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 221 Research Studies DisplayedOh ES, Needham DM, Nikooie R
Antipsychotics for preventing delirium in hospitalized adults: a systematic review.
The purpose of this study was to conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults. Results showed that there was little evidence demonstrating neurologic harms associated with short-term use of antipsychotics for treating delirium in adult inpatients, but potentially harmful cardiac effects tended to occur more frequently. Current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.
AHRQ-funded; 290201500006I.
Citation: Oh ES, Needham DM, Nikooie R .
Antipsychotics for preventing delirium in hospitalized adults: a systematic review.
Ann Intern Med 2019 Oct 1;171(7):474-84. doi: 10.7326/m19-1859..
Keywords: Neurological Disorders, Medication, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Comparative Effectiveness, Behavioral Health, Prevention
Nikooie R, Neufeld KJ, Oh ES
Antipsychotics for treating delirium in hospitalized adults: a systematic review.
The purpose of this study was to conduct a systematic review evaluating the benefits and harms of antipsychotics to treat delirium in adults. Results showed that there was little evidence demonstrating neurologic harms associated with short-term use of antipsychotics for treating delirium in adult inpatients, but potentially harmful cardiac effects tended to occur more frequently. Current evidence does not support routine use of haloperidol or second-generation antipsychotics to treat delirium in adult inpatients.
AHRQ-funded; 290201500006I.
Citation: Nikooie R, Neufeld KJ, Oh ES .
Antipsychotics for treating delirium in hospitalized adults: a systematic review.
Ann Intern Med 2019 Oct 1;171(7):485-95. doi: 10.7326/m19-1860.
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Keywords: Neurological Disorders, Medication, Hospitalization, Inpatient Care, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Comparative Effectiveness, Behavioral Health
Jones KJ, Skinner A, Venema D
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Researchers evaluated the implementation and outcomes of evidence-based fall-risk-reduction processes when those processes are implemented using a multiteam system (MTS) structure. They found that multiteam systems that effectively coordinate fall-risk-reduction processes may improve the capacity of hospitals to manage the complex patient, environmental, and system factors that result in falls.
AHRQ-funded; HS024630; HS021429.
Citation: Jones KJ, Skinner A, Venema D .
Evaluating the use of multiteam systems to manage the complexity of inpatient falls in rural hospitals.
Health Serv Res 2019 Oct;54(5):994-1006. doi: 10.1111/1475-6773.13186..
Keywords: Falls, Hospitals, Inpatient Care, Quality of Care, Quality Improvement, Patient Safety, Prevention, Risk
Choe AY, Unaka NI, Schondelmeyer AC
Inpatient communication barriers and drivers when caring for limited english proficiency children.
The authors identified barriers to and drivers of effective interpreter service use when caring for hospitalized limited English proficiency (LEP) children from the perspectives of pediatric medical providers and interpreters. Using Group Level Assessment, they found that participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. They suggested that future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.
AHRQ-funded; HS025138.
Citation: Choe AY, Unaka NI, Schondelmeyer AC .
Inpatient communication barriers and drivers when caring for limited english proficiency children.
J Hosp Med 2019 Oct;14(10):607-13. doi: 10.12788/jhm.3240..
Keywords: Clinician-Patient Communication, Communication, Cultural Competence, Children/Adolescents, Inpatient Care, Patient and Family Engagement, Caregiving
Stevens JP, Sheridan AR, Bernstein HB
A multidimensional profile of dyspnea in hospitalized patients.
Dyspnea is prevalent among hospitalized patients but little is known about the experience of dyspnea among inpatients. In this study, the investigators sought to characterize the multiple sensations and associated emotions of dyspnea in patients admitted with dyspnea to a tertiary care hospital. The investigators indicated that this first multidimensional portrait of dyspnea in a general inpatient population characterized the sensations and emotions dyspneic patients endure.
AHRQ-funded; HS024288.
Citation: Stevens JP, Sheridan AR, Bernstein HB .
A multidimensional profile of dyspnea in hospitalized patients.
Chest 2019 Sep;156(3):507-17. doi: 10.1016/j.chest.2019.04.128..
Keywords: Hospitalization, Inpatient Care
Desai S, Aronson PL, Shabanova V
Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections.
