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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 148 Research Studies DisplayedHoriguchi M, Tian L, Uno H
Quantification of long-term survival benefit in a comparative oncology clinical study.
The authors discuss the quantification of long-term survival benefit in a comparative oncology clinical study. They assert that from the perspective of cost-risk-benefit, using a long-term survival benefit criterion for selecting anticancer therapies may be more appropriate.
AHRQ-funded; HS022193.
Citation: Horiguchi M, Tian L, Uno H .
Quantification of long-term survival benefit in a comparative oncology clinical study.
JAMA Oncol 2018 Jun;4(6):881-82. doi: 10.1001/jamaoncol.2018.0518..
Keywords: Cancer, Comparative Effectiveness, Outcomes, Research Methodologies
Skrivankova V, Heagerty PJ
Single index methods for evaluation of marker-guided treatment rules based on multivariate marker panels.
Answering the scientific challenge to identify and validate the factors that can reliably be used to target treatment and to quantify the expected treatment benefit as a function of candidate markers, the authors of this article propose to focus on a smooth, non-parametric evaluation of a canonical single-index score that estimates the expected treatment benefit associated with patient characteristics. Their methods decouple the model used to generate the treatment benefit score from the methods adopted in order to evaluate the performance of the resulting single-index score. They also demonstrate that the canonical single-index treatment benefit score can be used for selecting subsets of patients with enriched expected treatment response.
AHRQ-funded; HS019222.
Citation: Skrivankova V, Heagerty PJ .
Single index methods for evaluation of marker-guided treatment rules based on multivariate marker panels.
Biometrics 2018 Jun;74(2):663-72. doi: 10.1111/biom.12752..
Keywords: Comparative Effectiveness, Shared Decision Making, Outcomes, Treatments
Smith AB, Meyer AM, Meng K
The relationship of travel distance with cystectomy access and outcomes.
The objectives of this study was to evaluate the effect of differential distance on cystectomy receipt among patients with muscle-invasive bladder cancer (MIBC) and investigate the association between travel distance and cystectomy outcomes such as readmission. The investigators found that the additional distance needed to reach a cystectomy provider did not predict receipt of surgery for MIBC. Furthermore, travel distance from cystectomy provider was not a significant predictor for subsequent readmission after cystectomy and did not affect overall survival.
AHRQ-funded; HS024134.
Citation: Smith AB, Meyer AM, Meng K .
The relationship of travel distance with cystectomy access and outcomes.
Urol Oncol 2018 Jun;36(6):308.e1-08.e9. doi: 10.1016/j.urolonc.2018.03.005..
Keywords: Access to Care, Cancer, Hospital Readmissions, Outcomes, Surgery
Niknam BA, Arriaga AF, Rosenbaum PR
Adjustment for atherosclerosis diagnosis distorts the effects of percutaneous coronary intervention and the ranking of hospital performance.
The researchers investigated how adjustment for atherosclerosis affects rankings of hospitals that perform percutaneous coronary intervention (PCI). They found that atherosclerosis is almost always noted in patients with acute myocardial infarction (AMI) who undergo interventional cardiology but less often in medically managed patients, so adjustment for its notation likely removes part of the effect of interventional treatment. Thus, hospitals performing more extensive imaging and more PCIs have higher atherosclerosis diagnosis rates, making their patients appear healthier and artificially reducing the expected mortality rate against which they are benchmarked. The authors concluded that atherosclerosis adjustment is detrimental to hospitals providing more thorough AMI care.
AHRQ-funded; HS023560.
Citation: Niknam BA, Arriaga AF, Rosenbaum PR .
Adjustment for atherosclerosis diagnosis distorts the effects of percutaneous coronary intervention and the ranking of hospital performance.
J Am Heart Assoc 2018 May 25;7(11). doi: 10.1161/jaha.117.008366.
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Keywords: Cardiovascular Conditions, Outcomes, Heart Disease and Health, Provider Performance, Quality Measures
Eaton EF, Tamhane A, Davy-Mendez T
Brief report: kidney dysfunction does not contribute significantly to antiretroviral therapy modification in treatment-naive PLWH receiving initial ART.
Antiretroviral therapy (ART) durability, time to modification or cessation, has declined. The objective of this retrospective follow up study was to determine whether kidney dysfunction was contributing to reduced durability. The investigator found that for patients in their study initiated on ART, including TDF-based ART, in the last decade, kidney dysfunction was not a major factor leading to regimen modification.
AHRQ-funded; HS023009.
