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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 535 Research Studies DisplayedWhittington C, Skains RM, Zhang Y
Delirium due to potentially avoidable hospitalizations among older adults.
This retrospective cross-sectional study examined delirium rates among 39,933 older adults hospitalized for ambulatory care-sensitive conditions (ACSCs) at a large Southeastern academic medical center from 2015 to 2019. Delirium occurred in 15.6% of admissions, with lower rates observed for ACSC admissions compared to non-ACSC admissions. Older age and higher comorbidity were significant predictors of delirium development. While delirium rates were lower for ACSC admissions, optimizing outpatient management of ACSCs remains crucial for reducing hospitalizations and associated complications like delirium.
AHRQ-funded; HS013852.
Citation: Whittington C, Skains RM, Zhang Y .
Delirium due to potentially avoidable hospitalizations among older adults.
J Gerontol A Biol Sci Med Sci 2024 Mar; 79(3). doi: 10.1093/gerona/glad256.
Keywords: Elderly, Hospitalization
Hogg-Graham R, Benitez JA, Lacy ME
Association between community social vulnerability and preventable hospitalizations.
The purpose of this study was to explore the relationship between variations in social vulnerability and preventable hospitalization rates. The researchers analyzed county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). The study found that preventable hospitalizations were 40% greater in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations.
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Benitez JA, Lacy ME .
Association between community social vulnerability and preventable hospitalizations.
Med Care Res Rev 2024 Feb; 81(1):31-38. doi: 10.1177/10775587231197248..
Keywords: Hospitalization, Social Determinants of Health
Carroll AR, Hall M, Noelke C
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
This study examined associations between a validated, multidimensional measure of social determinants of health and population-based hospitalization rates among children <18 years across 18 states from the 2017 Healthcare Cost and Utilization Project State Inpatient Databases and the US Census. Exposure was ZIP code-level Child Opportunity Index (COI), a composite measure of neighborhood resources and conditions that matter for children's health. The cohort included 614,823 hospitalizations among a population of 29,244,065 children, which measures at 21.02 hospitalizations per 1000. Adjusted hospitalization rates decreased significantly and in a stepwise fashion as COI increased, from 26.56 per 1000 in very low COI areas to 14.76 per 1000 in very high COI areas (incidence rate ratio 1.8). Decreasing neighborhood opportunity was associated with increasing hospitalization rates among children in the study.
AHRQ-funded; HS026122.
Citation: Carroll AR, Hall M, Noelke C .
Association of neighborhood opportunity and pediatric hospitalization rates in the United States.
J Hosp Med 2024 Feb; 19(2):120-25. doi: 10.1002/jhm.13252..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitalization, Social Determinants of Health
Li J
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Accurate Medicare Quality of Patient Care home health star ratings are crucial to helping patients find high-quality care, yet critics of these ratings indicate that they are not valid. The purpose of this retrospective study was to assess whether using the highest-rated home health agency available in a ZIP code improves outcomes. The researchers included 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. The study found that treatment by the highest-rated agencies available decreased risks of hospitalization, emergency department use, and institutionalization during the initial episode, and increased days independently at home by 2.6% or 3.75 days in the 180 days after the end of the initial episode. Treatment effects were stronger for agencies that were above-average, had 1 or more stars than the next-best agency, and nonrural residents. Effects were positive for both postacute and community-entry patients.
AHRQ-funded; HS026836.
Citation: Li J .
Home health agencies with high quality of patient care star ratings reduced short-term hospitalization rates and increased days independently at home.
Med Care 2024 Jan; 62(1):11-20. doi: 10.1097/mlr.0000000000001930..
Keywords: Home Healthcare, Quality of Care, Hospitalization, Provider Performance
Meille G, Decker SL, Owens PL
AHRQ Author: Meille G, Decker SL, Owens PL
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
The objective of this cross-sectional study was to measure the relationship between COVID-19 admission rates and hospital occupancy in different US areas at different time periods during 2020. Data were taken from the HCUP State Inpatient Databases for patients in nonfederal acute care hospitals. The results showed that hospital occupancy decreased during weeks with low COVID-19 admissions and increased during weeks with high COVID-19 admissions; the largest changes occurred early in the pandemic. The authors concluded that their findings suggest that COVID-19 surges strained intensive care unit capacity and were associated with decreases in the number of surgical patients. These occupancy fluctuations may have affected quality of care and hospital finances.
