National Healthcare Quality and Disparities Report
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- Adverse Events (1)
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- Human Immunodeficiency Virus (HIV) (1)
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- Inpatient Care (1)
- Long-Term Care (2)
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- Quality Indicators (QIs) (8)
- (-) Quality Measures (31)
- Quality of Care (27)
- Quality of Life (1)
- Racial and Ethnic Minorities (1)
- Registries (1)
- Research Methodologies (1)
- Rural Health (1)
- Screening (1)
- Sepsis (1)
- Skin Conditions (1)
- Surgery (4)
- Urban Health (1)
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 25 of 31 Research Studies DisplayedGreenberg JK, Olsen MA, Dibble CF
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Investigators sought to evaluate the reliability of 90-day inpatient hospital costs, overall complications, and rates of serious complications for profiling hospital performance in lumbar fusion surgery for spondylolisthesis. Using HCUP data, they found that 90-day inpatient costs were highly reliable for assessing variation across hospitals, whereas overall and serious complications were only moderately reliable for profiling performance. They concluded that their results support the viability of emerging bundled payment programs that assume true differences in costs of care exist across hospitals.
AHRQ-funded; HS027075; HS019455.
Citation: Greenberg JK, Olsen MA, Dibble CF .
Comparison of cost and complication rates for profiling hospital performance in lumbar fusion for spondylolisthesis.
Spine J 2021 Dec;21(12):2026-34. doi: 10.1016/j.spinee.2021.06.014..
Keywords: Healthcare Costs, Hospitals, Provider Performance, Surgery, Quality Measures, Quality of Care
Davila H, Shippee TP, Park YS
Inside the black box of improving on nursing home quality measures.
This qualitative study investigated how nursing homes (NHs) interact with quality measures (QMs) used by Nursing Home Compare (NHC) as part of its 5-star rating system. Semistructured interviews were conducted with 110 NH personnel and 23 NH provider association representatives. Observations of organizational processes in 12 NHs in three states were also done. The authors found that most NHs are working to improve the quality of care they provide, not merely to improve their QM scores. They also found limitations with the QMs, suggesting that the QMs on their own may not accurately reflect the quality of care that NHs provide. The findings suggest several changes to improve NHC.
AHRQ-funded; HS024967.
Citation: Davila H, Shippee TP, Park YS .
Inside the black box of improving on nursing home quality measures.
Med Care Res Rev 2021 Dec;78(6):758-70. doi: 10.1177/1077558720960326..
Keywords: Nursing Homes, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Provider Performance, Long-Term Care
Fowler FJ, Brenner PS, Hargraves JL
Comparing web and mail protocols for administering Hospital Consumer Assessment of Healthcare Providers and Systems surveys.
This study’s objective was to compare results of using web-based and mail HCAHPS data collection protocols. The cohort included patients who were hospitalized in a New England Hospital. Patients who provided email addresses were randomized to 1 of 3 data collection protocols: web-only, web with postal mail follow-up, and postal mail only. Those who did not provide email addresses were surveyed by postal mail only. The study lasted 8 weeks. Measures looked at included response rates, characteristics of respondents, 6 composite measures of their patient experiences, and two ratings of the hospital. Web-only response rates were significantly lower than for mail or combined protocols, and those who had not provided email addresses also had lower response rates. Older adults over age 65 were more likely to respond to all protocols, especially for mail-only respondents. Respondents without email addresses were older, less educated, and reported worse health than those who had email addresses.
AHRQ-funded; HS016978.
Citation: Fowler FJ, Brenner PS, Hargraves JL .
Comparing web and mail protocols for administering Hospital Consumer Assessment of Healthcare Providers and Systems surveys.
Med Care 2021 Oct;59(10):907-12. doi: 10.1097/mlr.0000000000001627..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Hospitals, Health Information Technology (HIT), Quality Measures, Provider Performance, Quality of Care
Quigley DD, Slaughter ME, Gidengil C
Usefulness of child HCAHPS survey data for improving inpatient pediatric care experiences.
Quality improvement (QI) requires data, indicators, and national benchmarks. Knowledge about the usefulness of Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) data are lacking. In this study the investigators examined quality leader and frontline staff perceptions about patient experience measurement and use of Child HCAHPS data for QI. The investigators surveyed children's hospital leaders and staff about their use of Child HCAHPS for QI, including measures from other studies. They compared scale and item means for leaders and staff and compared means to other studies.
AHRQ-funded; HS025920.
Citation: Quigley DD, Slaughter ME, Gidengil C .
Usefulness of child HCAHPS survey data for improving inpatient pediatric care experiences.