Citation: Eaton EF, Tamhane A, Davy-Mendez T .
Brief report: kidney dysfunction does not contribute significantly to antiretroviral therapy modification in treatment-naive PLWH receiving initial ART.
J Acquir Immune Defic Syndr 2019 May 1;81(1):e6-e9. doi: 10.1097/qai.0000000000001999..
Keywords: Patient-Centered Outcomes Research, Kidney Disease and Health, Evidence-Based Practice, Outcomes
Semenkovich TR, Panni RZ, Hudson JL
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
This study examined comparative effectiveness and survival rates for upfront esophagectomy versus induction chemoradiation in patients with clinical stage T2N20 esophageal cancer. A decision analysis model was created for the two treatment strategies. Results showed comparable median survival rates for both strategies. The optimal treatment strategy depended on the accuracy of endoscopic ultrasound staging.
AHRQ-funded; HS022330.
Citation: Semenkovich TR, Panni RZ, Hudson JL .
Comparative effectiveness of upfront esophagectomy versus induction chemoradiation in clinical stage T2N0 esophageal cancer: a decision analysis.
J Thorac Cardiovasc Surg 2018 May;155(5):2221-30.e1. doi: 10.1016/j.jtcvs.2018.01.006..
Keywords: Treatments, Cancer, Surgery, Comparative Effectiveness, Shared Decision Making, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Medication
Glazer KB, Eliot MN, Danilack VA
Residential green space and birth outcomes in a coastal setting.
The objective of this study was to evaluate associations between green and blue space and birth outcomes in a coastal area of the northeastern US. Findings from this study did not support the hypothesis that residential green space was associated with reduced risk of preterm birth or higher birthweight after adjustment for individual and contextual socioeconomic factors, but variation in results with incremental adjustment raised questions about the optimal degree of control for confounding by markers of SES. The investigators found that living near a freshwater body was associated with higher birthweight.
AHRQ-funded; HS025013.
Citation: Glazer KB, Eliot MN, Danilack VA .
Residential green space and birth outcomes in a coastal setting.
Environ Res 2018 May;163:97-107. doi: 10.1016/j.envres.2018.01.006..
Keywords: Pregnancy, Newborns/Infants, Outcomes, Adverse Events, Women
Westover AN, Nakonezny PA, Halm EA
Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration.
This study's aims were to ascertain the demographics of stimulant medication users compared with non-users, examine temporal trends of stimulant medication use and estimate risk factors for development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. The investigators concluded that in their cohort comorbid substance use disorders were common and were risk factors for development of (AUD).
AHRQ-funded; HS022418.
Citation: Westover AN, Nakonezny PA, Halm EA .
Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration.
Addiction 2018 May;113(5):857-67. doi: 10.1111/add.14122..
Keywords: Substance Abuse, Medication, Risk, Mortality, Patient-Centered Outcomes Research, Outcomes
Rudra S, Hui C, Rao YJ
Effect of radiation treatment volume reduction on lymphopenia in patients receiving chemoradiotherapy for glioblastoma.
The purpose of this study was to evaluate whether reduction in glioblastoma radiation treatment (RT) volume can reduce risk of acute severe lymphopenia (ASL). The investigators concluded that, among other findings, limited-field RT was associated with less lymphopenia after RT plus temozolomide and did not adversely affect progression-free survival or overall survival.
AHRQ-funded; HS022888.
Citation: Rudra S, Hui C, Rao YJ .
Effect of radiation treatment volume reduction on lymphopenia in patients receiving chemoradiotherapy for glioblastoma.
Int J Radiat Oncol Biol Phys 2018 May 1;101(1):217-25. doi: 10.1016/j.ijrobp.2018.01.069..
Keywords: Outcomes, Patient Safety, Risk
Stevens H, Carlin AM, Ross R
Effect of surgeon age on bariatric surgery outcomes.
This study examined the effect of surgeon age on complication rates for bariatric surgery. A retrospective study was done with 71 surgeons in Michigan who participated in a statewide collaborative improvement program. Older surgeons performed more Roux-en Y Gastric Bypass (40%) and less sleeve gastrectomy (38.8%) than younger surgeons. There was not found to be any statistically significant differences in patient outcome between the two age groups.
AHRQ-funded; HS024403.
Citation: Stevens H, Carlin AM, Ross R .
Effect of surgeon age on bariatric surgery outcomes.
Ann Surg 2018 May;267(5):905-09. doi: 10.1097/sla.0000000000002297..
