National Healthcare Quality and Disparities Report
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- Brain Injury (1)
- Cancer (7)
- Cancer: Lung Cancer (2)
- Cancer: Skin Cancer (1)
- Cardiovascular Conditions (1)
- Care Management (4)
- Case Study (1)
- Chronic Conditions (2)
- Communication (1)
- Community-Based Practice (2)
- Critical Care (2)
- Dementia (2)
- Diagnostic Safety and Quality (1)
- Disparities (1)
- (-) Elderly (27)
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- Neurological Disorders (2)
- Nursing Homes (1)
- Outcomes (2)
- (-) Palliative Care (27)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (4)
- Patient Experience (1)
- Policy (1)
- Practice Patterns (1)
- Provider: Health Personnel (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (2)
- Risk (1)
- Sex Factors (1)
- Shared Decision Making (2)
- Social Determinants of Health (1)
- Surgery (2)
- Transitions of Care (3)
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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 25 of 27 Research Studies DisplayedGuo W, Cai S, Caprio T
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
This study’s objective was to examine the frequency and categories of end-of-life care transitions among assisted living community decedents and their associations with state staffing and training regulations. This cohort study included Medicare beneficiaries who resided in assisted living facilities and had validated death dates in 2018-2019 (N = 113,662). The authors found end-of-life care transitions were observed among 34.89% of our study sample in the last 30 days before death, and among 17.25% in the last 7 days. Higher frequency of care transitions in the last 7 days of life was associated with higher regulatory specificity of licensed [incidence risk ratio (IRR) = 1.08] and direct care worker staffing (IRR = 1.22). Greater regulatory specificity of direct care worker training (IRR = 0.75) was associated with fewer transitions. Similar associations were found for direct care worker staffing (IRR = 1.15) and training (IRR = 0.79) and transitions within 30 days of death. There were significant variations in the number of care transitions in different states.
AHRQ-funded; HS026893.
Citation: Guo W, Cai S, Caprio T .
End-of-life care transitions in assisted living: associations with state staffing and training regulations.
J Am Med Dir Assoc 2023 Jun; 24(6):827-32.e3. doi: 10.1016/j.jamda.2023.02.002..
Keywords: Transitions of Care, Long-Term Care, Policy, Palliative Care, Elderly
Wu A, Zhou J, Quinlan N
Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: insights from a level 1 trauma center.
The purpose of this study was to identify variables and outcomes related to inpatient palliative care (PC) consultation for patients age 65+ with traumatic brain injuries (TBI). The researchers included individuals over age 65 presenting from January 2013-September 2020 with TBI and intracranial hemorrhage. The study found that inpatient PC consultation was uncommon; with only 4% of 576 patients receiving. Features associated with likelihood of consultation were severe TBI and pre-existing dementia. Patients with PC consults had longer overall and intensive care unit (ICU) length of stays (LOS), more days intubated and higher costs. However, those patients with earlier-than-average PC consultation had shorter overall and ICU LOS as well as fewer ventilator days on a ventilator and lower costs. The study concluded that older patients with TBI have a greater likelihood of receiving PC consultation based on pre-existing dementia and severe TBI and patients with PC consultations had worse LOS and higher costs, but those impacts were diminished by earlier involvement from the PC.
AHRQ-funded; HS028747.
Citation: Wu A, Zhou J, Quinlan N .
Early palliative care consultation offsets hospitalization duration and costs for elderly patients with traumatic brain injuries: insights from a level 1 trauma center.
J Clin Neurosci 2023 Feb; 108:1-5. doi: 10.1016/j.jocn.2022.12.013..