This study compared rates of recurring bacteremic urinary tract infections (UTIs) among hospitalized infants who received parenteral antibiotics 7 days or less compared with infants who received long-term treatment defined as greater than 7 days. Among 115 infants with bactermic UTI, half received short-course parenteral antibiotics and no difference in 30-day UTI recurrence was found.
AHRQ-funded; HS026006.
Citation: Desai S, Aronson PL, Shabanova V .
Parenteral antibiotic therapy duration in young infants with bacteremic urinary tract infections.
Pediatrics 2019 Sep;144(3). doi: 10.1542/peds.2018-3844..
Keywords: Newborns/Infants, Antibiotics, Urinary Tract Infection (UTI), Medication, Inpatient Care, Hospitalization, Outcomes, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice
Wooldridge A, Carayon P, Hoonakker P
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, the investigators combined interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity.
AHRQ-funded; HS023837.
Citation: Wooldridge A, Carayon P, Hoonakker P .
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Cogn Technol Work 2019 Aug;21(3):397-416. doi: 10.1007/s10111-018-0520-0..
Keywords: Care Coordination, Children/Adolescents, Critical Care, Health Services Research (HSR), Healthcare Delivery, Inpatient Care, Patient Safety, Teams, Trauma, Young Adults
Hussain FS, Sosa T, Ambroggio L
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
This case-control study aimed to determine the predictive validity of an emergency transfer (ET) for outcomes in a free-standing children's hospital. Controls were matched in terms of age, hospital unit, and time of year. Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality (22% vs 9%), longer ICU length of stay (4.9 vs 2.2 days), and longer posttransfer length of stay (26.4 vs 14.7 days) compared with controls (P < .03 for each).
AHRQ-funded; HS023827.
Citation: Hussain FS, Sosa T, Ambroggio L .
Emergency transfers: an important predictor of adverse outcomes in hospitalized children.
J Hosp Med 2019 Aug;14(8):482-85. doi: 10.12788/jhm.3219..
Keywords: Transitions of Care, Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Outcomes, Patient-Centered Outcomes Research, Inpatient Care, Hospitalization, Hospitals, Healthcare Delivery
Beck J, Wignall J, Jacob-Files E
Parent attitudes and preferences for discussing health care costs in the inpatient setting.
This study examined parent attitudes towards discussing their child’s health care costs in an inpatient setting with health care providers and others. Semistructured interviews were conducted with 42 parents of children who received care at a tertiary academic children’s hospital with and without chronic disease. Two domains for discussion were identified: factors that influence the parent’s desire to discuss health care costs in the inpatient setting and parent preference regarding the execution of cost discussions. Most parents highlighted concerns regarding physician involvement and felt that it was better explored with a financial counselor or social worker. They also felt that the discussions should be optional.
AHRQ-funded; HS024299.
Citation: Beck J, Wignall J, Jacob-Files E .
Parent attitudes and preferences for discussing health care costs in the inpatient setting.
Pediatrics 2019 Aug;144(2). doi: 10.1542/peds.2018-4029..
Keywords: Caregiving, Children/Adolescents, Healthcare Costs, Inpatient Care, Hospitalization, Hospitals
Trent SA, Jarou ZJ, Havranek EP
Variation in emergency department adherence to treatment guidelines for inpatient pneumonia and sepsis: a retrospective cohort study.
Evidence-based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. The objectives of this study were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence.
AHRQ-funded; HS022400.
Citation: Trent SA, Jarou ZJ, Havranek EP .
Variation in emergency department adherence to treatment guidelines for inpatient pneumonia and sepsis: a retrospective cohort study.
Acad Emerg Med 2019 Aug;26(8):908-20. doi: 10.1111/acem.13639.
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Keywords: Emergency Department, Evidence-Based Practice, Guidelines, Inpatient Care, Pneumonia, Sepsis
Glick AF, Brach C, Yin HS
AHRQ Author: Brach C
Health literacy in the inpatient setting: implications for patient care and patient safety.
This article considers how health literacy plays a part in events that lead up to children's hospitalizations both during hospital admission and after discharge. The authors discussed interventions that incorporate health-literacy-informed strategies and that target patients, families, and health care systems that should be implemented to improve patient outcomes and patient-centered and family-centered care.
AHRQ-authored.
Citation: Glick AF, Brach C, Yin HS .