Keywords: Adverse Events, Obesity, Outcomes, Patient Safety, Provider, Provider: Physician, Provider Performance
Austrian JS, Jamin CT, Doty GR
Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.
The goal of this study was to determine if an electronic health record (EHR) based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. A patient-level, interrupted time series study of emergency department patients with severe sepsis or septic shock was conducted, with an intervention introduced at the approximate mid-point--a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Mean length of stay for patients with sepsis decreased significantly following the introduction of the alert, but the alert system had no effect on mortality or other clinical or process measures. The researchers conclude that a more sophisticated algorithm for sepsis identification is needed to improve outcomes.
AHRQ-funded; HS023683.
Citation: Austrian JS, Jamin CT, Doty GR .
Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.
J Am Med Inform Assoc 2018 May;25(5):523-29. doi: 10.1093/jamia/ocx072..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Hospitals, Mortality, Outcomes, Quality Improvement, Quality of Care, Sepsis
Levin S, Toerper M, Hamrock E
Machine-learning-based electronic triage more accurately differentiates patients with respect to clinical outcomes compared with the emergency severity index.
This study seeks to evaluate an electronic triage system (e-triage) based on machine learning that predicts likelihood of acute outcomes enabling improved patient differentiation. It concluded that E-triage more accurately classifies emergency severity index (ESI) level 3 patients and highlights opportunities to use predictive analytics to support triage decisionmaking.
AHRQ-funded; HS023641.
Citation: Levin S, Toerper M, Hamrock E .
Machine-learning-based electronic triage more accurately differentiates patients with respect to clinical outcomes compared with the emergency severity index.
Ann Emerg Med 2018 May;71(5):565-74.e2. doi: 10.1016/j.annemergmed.2017.08.005.
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Keywords: Shared Decision Making, Health Information Technology (HIT), Health Information Technology (HIT), Outcomes
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
AHRQ-funded; HS022998.
Citation: Mahmoud L, Zullo AR, Thompson BB .
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Fudim M, Liu PR, Shrader P
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
Mineralocorticoid receptor antagonist (MRA) therapy may be beneficial to patients with atrial fibrillation (AF), but little is known about their use in patients with AF and subsequent outcomes. In order to better understand MRA use and subsequent outcomes, the investigators performed a retrospective cohort study of the contemporary ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
AHRQ-funded; HS021092.
Citation: Fudim M, Liu PR, Shrader P .
Mineralocorticoid receptor antagonism in patients with atrial fibrillation: findings from the ORBIT-AF (Outcomes Registry for Better Informed Treatment of Atrial Fibrillation) registry.
J Am Heart Assoc 2018 Apr 13;7(8). doi: 10.1161/jaha.117.007987..
Keywords: Cardiovascular Conditions, Evidence-Based Practice, Heart Disease and Health, Medication, Outcomes, Patient-Centered Outcomes Research, Prevention, Registries, Stroke
Kalbaugh CA, Loehr L, Wruck L
Frequency of care and mortality following an incident diagnosis of peripheral artery disease in the inpatient or outpatient setting: the ARIC (Atherosclerosis Risk in Communities) study.
Researchers analyzed frequency of care and mortality date for patients with an initial peripheral artery disease (PAD) diagnosis in the outpatient or inpatient setting. Data was analyzed from the ARIC (Atherosclerosis Risk in Communities) study cohort linked with Centers for Medicare and Medicaid Services fee-for-services claims data for 2002-2012. Patients diagnosed in the outpatient setting had higher follow-up rates with lower hospitalizations and mortality than those diagnosed in the inpatient setting.
AHRQ-funded; HS000032; HS023728.
Citation: Kalbaugh CA, Loehr L, Wruck L .
Frequency of care and mortality following an incident diagnosis of peripheral artery disease in the inpatient or outpatient setting: the ARIC (Atherosclerosis Risk in Communities) study.
J Am Heart Assoc 2018 Apr 13;7(8). doi: 10.1161/jaha.117.007332..
Keywords: Cardiovascular Conditions, Healthcare Utilization, Hospitalization, Mortality, Outcomes
Bachmann JM, Shah AS, Duncan MS
Cardiac rehabilitation and readmissions after heart transplantation.