Keywords: Elderly, Palliative Care, Hospitalization, Brain Injury
Temkin-Greener H, Guo W, Hua Y
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
The purpose of this study was to evaluate the relationships between death at home and home hospice care with race, ethnicity, community characteristics, strictness of state-level regulations for assisted living facilities, dual Medicare-Medicaid enrollment, and other individual characteristics. The researchers found that almost 60% of the 100,783 fee-for-service Medicare beneficiaries residing in 16,560 assisted living communities who died in 2018-2019, died at home. Of those individuals, 84% were with home hospice care. Dual Medicare-Medicaid enrollment was a more important predictor of death at home than race or ethnicity; yet race was a stronger predictor than dual enrollment for hospice care at death. In states with lower regulatory strictness for assisted living communities, residents were less likely to die at home. The study concludes that these results imply an important role for state regulation of assisted living facilities and can help guide efforts to ensure equitable access to the individual’s preference for end-of-life-care.
Citation: Temkin-Greener H, Guo W, Hua Y .
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
Health Aff 2022 May;41(5):654-62. doi: 10.1377/hlthaff.2021.01677..
Keywords: Elderly, Palliative Care, Long-Term Care, Racial and Ethnic Minorities
Orth J, Li Y, Simning A
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
This study’s objectives were to examine variations in end-of-life (EOL) care/outcomes among decedents with Alzheimer's disease/related dementias (ADRD) and to identify associations with nursing home (NH)/market characteristics. Findings showed that decedents with ADRD in NHs that were nonprofit, had Alzheimer's units, higher licensed nurse staffing, and in more competitive markets, had better EOL care/outcomes. Recommendations included modifications to state Medicaid NH payments to promote better EOL care/outcomes and future research to understand NH care practices associated with presence of Alzheimer's units in order to identify mechanisms possibly promoting higher-quality EOL care.
AHRQ-funded; HS024923.
Citation: Orth J, Li Y, Simning A .
End-of-life care among nursing home residents with dementia varies by nursing home and market characteristics.
J Am Med Dir Assoc 2021 Feb;22(2):320-28.e4. doi: 10.1016/j.jamda.2020.06.021..
Keywords: Elderly, Palliative Care, Dementia, Nursing Homes, Long-Term Care
Iyer AS, Goodrich CA, Dransfield MT
End-of-life spending and healthcare utilization among older adults with chronic obstructive pulmonary disease.
This study examined end-of-life spending and healthcare utilization among Medicare beneficiaries aged 65 years or older with chronic obstructive pulmonary disease (COPD) who died during the period 2013-2014. Data on 146,240 decedents with COPD was investigated from 306 hospital referral regions (HRRs). The overall spending during the last 2 years of life varied significantly nationwide. Inpatient care accounted for 40.2% of spending, with 82% of decedents admitted to the hospital for 13.7±3.1 days and 55%±11% admitted to an intensive care unit for 3-7 days. Skilled nursing facilities accounted for 11.6% of spending and were utilized by 31-45% of decedents for 14-23 days. Hospitals were utilized by 39-56% of decedents and accounted for 10.3% of spending.
AHRQ-funded; HS023009.
Citation: Iyer AS, Goodrich CA, Dransfield MT .
End-of-life spending and healthcare utilization among older adults with chronic obstructive pulmonary disease.
Am J Med 2020 Jul;133(7):817-24.e1. doi: 10.1016/j.amjmed.2019.11.024..
Keywords: Elderly, Healthcare Utilization, Respiratory Conditions, Chronic Conditions, Healthcare Costs, Palliative Care
Fiala MA, Gettinger T, Wallace CL
Cost differential associated with hospice use among older patients with multiple myeloma.
Hospice is an effective end-of-life care approach for patients with incurable illnesses such as multiple myeloma; however, it has been historically underutilized. In addition to improving quality of life, hospice enrollment reduces healthcare spending in many incurable illnesses but this has been unstudied in the myeloma population to date. This study examined the cost differential associated with hospice use among older patients with multiple myeloma.
AHRQ-funded; R24 HS019455.
Citation: Fiala MA, Gettinger T, Wallace CL .
Cost differential associated with hospice use among older patients with multiple myeloma.