AHRQ-authored.
Citation: Meille G, Decker SL, Owens PL .
COVID-19 admission rates and changes in US hospital inpatient and intensive care unit occupancy.
JAMA Health Forum 2023 Dec; 4(12):e234206. doi: 10.1001/jamahealthforum.2023.4206..
Keywords: COVID-19, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospitals
Roemer M, Schaefer MB, Pickens GT
AHRQ Author: Roemer M
Estimating state-specific population-based hospitalization rates from in-state hospital discharge data.
The purpose of this study was to develop weights to estimate state population-based hospitalization rates for all residents of a state using only data from in-state hospitals. The researchers utilized Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID), for data from 2018-2019, including 47 states plus Washington D.C. and excluding residents treated in other states. SID were based on administrative billing records collected by hospitals, shared with statewide data organizations, and provided to HCUP. The study found that of 34,186,766 discharged patients in 2018, 4.2% were movers. A greater share of movers (vs. stayers) lived in state border and rural counties; a lower share had discharges billed to Medicaid or were hospitalized for maternal/neonatal services. The difference between 2019 observed and estimated total discharges for all included states and D.C. was 9,402. The researchers reported an overestimation of discharges with an expected payer of Medicaid, from the lowest income communities, and for maternal/neonatal care. The researchers reported an underestimation of discharges with an expected payer of private insurance, from the highest income communities, and with injury diagnoses and surgical services. Estimates for the majority of subsets were reported to be not within a 95% confidence interval, attributed to factors such as hospital closures/openings, shifting consumer preferences, and other issues impossible to account for.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Roemer M, Schaefer MB, Pickens GT .
Estimating state-specific population-based hospitalization rates from in-state hospital discharge data.
Health Serv Res 2023 Dec; 58(6):1314-27. doi: 10.1111/1475-6773.14216..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Hospital Discharge
Xu JF, Anderson KE, Liu A
Role of patient sorting in avoidable hospital stays in Medicare Advantage vs traditional Medicare.
The purpose of this cross-sectional study was to explore whether differences in avoidable hospital stays between Medicare Advantage (MA) patients and traditional Medicare (TM) patients can be explained by the primary care clinicians who treat MA and TM beneficiaries. The study’s main outcome and measures included whether a beneficiary had avoidable hospital stays in 2019 due to any of the 5 chronic ambulatory care-sensitive conditions (ACSCs). Avoidable hospital stays included both hospitalizations and observation stays. The study found that when controlling for the primary care clinician, the relative risk (RR) of avoidable hospital stays in MA vs TM changed by 2.6 percentage points, indicating that when compared with TM beneficiaries, MA beneficiaries saw clinicians with lower rates of avoidable hospital stays.
AHRQ-funded; HS000029.
Citation: Xu JF, Anderson KE, Liu A .
Role of patient sorting in avoidable hospital stays in Medicare Advantage vs traditional Medicare.
JAMA Health Forum 2023 Nov 3; 4(11):e233931. doi: 10.1001/jamahealthforum.2023.3931..
Keywords: Medicare, Hospitalization
Winer JC, Richardson T, Berg KJ
Effect modifiers of the association of high-flow nasal cannula and bronchiolitis length of stay.
In hospitalized children with bronchiolitis, the use of High-flow nasal cannula (HFNC) therapy is related with a longer length of stay (LOS) when used outside of the ICU. The purpose of this study was to explore the relationship between HFNC and LOS to determine if demographic and clinical factors modify the effect of HFNC usage on LOS. Of 8,060 included patients, 27.0% received HFNC during admission. The study found that age group, weight, complex chronic condition, initial tachypnea, initial desaturation, and ICU services were significantly related with LOS. The effect of HFNC on LOS varied among hospitals (P < .001), with the estimated increase in LOS ranging from 32% to 139%. 1- to 6-month-old infants, patients without initial desaturation, and patients without ICU services had the highest relationship between HFNC and LOS, respectively.