Health literacy in the inpatient setting: implications for patient care and patient safety.
Pediatr Clin North Am 2019 Aug;66(4):805-26. doi: 10.1016/j.pcl.2019.03.007..
Keywords: Children/Adolescents, Health Literacy, Hospital Discharge, Hospitalization, Hospitals, Inpatient Care, Patient Safety
Ye L, Owens RL, Dykes P
Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.
The aim of this study was develop a tool that can be used to measure factors that affect patient sleep in acute care hospitals. A tool called Factors Affected Inpatient Sleep (FAIS) was developed using literature review and was validated by content validity testing. The scale was tested on 105 hospitalized patients and the most significant sleep disruptors were identified. The final FAIS scale included 14 items in three subscales. The biggest factors for sleep disruption included 1) emotional or physical impairment due to illness or hospitalization; 2) sleep disturbance due to discomfort of their care plan schedule; and 3) sleep interruption due to the hospital environment or medical care. The reliability of the scale was measured at 0.87 with Cronbach’s alpha coefficient and reliability of the subscales ranged from 0.72 to 0.81.
AHRQ-funded; HS024330.
Citation: Ye L, Owens RL, Dykes P .
Individualized sleep promotion in acute care hospitals: Identifying factors that affect patient sleep.
Appl Nurs Res 2019 Aug;48:63-67. doi: 10.1016/j.apnr.2019.05.006..
Keywords: Health Promotion, Hospitalization, Hospitals, Inpatient Care, Sleep Problems
Schnock KO, Snyder JE, Fuller TE
Acute care patient portal intervention: portal use and patient activation.
The aim of this study was to describe the use of an acute care patient portal and investigate its association with patient and care partner activation in the hospital setting. The investigators concluded that portal users most often accessed the portal to view their clinical information, though portal usage was limited to only the first few days of enrollment. They found an association between the use of the portal and HIT tools with improved levels of patient activation.
AHRQ-funded; HS023535.
Citation: Schnock KO, Snyder JE, Fuller TE .
Acute care patient portal intervention: portal use and patient activation.
J Med Internet Res 2019 Jul 18;21(7):e13336. doi: 10.2196/13336..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient and Family Engagement, Patient-Centered Healthcare, Inpatient Care
O'Leary KJ, Johnson JK, Manojlovich M
Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems.
The goal of this study was to implement the Advanced and Integrated MicroSystems (AIMS) set of evidence-based complementary interventions across a range of clinical microsystems, to identify factors and strategies associated with successful implementation, and to evaluate impact on quality. The AIMS interventions are Unit-based Physician Teams; Unit Nurse-Physician Co-leadership; Enhanced Interprofessional Rounds; Unit-level Performance Reports; Patient Engagement Activities. Four hospital sites, each with a local leadership team, received guidance and resources to implement the AIMS interventions. A multi-method approach was used to collect and triangulate qualitative data during three visits to the sites. Outcomes included teamwork climate and adverse events.
AHRQ-funded; HS025649.
Citation: O'Leary KJ, Johnson JK, Manojlovich M .
Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems.
BMC Health Serv Res 2019 May 8;19(1):293. doi: 10.1186/s12913-019-4116-z..
Keywords: Evidence-Based Practice, Healthcare Delivery, Hospitalization, Inpatient Care, Quality of Care, Quality Improvement, Teams
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis
Roche SD, Reichheld AM, Demosthenes N
Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication.
The purpose of this study was to document the receipt of communication by nurses and family members regarding consultations performed on their patient or loved one, and to quantify how this impacted their overall perceptions of the quality of specialty care. The investigators found that most ICU families and nurses had no interaction with specialist providers. They concluded that nurses' frequent exclusion from conversations about specialty care may pose safety risks and increase the likelihood of mixed messages for patients and families, most of whom desire some interaction with specialists.
AHRQ-funded; K08 HS024288.
Citation: Roche SD, Reichheld AM, Demosthenes N .
Measuring the quality of inpatient specialist consultation in the intensive care unit: Nursing and family experiences of communication.
PLoS One 2019 Apr 11;14(4):e0214918. doi: 10.1371/journal.pone.0214918..
Keywords: Clinician-Patient Communication, Communication, Quality of Care, Intensive Care Unit (ICU), Patient Experience, Inpatient Care
Gupta R, J J, Collins S
Diuretic resistance in heart failure.