J Geriatr Oncol 2020 Jan;11(1):88-92. doi: 10.1016/j.jgo.2019.06.010..
Keywords: Elderly, Palliative Care, Cancer, Healthcare Costs
Makam AN, Tran T, Miller ME
The clinical course after long-term acute care hospital admission among older Medicare beneficiaries.
Investigators sought to examine the clinical course after long-term acute care (LTAC) admission. They found that hospitalized older adults transferred to LTAC hospitals had poor survival, spent most of their remaining life as an inpatient, and frequently underwent life-prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and to prioritize healthcare needs for these adults. Given the exceedingly low rates of palliative care consultations, they recommend future research to examine unmet palliative care needs in this population.
AHRQ-funded; HS022418.
Citation: Makam AN, Tran T, Miller ME .
The clinical course after long-term acute care hospital admission among older Medicare beneficiaries.
J Am Geriatr Soc 2019 Nov;67(11):2282-88. doi: 10.1111/jgs.16106..
Keywords: Elderly, Medicare, Palliative Care, Patient-Centered Outcomes Research, Outcomes, Care Management, Healthcare Delivery
Armstrong MJ, Alliance S, Corsentino P
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
Researchers investigate the natural history, cause of death, and end-of-life experiences of individuals diagnosed with dementia with Lewy bodies (DLB). In the 20-question survey, respondents indicated that physicians rarely discussed what to expect at the end of life and that the caregiver usually initiated such conversations. Failure to thrive was the most common cause of death, followed by pneumonia and swallowing difficulties, other medical conditions, and complications from falling. The researchers conclude that the study results highlight a critical need for better prognostic counseling and education for persons and families living with DLB, and they recommended further study.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Alliance S, Corsentino P .
Cause of death and end-of-life experiences in individuals with dementia with Lewy bodies.
J Am Geriatr Soc 2019 Jan;67(1):67-73. doi: 10.1111/jgs.15608..
Keywords: Dementia, Neurological Disorders, Patient Experience, Palliative Care, Mortality, Elderly
Cooper Z, Lilley EJ, Bollens-Lund E
High burden of palliative care needs of older adults during emergency major abdominal surgery.
The purpose of this retrospective study was to quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. The investigators found that most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life.
AHRQ-funded; HS022763.
Citation: Cooper Z, Lilley EJ, Bollens-Lund E .
High burden of palliative care needs of older adults during emergency major abdominal surgery.
J Am Geriatr Soc 2018 Nov;66(11):2072-78. doi: 10.1111/jgs.15516..
Keywords: Critical Care, Elderly, Palliative Care, Surgery
Satchidanand N, Servoss TJ, Singh R
Development of a risk tool to support discussions of care for older adults admitted to the ICU with pneumonia.
The purpose of this study was to develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. The authors suggest that their risk tool can help care teams make more informed decisions among care options by identifying a patient group for whom a careful review of goals of care is indicated both during and after hospitalization.
AHRQ-funded; HS023656.
Citation: Satchidanand N, Servoss TJ, Singh R .
Development of a risk tool to support discussions of care for older adults admitted to the ICU with pneumonia.
Am J Hosp Palliat Care 2018 Sep;35(9):1201-06. doi: 10.1177/1049909118764093..
Keywords: Shared Decision Making, Elderly, Health Status, Intensive Care Unit (ICU), Palliative Care, Risk
Iyer AS, Benzo RP, Bakitas MA
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
This editorial discusses palliative care and intensive care in chronic obstructive pulmonary disease and comments on an article by Shen, et al., published, in 2018, in the Journal of Palliative Care, entitled “Life-sustaining procedures, palliative care consultation, and do-not resuscitate status in dying patients with COPD in US hospitals: 2010-2014.”
AHRQ-funded; HS023009.
Citation: Iyer AS, Benzo RP, Bakitas MA .
Easing the tension between palliative care and intensive care in chronic obstructive pulmonary disease.