AHRQ-funded; HS026006.
Citation: Winer JC, Richardson T, Berg KJ .
Effect modifiers of the association of high-flow nasal cannula and bronchiolitis length of stay.
Hosp Pediatr 2023 Nov; 13(11):1018-27. doi: 10.1542/hpeds.2023-007295..
Keywords: Children/Adolescents, Respiratory Conditions, Hospitalization
Song J, Min SH, Chae S
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
The purpose of this study was to characterize risk factor patterns documented in home health care (HHC) clinical notes and explore their relationships with hospitalizations or emergency department (ED) visits. The researchers analyzed data for 73,350 episodes of care from one large HHC organization utilizing dynamic time warping and hierarchical clustering analysis to characterize the patterns of risk factors over time documented in clinical notes. The study found that six temporal clusters emerged, reflecting varying patterns in how risk factors were documented. Patients with a sharp increase in documented risk factors over time had a 3 times greater probability of hospitalization or ED visit than patients with no documented risk factors. The majority of risk factors were found in the physiological domain, and a minority were found in the environmental domain.
AHRQ-funded; HS027742.
Citation: Song J, Min SH, Chae S .
Uncovering hidden trends: identifying time trajectories in risk factors documented in clinical notes and predicting hospitalizations and emergency department visits during home health care.
J Am Med Inform Assoc 2023 Oct 19; 30(11):1801-10. doi: 10.1093/jamia/ocad101..
Keywords: Emergency Department, Hospitalization, Home Healthcare, Risk
Herzig SJ, Anderson TS, Urman RD
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
The purpose of this retrospective cohort study was to identify risk factors for opioid-related adverse drug events (ORADEs) after hospital discharge following orthopedic procedures. The participants of this study included a national sample of Medicare beneficiaries who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid prescription filled within 2 days of discharge. The study found that among 30,514 hospitalizations with a major orthopedic procedure and an opioid claim, a potential ORADE requiring hospital revisit occurred in 2.5%. After adjustment for patient characteristics, prior opioid use, co-prescribed sedating medications, and opioid prescription characteristics were not related with ORADEs. Independent risk factors did include age of 80 years or older, female sex, and clinical conditions, including heart failure, respiratory illness, kidney disease, dementia/delirium, anxiety disorder, and musculoskeletal/nervous system injuries.
AHRQ-funded; HS026215.
Citation: Herzig SJ, Anderson TS, Urman RD .
Risk factors for opioid-related adverse drug events among older adults after hospitalization for major orthopedic procedures.
J Patient Saf 2023 Oct 1; 19(6):379-85. doi: 10.1097/pts.0000000000001144..
Keywords: Elderly, Opioids, Adverse Drug Events (ADE), Adverse Events, Hospitalization, Orthopedics, Surgery, Medication, Risk, Medication: Safety, Patient Safety
Soulsby WD, Lawson E, Okumura M
Socioeconomic factors are associated with severity of hospitalization in pediatric lupus: an analysis of the 2016 Kids' Inpatient Database.
This study’s goal was to investigate the relationship of income level and other socioeconomic factors with length of stay (LOS) in the hospital and severe lupus features using the 2016 Kids' Inpatient Database (KID). The cohort included children aged 2-20 identified with lupus hospitalization in the 2016 KID using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes (M32). A total of 3,367 unweighted lupus hospitalizations were identified. Income level was found to be a statistically significant predictor of increased LOS in the hospital for those in the lowest income quartile. Black race, "other" race, and public insurance were also associated with severe lupus features.
AHRQ-funded; HS026383.
Citation: Soulsby WD, Lawson E, Okumura M .
Socioeconomic factors are associated with severity of hospitalization in pediatric lupus: an analysis of the 2016 Kids' Inpatient Database.
Arthritis Care Res 2023 Oct; 75(10):2073-81. doi: 10.1002/acr.25121..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitalization, Chronic Conditions
Chae S, Davoudi A, Song J
Predicting emergency department visits and hospitalizations for patients with heart failure in home healthcare using a time series risk model.