Diuretic resistance (DR) occurs along a spectrum of relative severity and contributes to worsening of acute heart failure (AHF) during an inpatient stay. This review gives an overview of mechanisms of DR with a focus on loop diuretics and summarizes the current literature regarding the prognostic value of diuretic efficiency and predictors of natriuretic response in AHF.
AHRQ-funded; HS025411.
Citation: Gupta R, J J, Collins S .
Diuretic resistance in heart failure.
Curr Heart Fail Rep 2019 Apr;16(2):57-66. doi: 10.1007/s11897-019-0424-1..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Inpatient Care, Medication
Ray EM, Riedel RF, LeBlanc TW
Assessing the impact of a novel integrated palliative care and medical oncology inpatient service on health care utilization before hospice enrollment.
The goal of this retrospective cohort study was to assess the impact of integrating specialist palliative care (PC) on health care utilization among hospitalized cancer patients before hospice enrollment. Patients in the solid tumor inpatient unit who were discharged to hospice pre- and post-integration were compared on the following outcomes: intensive care unit days, invasive procedures, subspecialty consultations, radiographic studies, hospital length of stay, and use of chemotherapy or radiation. Health care utilization was relatively low in both groups, and researchers found no significant differences in utilization between the two groups. They conclude that PC integration may not impact health care utilization during the final hospitalization before discharge to hospice, which may reflect the greater benefits of integrating PC farther ‘upstream’ from the final hospitalization.
AHRQ-funded; HS000032.
Citation: Ray EM, Riedel RF, LeBlanc TW .
Assessing the impact of a novel integrated palliative care and medical oncology inpatient service on health care utilization before hospice enrollment.
J Palliat Med 2019 Apr;22(4):420-23. doi: 10.1089/jpm.2018.0235..
Keywords: Cancer, Healthcare Utilization, Inpatient Care, Palliative Care
Kempker JA, Kramer MR, Waller LA
State-level hospital compliance with and performance in the Centers for Medicaid & Medicare Services' Early Management Severe Sepsis and Septic Shock Bundle.
This research letter discusses a study that measured state-level hospital compliance and performance in the Centers for Medicaid & Medicare Services’(CMS) Early Management Severe Sepsis and Septic Shock Bundle (SEP-1) inpatient quality measure. There was a wide range of compliance from 97% (New Jersey) to North Dakota (15.9%). There was a state average of 48%.
AHRQ-funded; HS025240.
Citation: Kempker JA, Kramer MR, Waller LA .
State-level hospital compliance with and performance in the Centers for Medicaid & Medicare Services' Early Management Severe Sepsis and Septic Shock Bundle.
Crit Care 2019 Mar 18;23(1):92. doi: 10.1186/s13054-019-2382-0..
Keywords: Hospitals, Inpatient Care, Quality of Care, Quality Measures, Sepsis
McGrath SP, Perreard IM, Garland MD
Improving patient safety and clinician workflow in the general care setting with enhanced surveillance monitoring.
This researched analyzed the impact of implementing an improved clinical monitoring system with enhanced surveillance. This enhanced monitoring system was shown to improve patient safety and clinical workflow in inpatient hospital settings. After implementation higher staff satisfaction was shown and reduced average vital signs data collection time by 28%. It improved the availability and accuracy of patient information. However, there was little or no impact on clinical alarms.
AHRQ-funded; HS024403.
Citation: McGrath SP, Perreard IM, Garland MD .
Improving patient safety and clinician workflow in the general care setting with enhanced surveillance monitoring.
IEEE J Biomed Health Inform 2019 Mar;23(2):857-66. doi: 10.1109/jbhi.2018.2834863..
Keywords: Hospitals, Inpatient Care, Patient Safety, Provider: Clinician, Quality Improvement, Workflow
Hsu HE, Wang R, Jentzsch MS
Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting.
This letter discussed a study which was done on value-based incentive programs to reduce the number of catheter-associated urinary tract infections (CAUTI) in intensive care units (ICUs). The study used data from 592 hospitals in the District of Columbia and 49 states. Researchers found these incentive programs did not significantly reduce CAUTI.
AHRQ-funded; HS000063; HS025008; HS018414.
Citation: Hsu HE, Wang R, Jentzsch MS .
Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting.