Cardiac transplant recipients always are referred to cardiac rehabilitation (CR) after transplantation, and is associated with a lower 1-year readmission risk. This study’s objective was to determine rates of CR for heart transplant recipients in the US and also 1-year readmission rates using 2013-2014 Medicare data. Out of the 2,531 heart transplant patients in the US in 2013, about 24% received Medicare coverage and were included in the study. Rates of CR utilization was only, with only 55% participating in the program. Younger transplant patients ages 35 to 49 years were less likely to initiate CR than patients 65 and older. In all groups patients did not attend all 36 prescribed sessions, with a mean of 26.7 sessions attended. The 1-year readmission risk was 29% lower for CR participation patients.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Shah AS, Duncan MS .
Cardiac rehabilitation and readmissions after heart transplantation.
J Heart Lung Transplant 2018 Apr;37(4):467-76. doi: 10.1016/j.healun.2017.0.017.
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Keywords: Transplantation, Surgery, Rehabilitation, Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Yao Y, Ahn H, Stifter J
Continuity index measures in the acute care hospital setting: an analytic review and tests using electronic health record data and computer simulation.
This study examined continuity index measures in the acute care hospital setting. These measures can be used to examine the influence of nurse staffing patterns on patient outcomes. The researchers examined the behavior of continuity indexes as applied to clinical practice data that were collected with the Hands-On Automated Nursing Data System (HANDS) and data from computer simulation. The findings provided a deep understanding of the conceptual foundations and properties of various continuity measures.
AHRQ-funded; HS015054; HS023072.
Citation: Yao Y, Ahn H, Stifter J .
Continuity index measures in the acute care hospital setting: an analytic review and tests using electronic health record data and computer simulation.
J Nurs Meas 2018 Apr 1;26(1):20-35. doi: 10.1891/1061-3749.26.1.20..
Keywords: Transitions of Care, Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Provider, Hospitals, Outcomes
Wang SV, Huybrechts KF, Fischer MA
Generalized boosted modeling to identify subgroups where effect of dabigatran versus warfarin may differ: an observational cohort study of patients with atrial fibrillation.
The purpose of this study was to explore generalized boosted modeling (GBM) as a method for identifying subgroups with greater benefit or harm with dabigatran versus warfarin for treatment of atrial fibrillation. The investigators concluded that dabigatran's superiority to warfarin at prevention of thromboembolism may be greater in secondary than primary prevention. They indicated that in practice, secondary prevention patients are more often treated with warfarin.
AHRQ-funded; HS022193.
Citation: Wang SV, Huybrechts KF, Fischer MA .
Generalized boosted modeling to identify subgroups where effect of dabigatran versus warfarin may differ: an observational cohort study of patients with atrial fibrillation.
Pharmacoepidemiol Drug Saf 2018 Apr;27(4):383-90. doi: 10.1002/pds.4395..
Keywords: Blood Clots, Blood Thinners, Cardiovascular Conditions, Comparative Effectiveness, Evidence-Based Practice, Heart Disease and Health, Medication, Outcomes, Patient-Centered Outcomes Research, Prevention
Vakharia PP, Chopra R, Sacotte R
Severity strata for five patient-reported outcomes in adults with atopic dermatitis.
Several patient-reported outcomes have been used to assess the burden of atopic dermatitis (AD). Some are disease specific, such as the Patient-Oriented Eczema Measure (POEM), while others pertain to itch, for example the numerical rating scale (NRS)-itch, ItchyQoL and 5-D itch, or dermatological disease in general, for example the Dermatology Life Quality Index (DLQI). The purpose of this study was to confirm previously developed strata for POEM, DLQI and raw ItchyQoL, and develop strata for the NRS-itch, mean ItchyQoL and 5-D itch scale for use in adults with AD.
AHRQ-funded; HS023011.
Citation: Vakharia PP, Chopra R, Sacotte R .
Severity strata for five patient-reported outcomes in adults with atopic dermatitis.
Br J Dermatol 2018 Apr;178(4):925-30. doi: 10.1111/bjd.16078..
Keywords: Outcomes, Patient-Centered Outcomes Research, Quality of Life, Skin Conditions
Li S, Middleton A, Ottenbacher KJ
Trajectories over the first year of long-term care nursing home residence.
This retrospective cohort study examined changes in situation for Medicare fee-for-service beneficiaries newly admitted to long-term nursing homes from July 2012 to December 2013 for the first year after admission. Data was used from the Minimum Data Set and Medicare Provider and Analysis Reviews claims data. Median length of stay in long-term care was 127 days, and for any institution 158 days. At 12 months post admission, 35% had died, 36.9% remained in long-term care, 23.4% were in the community, and 4.7% were in acute care hospitals or other institutions.
AHRQ-funded; HS022134.