This study’s objective was to develop a time series risk model for predicting emergency department (ED) visits and hospitalizations in patients with heart failure (HF) using longitudinal electronic health record data. The authors explored which data sources yield the best-performing models over various time windows. They used data collected from 9362 patients from a large home healthcare (HHC) agency and iteratively developed risk models using both structured and unstructured data. They developed seven specific sets of variables including: (1) the Outcome and Assessment Information Set, (2) vital signs, (3) visit characteristics, (4) rule-based natural language processing-derived variables, (5) term frequency-inverse document frequency variables, (6) Bio-Clinical Bidirectional Encoder Representations from Transformers variables, and (7) topic modeling. Risk models for 18 time windows (1-15, 45, and 60 days) before an ED visit or hospitalization were developed. They compared risk prediction performances using recall, precision, accuracy, F1, and area under the receiver operating curve (AUC). The best-performing model was built using a combination of all 7 sets of variables and the time window of 4 days before an ED visit or hospitalization.
AHRQ-funded; HS027742.
Citation: Chae S, Davoudi A, Song J .
Predicting emergency department visits and hospitalizations for patients with heart failure in home healthcare using a time series risk model.
J Am Med Inform Assoc 2023 Sep 25; 30(10):1622-33. doi: 10.1093/jamia/ocad129..
Keywords: Hospitalization, Emergency Department, Risk
Holland JE, Rettew DC, Varni SE
Associations between mental and physical illness comorbidity and hospital utilization.
The purpose of this study was to describe the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and evaluate the relationship of comorbidity on hospital use. The sample analyzed was 50% female, 63% Medicaid, and 43% had 1 or more chronic illness. The study found that mental illness was common (31%) and highly comorbid with multiple physical illnesses. In AYA with pulmonary illness, those with comorbid mental illness had 1.74-times higher odds of ED use and 2.9-times higher odds of hospitalization than those without mental illness. Comorbid endocrine and mental illness had 1.84-times higher odds of ED use and 2.1-times higher odds of hospitalization, comorbid neurologic and mental illness had 1.36-times higher odds of ED use and 2.4-times higher odds of hospitalization and comorbid musculoskeletal and mental illness had 1.38-times higher odds of ED use and 2.1-times higher odds of hospitalization.
AHRQ-funded; HS024575.
Citation: Holland JE, Rettew DC, Varni SE .
Associations between mental and physical illness comorbidity and hospital utilization.
Hosp Pediatr 2023 Sep; 13(9):841-48. doi: 10.1542/hpeds.2022-006984..
Keywords: Behavioral Health, Chronic Conditions, Hospitalization
Min SH, Song J, Evans L
Home healthcare patients with distinct psychological, cognitive, and behavioral symptom profiles and at-risk subgroup for hospitalization and emergency department visits using latent class analysis.
The purpose of this study was to explore subgroups of older adults receiving home healthcare services with similar psychological, cognitive, and behavioral symptom profiles and an at-risk subgroup for future hospitalization and emergency department visits as an indicator of underdiagnosis or undertreatment. The three-class model applied in the study consisted of Class 1: "Moderate psychological symptoms without behavioral issues," Class 2: "Severe psychological symptoms with behavioral issues," and Class 3: "Mild psychological symptoms without behavioral issues." The study found that Class 1 patients had 1.14 higher odds and Class 2 patients had 1.26 higher odds of being hospitalized or visiting emergency departments compared to Class 3. The researchers discovered significant differences in individual characteristics such as age, gender, race/ethnicity, and insurance.
AHRQ-funded; HS027742.
Citation: Min SH, Song J, Evans L .
Home healthcare patients with distinct psychological, cognitive, and behavioral symptom profiles and at-risk subgroup for hospitalization and emergency department visits using latent class analysis.
Clin Nurs Res 2023 Sep; 32(7):1021-30. doi: 10.1177/10547738231183026..
