National Healthcare Quality and Disparities Report
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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
226 to 250 of 327 Research Studies DisplayedMeddings J, Saint S, Krein SL
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
This paper is a systematic literature review of strategies to reduce urinary tract infections (UTIs) in nursing home residents. It concludes that several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or catheter-associated UTI in nursing home residents.
AHRQ-funded; HS019767; HS018334; 290201000025I.
Citation: Meddings J, Saint S, Krein SL .
Systematic review of interventions to reduce urinary tract infection in nursing home residents.
J Hosp Med 2017 May;12(5):356-68. doi: 10.12788/jhm.2724.
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Keywords: Antibiotics, Catheter-Associated Urinary Tract Infection (CAUTI), Elderly, Evidence-Based Practice, Long-Term Care, Nursing Homes, Patient Safety, Prevention, Urinary Tract Infection (UTI)
Zullo AR, Lee Y, Daiello LA
Beta-blocker use in U.S. Nursing home residents after myocardial infarction: a national study.
This study evaluated how often beta-blockers were started after acute myocardial infarction (AMI) in nursing home (NH) residents who previously did not use these drugs and to evaluate which factors were associated with post-AMI use of beta-blockers. It found that almost half of older NH residents in the United States do not initiate a beta-blocker after AMI.
AHRQ-funded; HS022998.
Citation: Zullo AR, Lee Y, Daiello LA .
Beta-blocker use in U.S. Nursing home residents after myocardial infarction: a national study.
J Am Geriatr Soc 2017 Apr;65(4):754-62. doi: 10.1111/jgs.14671.
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Keywords: Elderly, Healthcare Utilization, Nursing Homes, Heart Disease and Health, Medication
Welsh RL, Graham JE, Karmarkar AM
Effects of postacute settings on readmission rates and reasons for readmission following total knee arthroplasty.
This study examined the effects of postacute discharge setting on unplanned hospital readmissions following total knee arthroplasty (TKA) in older adults. Inpatient rehabilitation facility (IRF), skilled nursing facility (SNF) concluded that patients discharged to either inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF), in comparison with those discharged to the community, had greater likelihood of readmission within 30 and 90 days.
AHRQ-funded; HS022907.
Citation: Welsh RL, Graham JE, Karmarkar AM .
Effects of postacute settings on readmission rates and reasons for readmission following total knee arthroplasty.
J Am Med Dir Assoc 2017 Apr;18(4):367.e1-67.e10. doi: 10.1016/j.jamda.2016.12.068.
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Keywords: Elderly, Nursing Homes, Hospital Readmissions, Rehabilitation, Surgery
Haber SG, Wensky SG, McCall NT
Reducing inpatient hospital and emergency room utilization among nursing home residents.
This study examined the association among nursing home residents between strength of relationship with a primary care provider (PCP) and inpatient hospital and emergency room (ER) utilization. Both measures of strength of patient-provider relationships were associated with fewer inpatient admissions and ER visits, except regularity of PCP visits and ambulatory care sensitive conditions (ACSC) ER visits.
AHRQ-funded; HS000029.
Citation: Haber SG, Wensky SG, McCall NT .
Reducing inpatient hospital and emergency room utilization among nursing home residents.
J Aging Health 2017 Apr;29(3):510-30. doi: 10.1177/0898264316641074.
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Keywords: Elderly, Emergency Department, Hospitalization, Nursing Homes, Primary Care
Mody L, Greene MT, Saint S
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Nursing homes provided baseline information about their infection prevention programs to assess strengths and gaps related to catheter-associated urinary tract infection (CAUTI) prevention via a needs assessment questionnaire. Among nursing homes participating in an AHRQ-funded collaborative, VA and non-VA nursing homes differed in their approach to CAUTI prevention. Best practices from both settings should be applied universally to create an optimal infection prevention program within emerging integrated healthcare systems.