J Palliat Care 2018 Jul;33(3):123-24. doi: 10.1177/0825859718782505..
Keywords: Chronic Conditions, Respiratory Conditions, Critical Care, Elderly, Palliative Care, Quality of Care
Chen LM, Levine DA, Hayward R
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
This study describes the use of early comfort care for patients with heart failure (HF), and whether hospitals that more commonly initiate comfort care have higher 30-day mortality rates. It found that hospital use of early comfort care for HF varies, has not increased over time, and on average, is not correlated with 30-day risk-standardized mortality rates.
AHRQ-funded; HS020671.
Citation: Chen LM, Levine DA, Hayward R .
Relationship between hospital 30-day mortality rates for heart failure and patterns of early inpatient comfort care.
J Hosp Med 2018 Mar;13(3):170-76. doi: 10.12788/jhm.2862.
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Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Inpatient Care, Mortality, Palliative Care
Khandelwal N, Curtis JR, Freedman VA
How often is end-of-life care in the United States inconsistent with patients' goals of care?
The purpose of this study was to document the proportion of bereaved respondents who reported care inconsistent with patients' wishes and characterize the predictors of end-of-life care associated with inconsistent care. The study found that one in eight respondents stated care in the last months of life was inconsistent with patients' wishes; such care was associated with worse ratings of care, pain management, and communication with clinicians.
AHRQ-funded; HS022982.
Citation: Khandelwal N, Curtis JR, Freedman VA .
How often is end-of-life care in the United States inconsistent with patients' goals of care?
J Palliat Med 2017 Dec;20(12):1400-04. doi: 10.1089/jpm.2017.0065..
Keywords: Care Management, Healthcare Delivery, Elderly, Palliative Care, Patient-Centered Healthcare, Quality of Care
Bull J, Kamal AH, Harker M
Standardization and scaling of a community-based palliative care model.
In 2014, Four Seasons Compassion for Life was awarded a Centers for Medicare and Medicaid Services Health Care Innovation (CMMI) Award to expand upon their existing model to implement, evaluate, and demonstrate Community-Based Palliative Care (CBPC) in the United States. The objective of this article is to describe the processes and challenges of scaling and standardizing the CBPC model.
AHRQ-funded; HS023681.
Citation: Bull J, Kamal AH, Harker M .
Standardization and scaling of a community-based palliative care model.
J Palliat Med 2017 Nov;20(11):1237-43. doi: 10.1089/jpm.2017.0027..
Keywords: Community-Based Practice, Palliative Care, Elderly
Bull J, Kamal AH, Harker M
Tracking patients in community-based palliative care through the centers for Medicare & Medicaid Services Healthcare Innovation Project.
In 2014, Four Seasons Compassion for Life was awarded a Centers for Medicare & Medicaid Services Healthcare Innovation Award to expand an existing Community-Based Palliative Care (CBPC) model into additional counties and to propose a new payment approach. The goal of this article is to evaluate the tracking of point of entry into palliative care and patient transition outcomes in the model.
AHRQ-funded; HS023681.
Citation: Bull J, Kamal AH, Harker M .
Tracking patients in community-based palliative care through the centers for Medicare & Medicaid Services Healthcare Innovation Project.
J Palliat Med 2017 Nov;20(11):1231-36. doi: 10.1089/jpm.2017.0080..
Keywords: Palliative Care, Community-Based Practice, Elderly, Transitions of Care
Wang SY, Dang W, Aldridge MD
Associations of hospice disenrollment and hospitalization with continuous home care provision.
The researchers examined rates of hospice disenrollment and posthospice hospitalization among patients who are enrolled in hospices that provide continuous home care (CHC) (CHC hospices) compared with patients who are enrolled in hospices that do not offer CHC (non-CHC hospices). They concluded that CHC hospices had significantly lower rates of hospice disenrollment and posthospice hospitalization, suggesting CHC service available may enable higher quality of end-of-life care.
AHRQ-funded; HS023900.