Keywords: Home Healthcare, Emergency Department, Hospitalization, Elderly
Rao S, Armistead I, Tyler A
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
This study compared demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 respiratory virus season. The authors conducted a retrospective cohort study using Colorado's hospital respiratory surveillance data comparing coronavirus disease 2019 (COVID-19)-, influenza-, and RSV-hospitalized cases < 18 years of age admitted and undergoing standardized molecular testing between October 1, 2021, and April 30, 2022. The cohort consisted of 847 hospitalized cases, of which 490 (57.9%) were RSV associated, 306 (36.1%) were COVID-19 associated, and 51 (6%) were influenza associated. Most RSV cases were children less than 4 years of age (92.9%), whereas influenza hospitalizations were observed in older children. RSV cases were more likely to require oxygen support higher than nasal cannula compared with COVID-19 and influenza cases, although COVID-19 cases were more likely to require invasive mechanical ventilation than influenza and RSV cases. Compared with children with COVID-19, the risk of intensive care unit admission was highest among children with influenza, whereas the risk of pneumonia, bronchiolitis, longer hospital length of stay, and need for oxygen were more likely among children with RSV.
AHRQ-funded; HS026512.
Citation: Rao S, Armistead I, Tyler A .
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
J Pediatr 2023 Sep; 260:113491. doi: 10.1016/j.jpeds.2023.113491..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Influenza, Hospitalization, Infectious Diseases
Hogg-Graham R, Gatton KR, Ingram R
Association between insurer connectivity in Appalachian population health networks and preventable hospitalizations: evidence from Kentucky.
Capacity in community health and social services networks may be limited in geographic regions like Appalachia because of the combined effects of rurality and consistently poor health and social outcomes. The purpose of this study was to examine insurer connectivity in cross-sector networks across Kentucky’s geographic regions and the relationship between connectivity and the probability of preventable hospitalizations. The study found sizable geographic differences in the relationship between insurer connectivity in community networks and preventable hospitalization. Insurer connectivity in rural Appalachian communities was related with decreased likelihood that an individual was admitted for a preventable hospitalization.
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Gatton KR, Ingram R .
Association between insurer connectivity in Appalachian population health networks and preventable hospitalizations: evidence from Kentucky.
J Appalach Health 2023 Aug; 5(2)..
Keywords: Rural Health, Rural/Inner-City Residents, Prevention, Hospitalization, Health Insurance
Campbell JI, Shanahan KH, Bartick M
Racial and ethnic differences in length of stay for US Children hospitalized for acute osteomyelitis.
The objective of this cross-sectional study was to examine the association between race/ethnicity and length of stay (LOS) for US children with acute osteomyelitis. Data was taken from the Kids' Inpatient Database. The median LOS was 5 days, but the findings indicated that Black, Hispanic, and other non-White race/ethnicity children with acute osteomyelitis experienced longer LOS than White children. The researchers concluded that elucidation of the mechanisms underlying these race- and ethnicity-based differences, including social drivers, may improve management and outcomes.
AHRQ-funded; HS000063.
Citation: Campbell JI, Shanahan KH, Bartick M .
Racial and ethnic differences in length of stay for US Children hospitalized for acute osteomyelitis.
J Pediatr 2023 Aug; 259:113424. doi: 10.1016/j.jpeds.2023.113424..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Hospitalization
Wang M, Wadhwani SI, Cullaro G
Racial and ethnic disparities among patients hospitalized for acute cholangitis in the United States.
Researchers used HCUP NIS data to analyze hospitalizations from 2009-18 to determine whether race/ethnicity is associated with hospitalization outcomes among patients admitted with acute cholangitis. Their analysis included patients aged 18 or older who were hospitalized with an ICD9/10 diagnosis of cholangitis. Results indicated that black patients had higher in-hospital mortality rates, were associated with fewer and delayed endoscopic retrograde cholangiopancreatography (ERCP) procedures, and had longer length of stay. The researchers concluded that future studies with more granular social determinants of health data should explore underlying reasons for these disparities to develop interventions aimed at reducing racial disparities in outcomes among patients with acute cholangitis.
AHRQ-funded; HS027369.
Citation: Wang M, Wadhwani SI, Cullaro G .
Racial and ethnic disparities among patients hospitalized for acute cholangitis in the United States.