Hosp Pediatr 2021 Oct;11(10):e199-e214. doi: 10.1542/hpeds.2020-004283..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Children/Adolescents, Hospitals, Patient Experience, Quality Improvement, Quality Measures, Quality of Care
Holmgren AJ, Kuznetsova M, Classen D
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
The authors measured hospital performance, stratified by electronic health record (EHR) vendor, across 4 quality metrics. They found that no EHR vendor was associated with higher quality across all measures, and the 2 largest vendors were not associated with the highest scores. Only a small fraction of quality variation was explained by EHR vendor choice. They concluded that top performance on quality measures can be achieved with any EHR vendor, as much of quality performance is driven by the hospital and how it uses the EHR.
AHRQ-funded; HS023696.
Citation: Holmgren AJ, Kuznetsova M, Classen D .
Assessing hospital electronic health record vendor performance across publicly reported quality measures.
J Am Med Inform Assoc 2021 Sep 18;28(10):2101-07. doi: 10.1093/jamia/ocab120..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Measures, Hospitals, Quality of Care, Provider Performance
Connell SK, Burkhart Q, Tolpadi A
Quality of care for youth hospitalized for suicidal ideation and self-harm.
The authors examined performance on quality measures for pediatric inpatient suicidal ideation/self-harm care, and whether performance is associated with reutilization. Subjects were patients aged 5 to 17 years hospitalized for suicidal ideation/self-harm. Their findings revealed disparities and deficits in the quality of care received by youth with suicidal ideation/self-harm. They recommended providing caregivers lethal means restriction counseling prior to discharge in order to help prevent readmission.
AHRQ-funded; HS025291.
Citation: Connell SK, Burkhart Q, Tolpadi A .
Quality of care for youth hospitalized for suicidal ideation and self-harm.
Acad Pediatr 2021 Sep-Oct;21(7):1179-86. doi: 10.1016/j.acap.2021.05.019..
Keywords: Children/Adolescents, Behavioral Health, Inpatient Care, Quality Measures, Quality of Care
Sherer MV, Lin D, Elguindi S
Metrics to evaluate the performance of auto-segmentation for radiation treatment planning: a critical review.
Metrics to evaluate the performance of auto-segmentation for radiation treatment planning: a critical review.
AHRQ-funded; HS026881.
Citation: Sherer MV, Lin D, Elguindi S .
Metrics to evaluate the performance of auto-segmentation for radiation treatment planning: a critical review.
Radiother Oncol 2021 Jul;160:185-91. doi: 10.1016/j.radonc.2021.05.003..
Keywords: Quality Measures, Quality of Care
Barbash IJ, Davis BS, Yabes JG
Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1).
This study evaluated the effect of Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) on treatment patterns and patient outcomes. Findings showed that, two years after its implementation, SEP-1 was associated with variable changes in process measures, with the greatest effect being an increase in lactate measurement within 3 hours of sepsis onset. There were small increases in antibiotic administration and fluid administration, a small increase in ICU admissions, and no changes in mortality or discharge to home.
Citation: Barbash IJ, Davis BS, Yabes JG .
Treatment patterns and clinical outcomes after the introduction of the Medicare Sepsis Performance Measure (SEP-1).
Ann Intern Med 2021 Jul;174(7):927-35. doi: 10.7326/m20-5043..
Keywords: Sepsis, Medicare, Outcomes, Quality Measures, Quality of Care
Meyers DJ, Rahman M, Mor V
Association of Medicare Advantage Star Ratings with racial, ethnic, and socioeconomic disparities in quality of care.
This cross-sectional study looked at racial/ethnic minority and socioeconomic disparities in ratings for Medicare Advantage (MA) plans, which disproportionately enroll these populations. A total of 1,578,564 enrollees were included in this analysis that used 22 measures of quality and satisfaction at the individual enrollee level, aggregated into simulated star ratings from 2-5 stratified by socioeconomic status (SES) and race/ethnicity. Low SES enrollees had simulated stratified star ratings 0.5 stars lower than individuals with high SES in the same contract. Black enrollees had simulated star ratings that were 0.3 stars lower and Hispanic enrollees had 0.1 lower simulated star ratings than White enrollees in the same contract. There was a larger difference in ratings with 4.5 to 5-star contracts with Black and Hispanic enrollees with Whites, and no statistical difference in 2.0 to 2.5 star-rated contracts. There was only low correlation between simulated ratings for enrollees of low SES and high SES.
AHRQ-funded; HS02705101.
Citation: Meyers DJ, Rahman M, Mor V .