Citation: Li S, Middleton A, Ottenbacher KJ .
Trajectories over the first year of long-term care nursing home residence.
J Am Med Dir Assoc 2018 Apr;19(4):333-41. doi: 10.1016/j.jamda.2017.09.021.
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Keywords: Long-Term Care, Nursing Homes, Elderly, Medicare, Patient-Centered Outcomes Research, Outcomes
Yarbrough CK, Bommarito KM, Gamble PG
Population-based approaches to treatment and readmission after spinal cord injury.
Recent studies in surgical and non-surgical specialties have suggested that patients admitted on the weekend may have worse outcomes. It is unclear whether this extends to patients with spinal cord injury (SCI). This study was designed to evaluate factors for readmission after index hospitalization for spinal cord injury. The study’s results suggested that the weekend effect, described previously in other patient populations, may not play as important a role in patients with SCI.
AHRQ-funded; HS019455.
Citation: Yarbrough CK, Bommarito KM, Gamble PG .
Population-based approaches to treatment and readmission after spinal cord injury.
J Neurosurg Sci 2018 Apr;62(2):107-15. doi: 10.23736/s0390-5616.16.03617-1..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Outcomes, Injuries and Wounds
Lau KSL, Rosenman MB, Wiehe SE
Race/ethnicity, and behavioral health status: first arrest and outcomes in a large sample of juvenile offenders.
The objective of this study was to assess the simultaneous effects of gender, race/ethnicity, and pre-arrest behavioral health (BH) service-use on age at first arrest, and first arrest outcomes. It found that black youth were arrested at younger ages than white or Hispanic youth. Youth with psychiatric problems were arrested at younger ages than youth with substance-use, dual-diagnoses, or no BH problems.
AHRQ-funded; HS024296; HS023318.
Citation: Lau KSL, Rosenman MB, Wiehe SE .
Race/ethnicity, and behavioral health status: first arrest and outcomes in a large sample of juvenile offenders.
J Behav Health Serv Res 2018 Apr;45(2):237-51. doi: 10.1007/s11414-017-9578-3.
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Keywords: Behavioral Health, Outcomes, Racial and Ethnic Minorities, Sex Factors
Chhatre S, Jayadevappa R
Racial and ethnic disparities in substance use disorders and outcomes in elderly prostate cancer patients.
This study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data to identify prevalence of substance use among patients with advanced-stage prostate cancer. There are racial and ethnic disparities between substance use and outcomes. A multidisciplinary coordinated care approach is recommended to address these disparities.
AHRQ-funded; HS024106.
Citation: Chhatre S, Jayadevappa R .
Racial and ethnic disparities in substance use disorders and outcomes in elderly prostate cancer patients.
J Ethn Subst Abuse 2018 Apr-Jun;17(2):135-49. doi: 10.1080/15332640.2016.1160019..
Keywords: Cancer: Prostate Cancer, Disparities, Elderly, Outcomes, Racial and Ethnic Minorities, Substance Abuse
Joseph A, Bayramzadeh S, Zamani Z
Safety, performance, and satisfaction outcomes in the operating room: a literature review.
This review of empirical literature focuses on the design of operating rooms (ORs) by investigating the physical environmental features of ORs associated with patient and staff outcomes. The article highlights gaps in the research and identifies areas where best practice and design assumptions need to be evaluated using rigorous design research.
AHRQ-funded; HS024380.
Citation: Joseph A, Bayramzadeh S, Zamani Z .
Safety, performance, and satisfaction outcomes in the operating room: a literature review.
HERD 2018 Apr;11(2):137-50. doi: 10.1177/1937586717705107..
Keywords: Patient Experience, Patient Safety, Outcomes, Surgery
McMahon LF, Jr., Howell JD
The hospital: still the doctors' workplace(s) - a cautionary note for approaches to safety and value improvement.
The authors discuss a study by Shahian et al. exploring an important concept: What is the relationship between global hospital safety indicators and specific hospital-level clinical outcomes? They insist that studies assessing hospital quality, safety, and outcomes also address the multiproduct nature of hospital outcomes, operations, safety, and quality.
AHRQ-funded; HS018334.
Citation: McMahon LF, Jr., Howell JD .
The hospital: still the doctors' workplace(s) - a cautionary note for approaches to safety and value improvement.
Health Serv Res 2018 Apr;53(2):601-07. doi: 10.1111/1475-6773.12780.
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Keywords: Hospitals, Outcomes, Quality Indicators (QIs), Quality Improvement