National Healthcare Quality and Disparities Report
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Topics
- Access to Care (12)
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- Alcohol Use (2)
- (-) Ambulatory Care and Surgery (205)
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- Sexual Health (1)
- Shared Decision Making (5)
- Skin Conditions (1)
- Social Determinants of Health (1)
- Stress (1)
- Substance Abuse (4)
- Surgery (26)
- Surveys on Patient Safety Culture (1)
- System Design (1)
- Teams (2)
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- Transitions of Care (2)
- Treatments (4)
- Uninsured (1)
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- Urinary Tract Infection (UTI) (2)
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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
151 to 175 of 205 Research Studies DisplayedCarney RM, Freedland KE, Steinmeyer BC
Collaborative care for depression symptoms in an outpatient cardiology setting: a randomized clinical trial.
The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). Tthis trial did not show that CC produces better depression outcomes than UC.
AHRQ-funded; HS018335.
Citation: Carney RM, Freedland KE, Steinmeyer BC .
Collaborative care for depression symptoms in an outpatient cardiology setting: a randomized clinical trial.
Int J Cardiol 2016 Sep 15;219:164-71. doi: 10.1016/j.ijcard.2016.06.045.
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Keywords: Care Management, Cardiovascular Conditions, Depression, Healthcare Delivery, Behavioral Health, Outcomes, Ambulatory Care and Surgery, Teams
Hickner J, Smith SA, Yount N
Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture.
This study examines differences in patient safety culture perceptions among providers, management and staff in a large national survey of safety culture in ambulatory practices in the USA. Its findings suggest that managers need to pay attention to the training needs of office staff, since this was an area with one of the greatest gaps in perceptions. In addition, both office managers and physicians need to encourage more open communication.
AHRQ-funded; 290200710024C.
Citation: Hickner J, Smith SA, Yount N .
Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture.
BMJ Qual Saf 2016 Aug;25(8):588-94. doi: 10.1136/bmjqs-2014-003914.
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Keywords: Ambulatory Care and Surgery, Organizational Change, Patient Safety, Provider
Senders A, Sando K, Wahbeh H
Managing psychological stress in the multiple sclerosis medical visit: patient perspectives and unmet needs.
Psychological stress can negatively impact multiple sclerosis. To further understand how stress is addressed in the multiple sclerosis medical visit, 34 people with multiple sclerosis participated in focus groups. Transcripts were analyzed by inductive thematic analysis. The majority of participants did not discuss stress with their provider, citing barriers to communication such as lack of time, poor coordination between specialties, physician reliance on pharmaceutical prescription, and patient lack of self-advocacy. Participants recommended several ways to better manage psychological well-being in the clinical setting. These findings provide a foundation for future studies aimed at minimizing the detrimental effect of stress in multiple sclerosis.
AHRQ-funded; HS017582.
Citation: Senders A, Sando K, Wahbeh H .
Managing psychological stress in the multiple sclerosis medical visit: patient perspectives and unmet needs.
J Health Psychol 2016 Aug;21(8):1676-87. doi: 10.1177/1359105314562084.
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Keywords: Care Management, Neurological Disorders, Ambulatory Care and Surgery, Stress
Rinke ML, Jan D, Nassim J
Surgical site infections following pediatric ambulatory surgery: an epidemiologic analysis.
The authors identified surgical site infection (SSI) rates following pediatric ambulatory surgery, SSI outcomes and risk factors, and sensitivity and specificity of SSI administrative billing codes. They concluded that SSI following pediatric ambulatory surgery occurs at an appreciable rate and conveys morbidity on children.
AHRQ-funded; HS021282.
Citation: Rinke ML, Jan D, Nassim J .
Surgical site infections following pediatric ambulatory surgery: an epidemiologic analysis.
Infect Control Hosp Epidemiol 2016 Aug;37(8):931-8. doi: 10.1017/ice.2016.98.