JAMA 2019 Feb 5;321(5):509-11. doi: 10.1001/jama.2018.18997.
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Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Critical Care, Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety, Urinary Tract Infection (UTI)
Masterson Creber RM, Grossman LV, Ryan B
Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal.
This study examined the effects of an inpatient portal intervention on patient activation, patient satisfaction, patient engagement with health information, and 30-day hospital admissions. A randomized trial was conducted from March 2014 to May 2017 with 426 English- or Spanish-speaking patients from 2 cardiac medical-surgical units at an urban academic medical center. Patients were randomized into 3 groups: 1) usual care, 2) tablet with general Internet access, and 3) tablet with an inpatient portal. There was a difference in patient activation between the 3 groups, but the inpatient portal group had lower 30-day hospital admissions. There was also a difference with patient engagement with health information between the inpatient portal and tablet-only groups.
AHRQ-funded; HS021816.
Citation: Masterson Creber RM, Grossman LV, Ryan B .
Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal.
J Am Med Inform Assoc 2019 Feb;26(2):115-23. doi: 10.1093/jamia/ocy146..
Keywords: Patient and Family Engagement, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Patient Experience, Inpatient Care
Chan CW, Green LV, Lekwijit S
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
In this study, the authors focused on estimating costs and benefits in a complex healthcare setting where the major differentiation among server types is the intensity of the service provided. They used data from ten hospitals and found that a step-down unit may be a cost-effective way to treat patients when used for those who are post-intensive care unit. However, they also found that the impact of step-down-unit care is more nuanced for patients admitted from the emergency department and may result in increased mortality risk and hospital length of stay for patients who should be treated in the intensive care unit. The authors recommended more study in this area.
AHRQ-funded; HS018480.
Citation: Chan CW, Green LV, Lekwijit S .
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
Management Science 2019 Feb;65(2):751-75. doi: 10.1287/mnsc.2017.2974..
Keywords: Care Management, Healthcare Costs, Healthcare Delivery, Hospitals, Inpatient Care
Nathan H, Thumma JR, Ryan AM
Early impact of Medicare accountable care organizations on inpatient surgical spending.
This study evaluated whether hospital participation in accountable care organizations (ACOs) is associated with reduced Medicare spending for inpatient surgery. Medicare Shared Savings Programs (MSSP) have shown some modest success in reducing overall medical spending, but has not been studied on its impact in reducing surgical spending. Medicare claims from 2010 to 2014 were evaluated for patients aged 65 to 99 years undergoing 6 common elective surgical procedures: abdominal aortic aneurysm, colectomy, coronary artery bypass grafting, hip or knee replacement, or lung resection. A total of 341,675 patients at 427 ACO hospitals and over 1 million matched controls at non-ACO hospitals were used to compare surgical costs. There was not an overall reducing in total Medicare patients between the two hospital types.
AHRQ-funded; HS024763.
Citation: Nathan H, Thumma JR, Ryan AM .
Early impact of Medicare accountable care organizations on inpatient surgical spending.
Ann Surg 2019 Feb;269(2):191-96. doi: 10.1097/sla.0000000000002819..
Keywords: Healthcare Costs, Hospitals, Inpatient Care, Medicare, Surgery, Quality of Care
Rhee C, Jones TM, Hamad Y
Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals.
The purpose of this study was to estimate the prevalence, underlying causes, and preventability of sepsis-associated mortality in acute care hospitals. A retrospective medical record review was conducted of 568 randomly selected adults admitted to six US academic and community hospitals who died in the hospital or were discharged to hospice and not readmitted. Medical records were reviewed. Sepsis was found to be the most common immediate cause of death; however, most underlying causes were related to severe chronic comorbidities. Most sepsis-associated deaths were unlikely to be preventable through better hospital-based care. The authors conclude that further innovations in the prevention and care of underlying conditions may be necessary before a significant reduction in sepsis-associated deaths can be achieved.
AHRQ-funded; HS025008.
Citation: Rhee C, Jones TM, Hamad Y .
Prevalence, underlying causes, and preventability of sepsis-associated mortality in US acute care hospitals.
JAMA Netw Open 2019 Feb;2(2):e187571. doi: 10.1001/jamanetworkopen.2018.7571..
Keywords: Mortality, Sepsis, Hospitals, Inpatient Care