Association of Medicare Advantage Star Ratings with racial, ethnic, and socioeconomic disparities in quality of care.
JAMA Health Forum 2021 Jun;2(6):e210793..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Medicare, Patient Experience, Disparities, Quality Measures, Provider Performance, Quality of Care, Racial and Ethnic Minorities
Tedesco D, Moghavem N, Weng Y
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
This study’s aim was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. The study analyzed 13 patient safety indicators (PSIs) that were developed by AHRQ. PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013 were analyzed. Twelve of the thirteen PSIs had decreasing or stable trends in the last 5 years of the study. Central-line bloodstream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013) whereas postoperative respiratory failure had the smallest annual percent change (-3.5 between 2005 and 2013). Significant decreases in trends preceded federal payment reform initiatives in all but postoperative hip fracture. These findings suggest that intense public discourses targeting patient safety may drive national policy reforms.
AHRQ-funded; HS018558.
Citation: Tedesco D, Moghavem N, Weng Y .
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
J Patient Saf 2021 Jun 1;17(4):e327-e34. doi: 10.1097/pts.0000000000000615..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Policy
Palen TE, Peterson L, Palen TE
Clinical quality measure exchange is not easy.
The Trial of Aggregate Data Exchange for Maintenance of Certification and Raising Quality was a randomized controlled trial which first had to test whether quality reporting could be a by-product of clinical care. The investigators reported on the initial descriptive study of the capacity for and quality of exchange of whole-panel, standardized quality measures from health systems. They concluded that the secure transfer of standardized, physician-level quality measures from 4 health systems with mature measure processes proved difficult. There were many errors that required human intervention and manual repair, precluding full automation.
AHRQ-funded; HS022583.
Citation: Palen TE, Peterson L, Palen TE .
Clinical quality measure exchange is not easy.
Ann Fam Med 2021 May-Jun;19(3):207-11. doi: 10.1370/afm.2649..
Keywords: Quality Measures, Quality Indicators (QIs), Quality of Care, Health Information Exchange (HIE), Health Information Technology (HIT)
Olivieri-Mui B, McGuire J, Griffith J
Exploring the association between the quality of HIV care in nursing homes and hospitalization.
Persons living with HIV/AIDS (PLWH) are living long enough to need age-related and HIV-related nursing home (NH) care. Nursing home quality of care has been associated with risk for hospitalization, but it is unknown if quality of HIV care in NHs affects hospitalization in this population. In this study, the investigators assessed HIV care quality with four national measures adapted for the NH setting.
AHRQ-funded; R36 HS025662.
Citation: Olivieri-Mui B, McGuire J, Griffith J .
Exploring the association between the quality of HIV care in nursing homes and hospitalization.
J Healthc Qual 2021 May-Jun;43(3):174-82. doi: 10.1097/jhq.0000000000000277..
Keywords: Elderly, Human Immunodeficiency Virus (HIV), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures
Dworsky JQ, Shenoy R, Childers CP
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
This study’s objective was to determine the documented compliance with best practice guidelines for optimal perioperative care for the older adult surgical patient that were created by the American College of Surgeons Quality Improvement Program and the American Geriatrics Society. The guidelines include 38 measures. A retrospective chart review was conducted on 86 older adults undergoing elective inpatient coronary artery bypass graft, prostatectomy, or colectomy over a 2-year period at a single Veterans Affairs hospital. Mean reported compliance across measures was 41% ± 4%. Of the 38 analyzed measures, 10 measures were achieved for 0 patients, and only 1 patient for 7 measures. Future work is needed to understand barriers for implementation.
AHRQ-funded; HS000046.
Citation: Dworsky JQ, Shenoy R, Childers CP .
Older veterans undergoing inpatient surgery: what is the compliance with best practice guidelines?
Surgery 2021 Feb;169(2):356-61. doi: 10.1016/j.surg.2020.08.033..
Keywords: Elderly, Surgery, Guidelines, Evidence-Based Practice, Quality Improvement, Quality of Care, Quality Measures
Liang C, Gong Y
Automated classification of multi-labeled patient safety reports: a shift from quantity to quality measure.
The capacity for extracting useful information from patient safety reports remains limited. This study investigated the multi-labeled nature of patient safety reports as a key to disclose the complex relations between many components during the courses and development of medical errors. The authors developed automated multi-label text classifiers to process patient safety reports. The experiments demonstrated feasibility and efficiency of a combination of multi-label algorithms in the benchmark comparison.
AHRQ-funded; HS022895.
Citation: Liang C, Gong Y .
Automated classification of multi-labeled patient safety reports: a shift from quantity to quality measure.