AHRQ-funded; 290201000025I; HS019767; HS024385; HS018334.
Citation: Mody L, Greene MT, Saint S .
Comparing catheter-associated urinary tract infection prevention programs between Veterans Affairs nursing homes and non-Veterans Affairs nursing homes.
Infect Control Hosp Epidemiol 2017 Mar;38(3):287-93. doi: 10.1017/ice.2016.279.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Long-Term Care, Nursing Homes, Prevention
Steinman MA, Zullo AR, Lee Y
Association of β-blockers with functional outcomes, death, and rehospitalization in older nursing home residents after acute myocardial infarction.
The researchers studied the association of beta-blockers after AMI with functional decline, mortality, and rehospitalization among long-stay nursing home residents 65 years or older. Use of beta-blockers after AMI was associated with functional decline in older nursing home residents with substantial cognitive or functional impairment, but not in those with relatively preserved mental and functional abilities.
AHRQ-funded; HS022998.
Citation: Steinman MA, Zullo AR, Lee Y .
Association of β-blockers with functional outcomes, death, and rehospitalization in older nursing home residents after acute myocardial infarction.
JAMA Intern Med 2017 Feb;177(2):254-62. doi: 10.1001/jamainternmed.2016.7701.
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Keywords: Nursing Homes, Patient-Centered Outcomes Research, Medication, Adverse Drug Events (ADE), Heart Disease and Health
Fain KM, Alexander GC, Dore DD
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
The purpose of this study was to quantify prescription analgesic use of elderly nursing home (NH) residents with persistent noncancer pain and to identify individual and facility traits associated with no treatment. The investigators concluded that through 2008, pain remained undertreated in NHs, especially in certain subpopulations, including cognitively impaired and older residents. The authors suggest that changes in pain management practice and policies may be necessary to target these vulnerable residents.
AHRQ-funded; HS022998.
Citation: Fain KM, Alexander GC, Dore DD .
Frequency and predictors of analgesic prescribing in U.S. nursing home residents with persistent pain.
J Am Geriatr Soc 2017 Feb;65(2):286-93. doi: 10.1111/jgs.14512..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Fain KM, Castillo-Salgado C, Dore DD
Inappropriate fentanyl prescribing among nursing home residents in the United States.
In this cross-sectional study, the investigators quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. The investigators concluded that most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. They suggest that changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
AHRQ-funded; HS018960.
Citation: Fain KM, Castillo-Salgado C, Dore DD .
Inappropriate fentanyl prescribing among nursing home residents in the United States.
J Am Med Dir Assoc 2017 Feb;18(2):138-44. doi: 10.1016/j.jamda.2016.08.015..
Keywords: Care Management, Chronic Conditions, Elderly, Long-Term Care, Medication, Nursing Homes, Opioids, Pain, Practice Patterns
Albrecht JS, Croft L, Morgan DJ
Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes.
This qualitative study explored current use and perceptions of glove and gown use in nursing homes. Analysis of recordings of three focus group discussions revealed that direct care staff reported using gowns and gloves primarily as self-protection against contact with bodily fluids, not to prevent MRSA transmission. Glove use was described as common and more acceptable to staff and residents than gown use.
AHRQ-funded; HS024560; HS022135.
Citation: Albrecht JS, Croft L, Morgan DJ .
Perceptions of gown and glove use to prevent methicillin-resistant staphylococcus aureus transmission in nursing homes.
J Am Med Dir Assoc 2017 Feb;18(2):158-61. doi: 10.1016/j.jamda.2016.08.016.
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Keywords: Healthcare-Associated Infections (HAIs), Long-Term Care, Methicillin-Resistant Staphylococcus aureus (MRSA), Nursing Homes, Prevention, Patient Safety
Nace DA, Archbald-Pannone LR, Ashraf MS
Pneumococcal vaccination guidance for post-acute and long-term care settings: recommendations from AMDA's infection advisory committee.