J Clin Gastroenterol 2023 Aug 1; 57(7):731-36. doi: 10.1097/mcg.0000000000001743..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Racial and Ethnic Minorities
Hogg-Graham R, Lang J, Waters TM
The Appalachian gap in preventable hospitalizations: are we seeing any progress? .
The purpose of this study was to explore whether within-rural variations in Kentucky’s preventable hospitalization rates exist and how these variations may be changing longitudinally. The study found that rural Appalachian counties had significantly higher preventable hospitalizations rates compared to their rural non-Appalachian and urban counterparts. A decreasing trend in overall preventable hospitalizations was witnessed for rural Appalachia over time, but trends were relatively stable for rural non-Appalachian and urban counties. Regression results revealed no significant longitudinal decrease in the “Appalachian gap.”
AHRQ-funded; HS025494.
Citation: Hogg-Graham R, Lang J, Waters TM .
The Appalachian gap in preventable hospitalizations: are we seeing any progress? .
J Appalach Health 2023 Aug; 5(2)..
Keywords: Rural Health, Rural/Inner-City Residents, Prevention, Hospitalization
Stonko DP, Weller JH, Gonzalez Salazar AJ
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
The purpose of this study was to design a tool that used only data available at time of admission for trauma to predict prolonged hospital length of stay (LOS). Data was collected from the trauma registry at an urban level-one adult trauma center. Single layer and deep artificial neural networks were trained to identify patients in the top quartile of LOS and optimized under the receiver operator characteristic curve. The results indicated that machine learning can predict which trauma patients will have prolonged LOS with physiologic and demographic data available at the time of admission. The authors concluded these patients may benefit from additional disposition planning resources at the time of admission.
AHRQ-funded; HS026640; HS024547; HS027793.
Citation: Stonko DP, Weller JH, Gonzalez Salazar AJ .
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
Surg Innov 2023 Jun; 30(3):356-65. doi: 10.1177/15533506221139965..
Keywords: Trauma, Hospitalization, Health Information Technology (HIT)
Loomer L, Rahman M, Mroz TM
Impact of higher payments for rural home health episodes on rehospitalizations.
This article evaluated the impact of higher Medicare payments for rural home health care on rehospitalizations. In 2010, Medicare began paying home health (HH) providers 3% more to serve rural beneficiaries. The authors used Medicare data on postacute HH episodes from 2007 to 2014 to estimate the impact of higher payments on beneficiaries outcomes using difference-in-differences analysis, comparing rehospitalizations between rural and urban postacute HH episodes before and after 2010. Their sample included 5.6 million post acute HH episodes (18% rural). After 2010 30- and 60-day rehospitalization rates declined by 10.08% and 16.49% for urban HH episodes and 9.87% and 16.08% for rural HH episodes, respectively. The difference-in-difference estimate was 0.29 percentage points and 0.57 percentage points for 30- and 60-day rehospitalization, respectively.
AHRQ-funded; HS027054.
Citation: Loomer L, Rahman M, Mroz TM .
Impact of higher payments for rural home health episodes on rehospitalizations.
J Rural Health 2023 Jun; 39(3):604-10. doi: 10.1111/jrh.12725..
Keywords: Payment, Rural Health, Rural/Inner-City Residents, Hospital Readmissions, Hospitalization
Piniella NR, Fuller TE, Smith L
Early expected discharge date accuracy during hospitalization: a multivariable analysis.
The purpose of this study was to assess the level at which accurate estimation of an expected discharge date (EDD) early during hospitalization impacts clinical operations and discharge planning. The researchers conducted a retrospective study of patients discharged from six general medicine units at an academic medical center in Boston, MA from January 2017 to June 2018. All EDD entries and patient, encounter, unit, and provider data were extracted from the electronic health record (EHR), and public weather data. The study found that of 3917 eligible hospitalizations 22.7% had at least one accurate early EDD entry. Clinician-entered EDD, admit day and discharge day during the work week, and teaching clinical units were the factors significantly positively associated with an accurate early EDD. An Elixhauser Comorbidity Index of 11 or more and length of stay of two or more days were the factors significantly negatively associated with an accurate early EDD. The researchers concluded that EDDs entered within the first 24 hours of admission were frequently inaccurate. Few of the factors associated with accurate early EDD entries would be useful for prospective prediction.
