.
Citation: Badawy J, Nguyen OK, Clark C .
Is everyone really breathing 20 times a minute? Assessing epidemiology and variation in recorded respiratory rate in hospitalised adults.
BMJ Qual Saf 2017 Oct;26(10):832-36. doi: 10.1136/bmjqs-2017-006671.
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Keywords: Hospitalization, Inpatient Care, Patient Safety, Quality Improvement, Respiratory Conditions
Parker MW, Carroll M, Bolser B
Implementation of a communication bundle for high-risk patients.
This study occurs in a large pediatric hospital with a history of success in decreasing unrecognized deterioration, in which patients at higher risk of deterioration are termed "watchers." Because communication errors often contribute to unrecognized deterioration, clear and timely communication of watcher status to all team members and contingency planning was desired. The researchers sought to increase the percentage of eligible watchers with a complete communication, teamwork, and planning bundle within 2 hours of identification from 28% to 80%.
AHRQ-funded; HS023827.
Citation: Parker MW, Carroll M, Bolser B .
Implementation of a communication bundle for high-risk patients.
Hosp Pediatr 2017 Sep;7(9):523-29. doi: 10.1542/hpeds.2016-0170..
Keywords: Children/Adolescents, Communication, Healthcare Delivery, Hospitals, Inpatient Care
Berger ZD, Boss EF, Beach MC
Communication behaviors and patient autonomy in hospital care: a qualitative study.
Researchers conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. They concluded that shared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict.
AHRQ-funded; HS022932.
Citation: Berger ZD, Boss EF, Beach MC .
Communication behaviors and patient autonomy in hospital care: a qualitative study.
Patient Educ Couns 2017 Aug;100(8):1473-81. doi: 10.1016/j.pec.2017.03.006.
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Keywords: Communication, Shared Decision Making, Inpatient Care, Clinician-Patient Communication
Luxenberg A, Chan B, Khanna R
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
The purpose of this analysis was to investigate text page message content and structure, focusing on efficiency and safety. The authors analyzed the messages generated at an academic tertiary care hospital sent or received by hospital staff via an internal service, including those relating to the care of specific patients. While most messages were nonurgent, those that were lacked consistent language to indicate urgency. The authors conclude that text paging has significant limitations for real-time communication in acute-care settings, and their data should be a basis to inform the development of guidelines on the effective, efficient use of text paging.
AHRQ-funded; HS023558.
Citation: Luxenberg A, Chan B, Khanna R .
Efficiency and interpretability of text paging communication for medical inpatients: a mixed-methods analysis.
JAMA Intern Med 2017 Aug;177(8):1218-20. doi: 10.1001/jamainternmed.2017.2133..
Keywords: Communication, Inpatient Care, Hospitals, Patient Safety
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
Fisher K, Smith K, Gallagher T
We want to know: eliciting hospitalized patients' perspectives on breakdowns in care.
Researchers interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient- perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events.
AHRQ-funded; HS024596; HS022757.
Citation: Fisher K, Smith K, Gallagher T .
We want to know: eliciting hospitalized patients' perspectives on breakdowns in care.
J Hosp Med 2017 Aug;12(8):603-09. doi: 10.12788/jhm.2783.
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Keywords: Communication, Quality of Care, Inpatient Care, Patient Experience, Patient-Centered Outcomes Research
Roosan D, Weir C, Samore M
Identifying complexity in infectious diseases inpatient settings: an observation study.
This study sought to identify specific complexity-contributing factors in the infectious disease domain and the relationship with the complexity perceived by clinicians. Its factor analysis revealed three factors explaining 47 percent of total variance, namely task interaction and goals, urgency and acuity, and psychosocial behavior. A linear regression analysis showed no statistically significant association between complexity perceived by the physicians and objective complexity.
AHRQ-funded; HS023349.
Citation: Roosan D, Weir C, Samore M .
Identifying complexity in infectious diseases inpatient settings: an observation study.
J Biomed Inform 2017 Jul;71s:S13-s21. doi: 10.1016/j.jbi.2016.10.018.
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Keywords: Clinical Decision Support (CDS), Infectious Diseases, Inpatient Care, Patient Safety
Le P, Martinez KA, Pappas MA
A decision model to estimate a risk threshold for venous thromboembolism prophylaxis in hospitalized medical patients.
To determine a threshold for prophylaxis based on risk of venous thromboembolism, the researchers constructed a decision model with a decision-tree following patients for 3 months after hospitalization, and a lifetime Markov model with 3-month cycles. They found that the prophylaxis threshold was relatively insensitive to low-molecular-weight heparin cost and bleeding risk, but very sensitive to patient age and life expectancy.
AHRQ-funded; HS022883.
Citation: Le P, Martinez KA, Pappas MA .
A decision model to estimate a risk threshold for venous thromboembolism prophylaxis in hospitalized medical patients.
J Thromb Haemost 2017 Jun;15(6):1132-41. doi: 10.1111/jth.13687.
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Keywords: Adverse Events, Clinical Decision Support (CDS), Inpatient Care, Patient Safety, Risk
Eriksson CO, Stoner RC, Eden KB
The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review.
This systematic literature review sought to understand whether hospital capacity strain is associated with worse health outcomes for hospitalized patients and to evaluate benefits and harms of health system interventions to improve care quality during times of hospital capacity strain. It concluded that in highly developed countries, hospital capacity strain is associated with increased mortality and worsened health outcomes.
AHRQ-funded; HS022981.
Citation: Eriksson CO, Stoner RC, Eden KB .
The association between hospital capacity strain and inpatient outcomes in highly developed countries: a systematic review.
J Gen Intern Med 2017 Jun;32(6):686-96. doi: 10.1007/s11606-016-3936-3.
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Keywords: Hospitalization, Hospitals, Inpatient Care, Patient-Centered Outcomes Research, Patient Safety
Seidelman J, Dicks KV, Durkin MJ
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
The authors of this research brief designed a 2-phase study (1) to define the types of clostridium difficile infections (CDI) that clinicians consider unlikely preventable by inpatient antibiotic stewardship programs and (2) to estimate the relative proportion of inpatient CDI cases at a tertiary-care hospital that belongs to this category of “nonpreventable” CDI.
AHRQ-funded; HS023866.
Citation: Seidelman J, Dicks KV, Durkin MJ .
Using clinical scenarios to understand preventability of Clostridium difficile infections by inpatient antibiotic stewardship programs.
Infect Control Hosp Epidemiol 2017 Jun;38(6):747-49. doi: 10.1017/ice.2017.32..
Keywords: Antibiotics, Antimicrobial Stewardship, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Inpatient Care
Hines AL, Raetzman SO, Barrett ML
AHRQ Author: Moy E, Andrews RM
Managed care and inpatient mortality in adults: effect of primary payer.
This study provides a comprehensive assessment of the association between managed care and inpatient mortality for Medicare and privately insured patients. Privately insured patients in managed care plans, especially older adults, had better outcomes than those in fee-for-service (FFS) plans. Patients in Medicare managed care had outcomes similar to those in Medicare FFS.
AHRQ-authored.
Citation: Hines AL, Raetzman SO, Barrett ML .
Managed care and inpatient mortality in adults: effect of primary payer.
BMC Health Serv Res 2017 Feb 8;17(1):121. doi: 10.1186/s12913-017-2062-1.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Inpatient Care, Mortality, Outcomes, Hospitalization, Medicare