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Keywords: Children/Adolescents, Ambulatory Care and Surgery, Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Risk
Clark BJ, Rubinsky AD, Ho PM
Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
This study sought to determine whether alcohol misuse was associated with admission to an intensive care unit (ICU) among patients receiving outpatient care. Among 486,115 veterans receiving outpatient care, the adjusted probability of ICU admission within 1 year was 2.0 percent for abstinent patients, 1.6 percent for patients with lower-risk alcohol use, 1.8 percent for patients with moderate alcohol misuse, and 2.5 percent for patients with severe alcohol misuse.
AHRQ-funded; HS022800.
Citation: Clark BJ, Rubinsky AD, Ho PM .
Alcohol screening scores and the risk of intensive care unit admission and hospital readmission.
Subst Abus 2016 Jul-Sep;37(3):466-73. doi: 10.1080/08897077.2015.1137259.
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Keywords: Alcohol Use, Hospital Readmissions, Intensive Care Unit (ICU), Ambulatory Care and Surgery, Screening, Substance Abuse
Keller SC, Gurses AP, Abaje AI
Learning from the patient: Human factors engineering in outpatient parenteral antimicrobial therapy.
When used in hospital settings, many of the complex devices adapted for use in outpatient parenteral antimicrobial therapy (OPAT) can lead to errors that may lead to patient harm. To reduce complications from OPAT in the home, such as catheter-associated venous thromboembolism, adverse drug events, or other side effects of OPAT, the authors argue that we need to understand how OPAT is performed by patients and their caregivers and the ways in which human factors engineering can contribute to their reduction.
AHRQ-funded; HS022916.
Citation: Keller SC, Gurses AP, Abaje AI .
Learning from the patient: Human factors engineering in outpatient parenteral antimicrobial therapy.
Am J Infect Control 2016 Jul;44(7):758-60. doi: 10.1016/j.ajic.2016.01.010.
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Keywords: Adverse Events, Antimicrobial Stewardship, Education: Patient and Caregiver, Ambulatory Care and Surgery, Patient Safety
Hultman G, Marquard J, Arsoniadis E
Usability testing of two ambulatory EHR navigators.
Researchers sought to understand if redesigning an EHR-based navigation tool with clinician input improved user performance and satisfaction. A usability evaluation was conducted to compare two versions of a redesigned ambulatory navigator. The version of navigator did not affect perceived workload, and time to complete tasks was longer in the redesigned navigator. Preferences for EHR navigation structures appeared to be individualized.
AHRQ-funded; HS022085.
Citation: Hultman G, Marquard J, Arsoniadis E .
Usability testing of two ambulatory EHR navigators.
Appl Clin Inform 2016 Jun 15;7(2):502-15. doi: 10.4338/aci-2015-10-ra-0129.
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Keywords: Education: Patient and Caregiver, Electronic Health Records (EHRs), Ambulatory Care and Surgery, Patient Experience
Hochman MJ, Wolf S, Zafar SY
Comparing unmet needs to optimize quality: characterizing inpatient and outpatient palliative care populations.
The researchers compared the unmet needs of palliative care patients by location of care to better characterize these populations. They found that outpatients are more burdened by pain at first palliative care encounter compared to inpatients, yet outpatients experience higher quality of life and better performance status.
AHRQ-funded; HS023681.
Citation: Hochman MJ, Wolf S, Zafar SY .
Comparing unmet needs to optimize quality: characterizing inpatient and outpatient palliative care populations.
J Pain Symptom Manage 2016 Jun;51(6):1033-39.e3. doi: 10.1016/j.jpainsymman.2015.12.338.
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Keywords: Quality of Care, Inpatient Care, Ambulatory Care and Surgery, Palliative Care, Patient-Centered Outcomes Research
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Wares JR, Lawson B, Shemin D
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
The researchers hypothesized that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of multidrug-resistant organisms (MDRO) and further that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. They found that reducing antimicrobial treatment markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. They suggested that improving the environmental decontamination efficacy between patient dialysis treatments as an effective method for reducing colonization and contamination rates.
AHRQ-funded; HS021666.
Citation: Wares JR, Lawson B, Shemin D .
Evaluating infection prevention strategies in out-patient dialysis units using agent-based modeling.
PLoS One 2016 May 19;11(5):e0153820. doi: 10.1371/journal.pone.0153820.