Citation: Wang SY, Dang W, Aldridge MD .
Associations of hospice disenrollment and hospitalization with continuous home care provision.
Med Care 2017 Sep;55(9):848-55. doi: 10.1097/mlr.0000000000000776.
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Keywords: Elderly, Home Healthcare, Hospitalization, Palliative Care
Jorgensen SM, Carnahan RM, Weckmann MT
Validity of the delirium observation screening scale in identifying delirium in home hospice patients.
The Delirium Observation Screening Scale (DOS) was developed to improve delirium recognition but has yet to be validated in the home hospice setting. This pilot study aimed to explore the accuracy of the DOS for identifying delirium in home hospice patients. It concluded that the DOS appears to be an accurate way to screen for delirium in home hospice patients.
AHRQ-funded; HS022666.
Citation: Jorgensen SM, Carnahan RM, Weckmann MT .
Validity of the delirium observation screening scale in identifying delirium in home hospice patients.
Am J Hosp Palliat Care 2017 Sep;34(8):744-47. doi: 10.1177/1049909116658468.
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Keywords: Diagnostic Safety and Quality, Elderly, Home Healthcare, Neurological Disorders, Palliative Care
Wang SY, Aldridge MD, Gross CP
End-of-life care transition patterns of Medicare beneficiaries.
The researchers characterized the patterns of transitions in care and factors associated with multiple transitions in the last 6 months of life of U.S. decedents (N = 660,132). They found that 218,731 had four or more transitions within the last 6 months of life. Women, blacks, individuals younger than 85, and individuals without dementia were more likely to have four or more transitions.
AHRQ-funded; HS023900.
Citation: Wang SY, Aldridge MD, Gross CP .
End-of-life care transition patterns of Medicare beneficiaries.
J Am Geriatr Soc 2017 Jul;65(7):1406-13. doi: 10.1111/jgs.14891.
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Keywords: Elderly, Medicare, Palliative Care, Transitions of Care
Schuler MS, Joyce NR, Huskamp HA
Medicare beneficiaries with advanced lung cancer experience diverse patterns of care from diagnosis to death.
Using Medicare claims data for patients diagnosed with extensive-stage small-cell lung cancer, the authors used latent class analysis to identify classes of people with different care patterns. The findings showed substantial heterogeneity in patterns of care for patients with advanced cancer, which should be accounted for in efforts to improve end-of-life care.
AHRQ-funded; HS022998.
Citation: Schuler MS, Joyce NR, Huskamp HA .
Medicare beneficiaries with advanced lung cancer experience diverse patterns of care from diagnosis to death.
Health Aff 2017 Jul;36(7):1193-200. doi: 10.1377/hlthaff.2017.0448..
Keywords: Cancer, Cancer: Lung Cancer, Care Management, Elderly, Medicare, Palliative Care
Iyer AS, Bakitas M
Early palliative care in advanced illness: do right by mama.
This letter describes a case study where the doctor and the family decided not to do aggressive treatment on their mother in her 80’s with metastatic lung cancer and pneumonia. After describing the intubation procedure and the use of mechanical ventilation, the family decided that palliative care was the best option. The doctor emphasizes the use of palliative care as the best outcome for many terminally ill patients.
AHRQ-funded; HS023009; HS013852.
Citation: Iyer AS, Bakitas M .
Early palliative care in advanced illness: do right by mama.
JAMA Intern Med 2017 Jun;177(6):761-62. doi: 10.1001/jamainternmed.2017.0764.
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Keywords: Cancer, Cancer: Lung Cancer, Case Study, Shared Decision Making, Elderly, Palliative Care, Patient-Centered Outcomes Research
Rocque GB, Dionne-Odom JN, Sylvia Huang CH
Implementation and impact of patient lay navigator-led advance care planning conversations.
Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). This study evaluated implementation of lay navigator-led ACP and concluded that a navigator-led ACP program was feasible and may be associated with lower rates of resource utilization near EOL.