Sorting out the indications and timing for 13 pneumococcal serotypes and 23 pneumococcal serotypes administration is complex. The authors discuss the importance of pneumococcal vaccination for older adults, detail AMDA-The Society for Post-Acute and Long-Term Care Medicine (The Society)'s recommendations for pneumococcal vaccination practice and procedures, and offer guidance to postacute and long-term care providers supporting the development and effective implementation of pneumococcal vaccine policies.
AHRQ-funded; HS023779.
Citation: Nace DA, Archbald-Pannone LR, Ashraf MS .
Pneumococcal vaccination guidance for post-acute and long-term care settings: recommendations from AMDA's infection advisory committee.
J Am Med Dir Assoc 2017 Feb;18(2):99-104. doi: 10.1016/j.jamda.2016.11.010.
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Keywords: Elderly, Guidelines, Nursing Homes, Pneumonia, Vaccination
Lindquist LA, Miller RK, Saltsman WS
SGIM-AMDA-AGS consensus best practice recommendations for transitioning patients' healthcare from skilled nursing facilities to the community.
The authors assembled a cross-cutting team of experts representing primary care physicians (PCPs), home care physicians, physicians who see patients in skilled nursing facilities (SNF physicians), skilled nursing facility medical directors, human factors engineers, transitional care researchers, geriatricians, internists, family practitioners, and three major organizations: AMDA, SGIM, and AGS. This team identified issues and developed best practices perceived as feasible for SNF physician and PCP practices to accomplish.
AHRQ-funded; HS022916.
Citation: Lindquist LA, Miller RK, Saltsman WS .
SGIM-AMDA-AGS consensus best practice recommendations for transitioning patients' healthcare from skilled nursing facilities to the community.
J Gen Intern Med 2017 Feb;32(2):199-203. doi: 10.1007/s11606-016-3850-8.
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Keywords: Quality of Care, Long-Term Care, Nursing Homes, Primary Care, Transitions of Care
Kane-Gill SL, Niznik JD, Kellum JA
Use of telemedicine to enhance pharmacist services in the nursing facility.
The researchers conducted a systematic literature review to determine what telemedicine services are provided by pharmacists and the impact of these services in the nursing facility setting. Since only three manuscripts met inclusion criteria, the researchers concluded that there is a general paucity of practice-related research to demonstrate potential benefits of pharmacists' services incorporating telemedicine.
AHRQ-funded; HS024208.
Citation: Kane-Gill SL, Niznik JD, Kellum JA .
Use of telemedicine to enhance pharmacist services in the nursing facility.
Consult Pharm 2017 Feb;32(2):93-98. doi: 10.4140/TCP.n.2017.93.
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Keywords: Telehealth, Nursing Homes, Medication, Elderly, Provider: Pharmacist
Scales K, Zimmerman S, Reed D
Nurse and medical provider perspectives on antibiotic stewardship in nursing homes.
The objective of this cross sectional survey was to examine perspectives on antibiotic use and antibiotic stewardship of nurses and medical providers in nursing homes ( NHs). The investigators concluded that nursing staff and medical providers share a commitment to reducing unnecessary antibiotic use. Antibiotic stewardship interventions should foster cooperation and build competency to implement alternative management approaches and to educate residents and families. Nurse leaders and medical providers with long-term care training may be especially effective champions for antibiotic stewardship.
AHRQ-funded; HS22846.
Citation: Scales K, Zimmerman S, Reed D .
Nurse and medical provider perspectives on antibiotic stewardship in nursing homes.
J Am Geriatr Soc 2017 Jan;65(1):165-71. doi: 10.1111/jgs.14504..
Keywords: Elderly, Antimicrobial Stewardship, Antibiotics, Medication, Nursing Homes, Long-Term Care, Provider: Nurse, Provider
Alexander G, Madsen R, Newton M
Analyzing change in nursing home information technology sophistication: a 2-year survey.