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Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Healthcare-Associated Infections (HAIs), Prevention, Ambulatory Care and Surgery, Infectious Diseases
Bickman L, Douglas SR, De Andrade AR
Implementing a measurement feedback system: a tale of two sites.
A randomized experiment was conducted in two outpatient clinics evaluating contextualized feedback systems. Only one of the two participating clinics had an enhanced outcome because of feedback. Clinicians' questionnaire completion rate and feedback viewing were 50 % higher at this clinic. The discussion focused on the differences in implementation at each site and how these differences may have contributed to the different outcomes of the experiment.
AHRQ-funded; HS018036.
Citation: Bickman L, Douglas SR, De Andrade AR .
Implementing a measurement feedback system: a tale of two sites.
Adm Policy Ment Health 2016 May;43(3):410-25. doi: 10.1007/s10488-015-0647-8.
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Keywords: Behavioral Health, Outcomes, Ambulatory Care and Surgery, Patient-Centered Healthcare
Chung S, Johns N, Zhao B
Clocks moving at different speeds: cultural variation in the satisfaction with wait time for outpatient care.
This study explored racial/ethnic differences in satisfaction with wait time of scheduled office visits by comparing electronic health record -based, patient-reported, and patient satisfaction with wait time. It found that given actual wait times, Asians perceive longer wait time and were less satisfied with wait times. Asians may have different expectations about wait time at the clinic.
AHRQ-funded; HS019815.
Citation: Chung S, Johns N, Zhao B .
Clocks moving at different speeds: cultural variation in the satisfaction with wait time for outpatient care.
Med Care 2016 Mar;54(3):269-76. doi: 10.1097/mlr.0000000000000473.
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Keywords: Patient Experience, Racial and Ethnic Minorities, Electronic Health Records (EHRs), Ambulatory Care and Surgery
Friedman B, Barbash GI, Glied SA
AHRQ Author: Friedman B, Steiner CA
Hospital revisits within 30 days after conventional and robotically assisted hysterectomy.
This study compared the rates of hospital readmissions, emergency department, and outpatient clinic visits after discharge for robotically assisted (RA) versus nonrobotic hysterectomy in women age 30 or more with nonmalignant conditions. It found that using 2 different methods to control for selection, there were higher rates of revisits among women undergoing RA versus non-RA hysterectomy for benign conditions.
AHRQ-authored
Citation: Friedman B, Barbash GI, Glied SA .
Hospital revisits within 30 days after conventional and robotically assisted hysterectomy.
Med Care 2016 Mar;54(3):311-8. doi: 10.1097/mlr.0000000000000482..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Emergency Department, Ambulatory Care and Surgery, Women
Geissler K, Stearns SC, Becker C
The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.
The authors quantified associations between violence in Mexico and decreases in access to care for border county residents. They found that increased homicide rates in Mexico were associated with increased hospitalizations for ambulatory care sensitive (ACS) conditions in the USA, although residence in a border county was associated with decreased probability of being hospitalized for an ACS condition.
AHRQ-funded; HS021074.
Citation: Geissler K, Stearns SC, Becker C .
The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.
J Public Health 2016 Mar;38(1):14-23. doi: 10.1093/pubmed/fdv012.
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Keywords: Access to Care, Hospitalization, Ambulatory Care and Surgery
Knackstedt ED, Stockmann C, Davis CR
Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship.
The researchers reviewed patient discharges with outpatient parenteral antimicrobial therapy (OPAT) to determine whether OPAT was modifiable or unnecessary at a large tertiary care children’s hospital. At least one modification definitely or possibly would have been recommended for 78 percent of episodes. For more than 40 percent of episodes, OPAT was potentially not indicated.
AHRQ-funded; HS023320.
Citation: Knackstedt ED, Stockmann C, Davis CR .
Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship.
Infect Control Hosp Epidemiol 2015 Feb;36(2):222-4. doi: 10.1017/ice.2014.27..
Keywords: Antimicrobial Stewardship, Children/Adolescents, Ambulatory Care and Surgery
Waljee JF, Zhong L, Hou H
The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study.
The authors examined the use of opioids following outpatient upper extremity procedures to discern the variation by procedure type and patient factors. They found that current opioid users are more likely to require postoperative opioid analgesics for routine procedures and more likely to receive inappropriate prescriptions.