AHRQ-funded; HS024751.
Citation: Piniella NR, Fuller TE, Smith L .
Early expected discharge date accuracy during hospitalization: a multivariable analysis.
J Med Syst 2023 May 12; 47(1):63. doi: 10.1007/s10916-023-01952-1..
Keywords: Hospital Discharge, Hospitalization
Kannan S, Song Z
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
Out-of-pocket costs for ICU care may be large at the beginning of the year due to high insurance deductibles that reset every year for US patients, and the expensive nature of ICU care. The purpose of this cross-sectional study was to explore cost-sharing changes from December to January for ICU admissions and non -ICU admissions among adults with employer-sponsored insurance. Among aggregate ICU hospitalizations, total cost-sharing averaged $1079 in December and $1871 in January, a 73.4% increase. Among non-ICU hospitalizations, total cost-sharing averaged $1043 in December and $1683 in January, a 61.3% increase. These increases and differences between ICU and non-ICU hospitalizations were greater among patients with high deductible health plans (HDHPs). For patients with HDHPs requiring an ICU stay, cost-sharing averaged $3093 per hospitalization in January vs $1301 in December.
AHRQ-funded; HS024072.
Citation: Kannan S, Song Z .
Changes in out-of-pocket costs for US hospital admissions between December and January every year.
JAMA Health Forum 2023 May 5; 4(5):e230784. doi: 10.1001/jamahealthforum.2023.0784..
Keywords: Healthcare Costs, Hospitals, Hospitalization, Intensive Care Unit (ICU)
Valley TS, Schutz A, Miller J
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
In order to understand factors influencing how intensive care unit (ICU) admission decisions are made, researchers conducted qualitative analysis of eight U.S. hospitals. Semi-structured, one-on-one interviews with 87 participants were supplemented by site visits and clinical observations. Four hospital-level factors were identified which influenced ICU admission decisionmaking. The researchers concluded that healthcare systems should evaluate use of ICU care and establish institutional patterns to ensure that ICU admission decisions are patient-centered as well as account for resources and hospital-specific constraints.
AHRQ-funded; HS028038.
Citation: Valley TS, Schutz A, Miller J .
Hospital factors that influence ICU admission decision-making: a qualitative study of eight hospitals.
Intensive Care Med 2023 May; 49(5):505-16. doi: 10.1007/s00134-023-07031-w..
Keywords: Intensive Care Unit (ICU), Hospitals, Shared Decision Making, Hospitalization
Skains RM, Zhang Y, Osborne JD
Hospital-associated disability due to avoidable hospitalizations among older adults.
A frequent complication during the course of acute care hospitalizations in older adults is Hospital-associated disability (HAD). Numerous admissions are for ambulatory care sensitive conditions (ACSCs), which are considered potentially avoidable hospitalizations-conditions that may be able to be treated in outpatient settings to prevent hospitalization and HAD. The purpose of this study was to compare the incidence of HAD between older adults hospitalized for ACSCs versus those hospitalized for other diagnoses. The researchers conducted a retrospective cohort study of 38,960 older adults 65 years of age or older admitted to inpatient (non-ICU) medical and surgical units of a large southeastern regional academic medical center. The primary study outcome was HAD. The study found that 10% of older adults were admitted for an ACSC, with rates of HAD in those admitted for ACSCs lower than those admitted for other conditions. Age, comorbidity, admission functional status, and admission cognitive impairment were significant predictors for development of HAD. Compared with admissions for other conditions, ACSC admissions to medical and medical/surgical services had decreased odds of HAD, with no significant differences between ACSC and non-ACSC admissions to surgical services.
AHRQ-funded; HS013852.
Citation: Skains RM, Zhang Y, Osborne JD .
Hospital-associated disability due to avoidable hospitalizations among older adults.
J Am Geriatr Soc 2023 May; 71(5):1395-405. doi: 10.1111/jgs.18238..
Keywords: Elderly, Hospitalization, Hospital Discharge