AHRQ-funded; HS023009.
Citation: Rocque GB, Dionne-Odom JN, Sylvia Huang CH .
Implementation and impact of patient lay navigator-led advance care planning conversations.
J Pain Symptom Manage 2017 Apr;53(4):682-92. doi: 10.1016/j.jpainsymman.2016.11.012.
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Keywords: Communication, Elderly, Palliative Care, Patient-Centered Healthcare, Provider: Health Personnel
Koroukian SM, Schiltz NK, Warner DF
Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer.
In this study, the researchers examined the association between end-of-life care and each of the social determinants of health and multimorbidity (MM), hypothesizing that higher MM is associated with less aggressive care. They found that, while 61.2 percent of the patients enrolled in hospice, 24.6 percent underwent cancer-directed treatment; 55.1 percent were admitted to the hospital and/or ED; and 21.7 percent died in the hospital.
AHRQ-funded; HS023113.
Citation: Koroukian SM, Schiltz NK, Warner DF .
Social determinants, multimorbidity, and patterns of end-of-life care in older adults dying from cancer.
J Geriatr Oncol 2017 Mar;8(2):117-24. doi: 10.1016/j.jgo.2016.10.001.
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Keywords: Cancer, Elderly, Palliative Care, Social Determinants of Health
Wang SY, Aldridge MD, Canavan M
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
The purpose of this paper is to identify hospice and patient characteristics associated with the use of continuous home care (CHC) and to examine the associations between CHC utilization and hospice disenrollment or hospitalization after hospice enrollment. The researchers found that patients who were white, had cancer, and had more comorbidities were more likely to use CHC and that patients who used CHC were less likely to have hospice disenrollment and less likely to be hospitalized after hospice enrollment.
AHRQ-funded; HS023900.
Citation: Wang SY, Aldridge MD, Canavan M .
Continuous home care reduces hospice disenrollment and hospitalization after hospice enrollment.
J Pain Symptom Manage 2016 Dec;52(6):813-21. doi: 10.1016/j.jpainsymman.2016.05.031.
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Keywords: Elderly, Home Healthcare, Hospitalization, Palliative Care
Wang SY, Hall J, Pollack CE
Associations between end-of-life cancer care patterns and Medicare expenditures.
The authors examined the extent to which patterns of intensive end-of-life care explain geographic variation in end-of-life care expenditures among cancer decedents. The mean expenditure per cancer decedent in the last month of life was $10,800, with considerable variation in the percentage of decedents receiving intensive end-of-life care intervention. Regional patterns of late chemotherapy or late hospice use explained only approximately 1% of the expenditure difference, while the proportion of decedents who had ICU admissions within 30 days of death was a major driver of variation, explaining 37.6% of the expenditure difference. They concluded that promoting appropriate end-of-life care has the potential to reduce geographic variation in end-of-life care expenditures.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Associations between end-of-life cancer care patterns and Medicare expenditures.
J Natl Compr Canc Netw 2016 Aug;14(8):1001-8.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Palliative Care
Just E, Casarett DJ, Asch DA
Differences in terminal hospitalization care between U.S. men and women.
The authors sought to determine whether men and women receive different care during terminal hospitalizations by examining sex-based differences in lengths of stay, resuscitation status, and intensive interventions and processes of care. They found that. compared with men, women had slightly shorter hospitalizations and were more likely to have a do-not-resuscitate order. Women remained less likely to receive care in an intensive care unit, cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, or surgical procedures. The researchers concluded that men who die in hospitals receive more aggressive care than women.
AHRQ-funded; HS018425.
Citation: Just E, Casarett DJ, Asch DA .
Differences in terminal hospitalization care between U.S. men and women.
J Pain Symptom Manage 2016 Aug;52(2):205-11. doi: 10.1016/j.jpainsymman.2016.01.013.
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Keywords: Disparities, Palliative Care, Hospitalization, Sex Factors, Elderly