AHRQ-funded; HS023313.
Citation: Waljee JF, Zhong L, Hou H .
The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study.
Plast Reconstr Surg 2016 Feb;137(2):355e-64e. doi: 10.1097/01.prs.0000475788.52446.7b..
Keywords: Ambulatory Care and Surgery, Medication, Opioids, Pain, Surgery
McDonough CM, Ni P, Coster WJ
Development of an IRT-based short form to assess applied cognitive function in outpatient rehabilitation.
The authors developed a 15-item outpatient rehabilitation self-report short form for the Activity Measure for Post-Acute Care Applied Cognition item bank. They concluded that their Applied Cognition outpatient short form demonstrated acceptable psychometric properties and provides a bridge to item response theory-based measurement when point-of-care computing is not available.
AHRQ-funded; HS021368.
Citation: McDonough CM, Ni P, Coster WJ .
Development of an IRT-based short form to assess applied cognitive function in outpatient rehabilitation.
Am J Phys Med Rehabil 2016 Jan;95(1):62-71. doi: 10.1097/phm.0000000000000340.
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Keywords: Elderly, Neurological Disorders, Ambulatory Care and Surgery, Rehabilitation
Stucky BD, Hays RD, Edelen MO
Possibilities for shortening the CAHPS Clinician and Group Survey.
This paper explores the impact on reliability and validity of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) domain scores of reducing the numbers of items used to assess the 3 core Clinician and Group adult survey CAHPS domains (Provider Communication, Access to Care, and Courteous and Helpful Office Staff).
AHRQ-funded; HS016980.
Citation: Stucky BD, Hays RD, Edelen MO .
Possibilities for shortening the CAHPS Clinician and Group Survey.
Med Care 2016 Jan;54(1):32-7. doi: 10.1097/mlr.0000000000000452..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Ambulatory Care and Surgery, Community-Based Practice
Steiner CA, Maggard-Gibbons M, Raetzman SO
Return to acute care following ambulatory surgery.
This study determined the rates of all-cause, unplanned revisits (i.e., not for routine medical care) within 30 days of ambulatory surgery and whether revisits were related to the operation. It found that acute care revisits following ambulatory operations in low-risk patients occurred with notable frequency across 6 diverse types of operations.
AHRQ-authored
Citation: Steiner CA, Maggard-Gibbons M, Raetzman SO .
Return to acute care following ambulatory surgery.
JAMA 2015 Oct 6;314(13):1397-9. doi: 10.1001/jama.2015.12210..
Keywords: Healthcare Cost and Utilization Project (HCUP), Ambulatory Care and Surgery, Surgery, Adverse Events
Hollenbeck BK, Dunn RL, Suskind AM
Ambulatory surgery centers and their intended effects on outpatient surgery.
Using a twenty percent national sample of Medicare beneficiaries, the researchers assessed the impact of ambulatory surgery centers (ASCs) on rates of hospital-based outpatient procedures and adverse events. They found that opening of an ambulatory surgery center in a Hospital Service Area resulted in a decline in hospital-based outpatient surgery without increasing mortality or admission.
AHRQ-funded; HS020927; HS018726.
Citation: Hollenbeck BK, Dunn RL, Suskind AM .
Ambulatory surgery centers and their intended effects on outpatient surgery.
Health Serv Res 2015 Oct;50(5):1491-507. doi: 10.1111/1475-6773.12278..
Keywords: Ambulatory Care and Surgery, Adverse Events, Patient Safety
Hurst DM, Oster ME, Smith S
Is clinic visit frequency associated with weight gain during the interstage period? A report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative (JCCHD-NPCQIC).
The researchers sought to determine whether frequency of outpatient clinic visits correlated with weight gain in patients with hypoplastic left heart syndrome or variant during the interstage period between discharge from stage I palliation and presentation for stage II palliation . There was no correlation between interstage visit frequency and change in weight-for-age z-score in this patient population.
AHRQ-funded; HS016957.
Citation: Hurst DM, Oster ME, Smith S .