Stud Health Technol Inform 2017;245:1070-74..
Keywords: Adverse Events, Data, Patient Safety, Quality Measures
Wang Y, Spatz ES, Tariq M
Home health agency performance in the United States: 2011-15.
This review’s evaluation of home health agency quality performance included 11,462 Medicare-certified home health agencies that served 92.4 percent of all ZIP codes nationwide, accounting for 315.2 million people. It found that home health agency performance on several quality indicators varied, and many agencies were persistently in the lowest quartile of performance.
AHRQ-funded; HS023000.
Citation: Wang Y, Spatz ES, Tariq M .
Home health agency performance in the United States: 2011-15.
J Am Geriatr Soc 2017 Dec;65(12):2572-79. doi: 10.1111/jgs.14987.
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Keywords: Quality of Care, Home Healthcare, Quality Indicators (QIs), Quality Measures
Masnick M, Morgan DJ, Sorkin JD
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
This study was designed to determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. The authors concluded that HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI.
AHRQ-funded; HS018111.
Citation: Masnick M, Morgan DJ, Sorkin JD .
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
Infect Control Hosp Epidemiol 2017 Oct;38(10):1167-71. doi: 10.1017/ice.2017.179..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance, Quality Measures
Cholan RA, Weiskopf NG, Rhoton D
From concepts and codes to healthcare quality measurement: understanding variations in value set vocabularies for a statin therapy clinical quality measure.
This study examined health care quality measures and found that the decisions Clinical Quality Measure developers make about which concepts and code groups to include or exclude in value set vocabularies can lead to inaccuracies in the measurement of quality of care.
AHRQ-funded; HS023908.
Citation: Cholan RA, Weiskopf NG, Rhoton D .
From concepts and codes to healthcare quality measurement: understanding variations in value set vocabularies for a statin therapy clinical quality measure.
eGEMS 2017 Sep 4;5(1):19. doi: 10.5334/egems.212..
Keywords: Quality of Care, Quality Measures, Quality Measures
Waljee JF, Dimick JB
Do patient-reported outcomes correlate with clinical outcomes following surgery?
This study examines whether patient-reported outcomes (PROs) correlate with clinical outcomes following surgery. PROs are distinct from clinical outcomes and represent a potential indicator of performance that can be targeted to improve quality of care. Future studies that examine the influence of measurement techniques, case mix, and disease characteristics on PROs will inform efforts to routinely and efficiently integrate these critical outcomes into existing strategies to capture treatment effectiveness and quality of care for surgical conditions.
AHRQ-funded; HS023313.
Citation: Waljee JF, Dimick JB .
Do patient-reported outcomes correlate with clinical outcomes following surgery?
Adv Surg 2017 Sep;51(1):141-50. doi: 10.1016/j.yasu.2017.03.011..
Keywords: Quality of Care, Outcomes, Patient-Centered Outcomes Research, Surgery, Patient Experience, Quality Measures
Ahluwalia SC, Damberg CL, Silverman M
What defines a high-performing health care delivery system: a systematic review.
A systematic review was conducted to determine if there is a commonly used, agreed-on definition of what constitutes a "high-performing" health care delivery system. No consistent definition of a high-performing health care system or organization was identified. High performance was variably defined across different dimensions, including quality (93 percent of articles), cost (67 percent), access (35 percent), equity (26 percent), patient experience (21 percent), and patient safety (18 percent).
AHRQ-funded; HS024067.
Citation: Ahluwalia SC, Damberg CL, Silverman M .
What defines a high-performing health care delivery system: a systematic review.
Jt Comm J Qual Patient Saf 2017 Sep;43(9):450-59. doi: 10.1016/j.jcjq.2017.03.010.
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Keywords: Healthcare Delivery, Quality of Care, Policy, Quality Measures
Hatfield LA, Zaslavsky AM
Implications of variation in the relationships between beneficiary characteristics and Medicare Advantage CAHPS measures.
The researchers studied how differences in quality score adjustments across Medicare Advantage contracts change comparisons for individuals and contracts. They found that, for average consumers, standard adjustment is sufficient to represent variation in contract quality standardized to a common population. For people with characteristics far from average, personalized reporting using their characteristics and contract-specific coefficients can substantially change the expected quality measures across contracts.
AHRQ-funded; HS016978.
Citation: Hatfield LA, Zaslavsky AM .
Implications of variation in the relationships between beneficiary characteristics and Medicare Advantage CAHPS measures.
Health Serv Res 2017 Aug;52(4):1310-29. doi: 10.1111/1475-6773.12544.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Medicare, Health Status, Patient Experience, Quality of Care, Quality Improvement, Quality Measures
Ottosen MJ, Engebretson JC, Etchegaray JM
Steps in developing a patient-centered measure of hospital design factors.