Is clinic visit frequency associated with weight gain during the interstage period? A report from the Joint Council on Congenital Heart Disease National Pediatric Cardiology Quality Improvement Collaborative (JCCHD-NPCQIC).
Pediatr Cardiol 2015 Oct;36(7):1382-5. doi: 10.1007/s00246-015-1169-6.
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Keywords: Newborns/Infants, Obesity: Weight Management, Heart Disease and Health, Ambulatory Care and Surgery
Carey K
Price increases were much lower in ambulatory surgery centers than hospital outpatient departments in 2007-12.
This study examined the revenue side of ASC growth by using a large national claims database that contains information on actual prices paid. It found that for six common outpatient surgical procedures, prices paid to ASCs on the whole grew in line with general medical care prices, while overall prices paid to hospital outpatient departments for the same procedures climbed sharply.
AHRQ-funded; HS023780.
Citation: Carey K .
Price increases were much lower in ambulatory surgery centers than hospital outpatient departments in 2007-12.
Health Aff 2015 Oct;34(10):1738-44. doi: 10.1377/hlthaff.2015.0252..
Keywords: Ambulatory Care and Surgery, Healthcare Costs, Surgery
Rangachari P, Mehta R, Rethemeyer RK
Short or long end of the lever? Associations between provider communication of the "asthma-action plan" and outpatient revisits for pediatric asthma.
This study addresses the gap in understanding the extent of leverage that healthcare providers may have in preventing hospital revisits for asthma through effective communication of the Asthma-Action Plan (AAP) in the outpatient setting. The Children's Hospital of Georgia survey results suggest limited potential of effective provider communication of AAP in reducing outpatient revisits for pediatric asthma and indicate a need for broader community-based interventions to address patient life variables impacting self-management and hospital revisits for pediatric asthma.
AHRQ-funded; HS019785.
Citation: Rangachari P, Mehta R, Rethemeyer RK .
Short or long end of the lever? Associations between provider communication of the "asthma-action plan" and outpatient revisits for pediatric asthma.
J Hosp Adm 2015 Oct;4(5):26-39. doi: 10.5430/jha.v4n5p26.
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Keywords: Asthma, Children/Adolescents, Ambulatory Care and Surgery, Clinician-Patient Communication, Patient Self-Management
Robinson JC, Brown TT, Whaley C
Consumer choice between hospital-based and freestanding facilities for arthroscopy: Impact on prices, spending, and surgical complications.
The purpose of this study was to evaluate the impact of reference-based benefits on consumer choices, facility prices, employer spending, and surgical outcomes for orthopaedic procedures performed at ambulatory surgery centers. It found that the shift to reference-based benefits was associated with an increase in the utilization of freestanding ambulatory surgery centers by 14.3 percentage points for knee arthroscopy and by 9.9 percentage points for shoulder arthroscopy and a corresponding decrease in the use of hospital-based facilities.
AHRQ-funded; HS022098.
Citation: Robinson JC, Brown TT, Whaley C .
Consumer choice between hospital-based and freestanding facilities for arthroscopy: Impact on prices, spending, and surgical complications.
J Bone Joint Surg Am 2015 Sep 16;97(18):1473-81. doi: 10.2106/jbjs.o.00240..
Keywords: Surgery, Ambulatory Care and Surgery, Outcomes
Wiseman JT, Fernandes-Taylor S, Barnes ML
Conceptualizing smartphone use in outpatient wound assessment: patients' and caregivers' willingness to use technology.
The researchers surveyed a vulnerable patient population to evaluate smartphone capability and willingness to adopt this technology. Their survey demonstrated that an older patient cohort with significant comorbidity is able and willing to adopt a smartphone-based postoperative monitoring program.
AHRQ-funded; HS023395.
Citation: Wiseman JT, Fernandes-Taylor S, Barnes ML .
Conceptualizing smartphone use in outpatient wound assessment: patients' and caregivers' willingness to use technology.
J Surg Res 2015 Sep;198(1):245-51. doi: 10.1016/j.jss.2015.05.011..
Keywords: Ambulatory Care and Surgery, Surgery, Telehealth, Health Information Technology (HIT), Injuries and Wounds, Adverse Events, Patient Safety, Caregiving