This research methodology column focuses on describing a four-step medical ethnography approach that can be used in developing patient-centered measures of interest to those studying built environments. The authors use this approach to illustrate how one might develop a measure that can be used to understand parent perceptions of the safety culture in neonatal intensive care units.
AHRQ-funded; HS022944.
Citation: Ottosen MJ, Engebretson JC, Etchegaray JM .
Steps in developing a patient-centered measure of hospital design factors.
HERD 2017 Jul;10(4):10-16. doi: 10.1177/1937586716685290.
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Keywords: Patient Safety, Neonatal Intensive Care Unit (NICU), Quality Measures, Research Methodologies
Cerully JL, Martino SC, Rybowski L
Using "roll-up" measures in healthcare quality reports: perspectives of report sponsors and national alliances.
The objective of this study, which used semi-structured qualitative interview design, was to understand the views of prominent organizations in the field of healthcare quality on the topic of reporting roll-up measures that combine indicators of multiple, often disparate, dimensions of care to consumers. The investigators concluded that the results of the interviews elucidated the need for research focused on construction and reporting of roll-up measures.
AHRQ-funded; HS016980; HS016978.
Citation: Cerully JL, Martino SC, Rybowski L .
Using "roll-up" measures in healthcare quality reports: perspectives of report sponsors and national alliances.
Am J Manag Care 2017 Jun;23(6):e202-e07..
Keywords: Quality of Care, Quality Improvement, Quality Indicators (QIs), Quality Measures
DeLancey JO, Softcheck J, Chung JW
Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
This study evaluated associations between hospital characteristics, number and types of measures reported, and the star ratings. Of 3,591 hospitals receiving a star rating,4 or 5 stars were awarded to 15.8 percent of major teaching hospitals, 18.8 percent of other teaching hospitals, 30.2 percent of community hospitals, 33.3 percent of critical access hospitals, and 87.3 percent of specialty hospitals.
AHRQ-funded; HS021857.
Citation: DeLancey JO, Softcheck J, Chung JW .
Associations between hospital characteristics, measure reporting, and the Centers for Medicare & Medicaid Services Overall Hospital Quality Star Ratings.
JAMA 2017 May 16;317(19):2015-17. doi: 10.1001/jama.2017.3148.
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Keywords: Hospitals, Quality of Care, Quality Measures, Provider Performance, Patient Safety
Baernholdt M, Hinton ID, Guofen Y
A national comparison of rural/urban pressure ulcer and fall rates.
Despite recent decline in hospital acquired conditions (HACs), rates for pressure ulcers (PURs) and falls (FRs) remain at levels that require improvement. Contextual factors and care processes may impact HACs. Using the National Database of Nursing Quality Indicators (NDNQI®) this study examined differences in care processes and community, hospital, and nursing unit characteristics that influence PURs and FRs in 4238 rural and urban nursing units.
AHRQ-funded; HS023147.
Citation: Baernholdt M, Hinton ID, Guofen Y .
A national comparison of rural/urban pressure ulcer and fall rates.
Online J Issues Nurs 2017 May;22(2):1-12. doi: 10.3912/OJIN.Vol22No02PPT60..
Keywords: Injuries and Wounds, Nursing, Patient Safety, Pressure Ulcers, Quality of Care, Quality Improvement, Quality Indicators (QIs), Quality Measures, Rural Health, Urban Health
Goldberg EM, Wilson T, Saucier C
Achieving the BpTRUth: emergency department hypertension screening and the Centers for Medicare & Medicaid Services quality measure.
The aims of this study were to (1) assess the reliability of ED triage blood pressure (BP) as a metric to establish when the CMS threshold (>/=120/80 mm Hg), and other clinically relevant BP thresholds (>/=140/90 and >/=160/100 mm Hg) have been met; and (2) determine whether correct identification varies by gender, race, or triage acuity. At the three suggested BP thresholds, 66.1 percent, 74.0 percent, and 88.8 percent of patients were confirmed to meet the CMS threshold, respectively. There were no differences by gender, race, or triage acuity.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Wilson T, Saucier C .
Achieving the BpTRUth: emergency department hypertension screening and the Centers for Medicare & Medicaid Services quality measure.
J Am Soc Hypertens 2017 May;11(5):290-94. doi: 10.1016/j.jash.2017.03.003.
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Keywords: Blood Pressure, Emergency Department, Quality Measures, Screening, Diagnostic Safety and Quality, Quality of Care