Currently, a national sample of nursing homes (NHs) is being surveyed for 3 consecutive years to determine trends in NH information technology (IT) sophistication (e.g., measures of IT capabilities, extent of IT use, IT integration with internal and external stakeholders). IT sophistication is measured in resident care, clinical support, and administrative activities. The current article provides details of the differences in NH IT sophistication reported by administrators completing Year 1 and Year 2 surveys.
AHRQ-funded; HS022497.
Citation: Alexander G, Madsen R, Newton M .
Analyzing change in nursing home information technology sophistication: a 2-year survey.
Analyzing change in nursing home information technology sophistication: a 2-year survey..
Keywords: Health Information Technology (HIT), Nursing Homes, Organizational Change
Trautner BW, Greene MT, Krein SL
Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel.
This study assessed knowledge about infection prevention among nursing home personnel and identified gaps potentially addressable through a quality improvement collaborative. It found that, while 99.1 percent of licensed personnel recognized the definition of asymptomatic bacteriuria, only 36.1 percent knew that pyuria could not distinguish a urinary tract infection from asymptomatic bacteriuria.
AHRQ-funded; 290201000025I.
Citation: Trautner BW, Greene MT, Krein SL .
Infection prevention and antimicrobial stewardship knowledge for selected infections among nursing home personnel.
Infect Control Hosp Epidemiol 2017 Jan;38(1):83-88. doi: 10.1017/ice.2016.228.
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Keywords: Antimicrobial Stewardship, Education: Continuing Medical Education, Healthcare-Associated Infections (HAIs), Nursing Homes, Prevention, Patient Safety
Tjia J, Lemay CA, Bonner A
Informed family member involvement to improve the quality of dementia care in nursing homes.
Researchers described the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40 percent of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process.
AHRQ-funded; HS019351.
Citation: Tjia J, Lemay CA, Bonner A .
Informed family member involvement to improve the quality of dementia care in nursing homes.
J Am Geriatr Soc 2017 Jan;65(1):59-65. doi: 10.1111/jgs.14299.
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Keywords: Shared Decision Making, Dementia, Medication, Nursing Homes, Patient and Family Engagement
Mukamel DB, Amin A, Weimer DL
Personalizing nursing home compare and the discharge from hospitals to nursing homes.
This study tested whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes. It found that about 85 percent of users indicated satisfaction with NHCPlus. Compared to controls, intervention patients were more satisfied with the choice process.
AHRQ-funded; R21 HS021844.
Citation: Mukamel DB, Amin A, Weimer DL .
Personalizing nursing home compare and the discharge from hospitals to nursing homes.
Health Serv Res 2016 Dec;51(6):2076-94. doi: 10.1111/1475-6773.12588.
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Keywords: Hospital Discharge, Hospitals, Nursing Homes, Patient Experience, Quality Indicators (QIs)
Wang Y, Pandolfi MM, Fine J
Community level association between home health and nursing home performance on quality and hospital 30-day readmissions for Medicare patients.
Using CMS data from 2010 to 2012, the researchers evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients. They found that increasing nursing home performance by one star for all of its 4 measures and home health performance by 10 points for all of its 6 measures is associated with decreases in community-level risk-standardized readmission rates.
AHRQ-funded; HS023000.
Citation: Wang Y, Pandolfi MM, Fine J .
Community level association between home health and nursing home performance on quality and hospital 30-day readmissions for Medicare patients.
Home Health Care Manag Pract 2016 Nov;28(4):201-08. doi: 10.1177/1084822316639032.
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Keywords: Quality of Care, Hospital Readmissions, Home Healthcare, Nursing Homes, Provider Performance
Zullo AR, Dore DD, Gutman R
National glucose-lowering treatment complexity is greater in nursing home residents than community-dwelling adults.
This letter describes common glucose-lowering medication usage patterns for a national cross-section of U.S. adults aged 65 and older residing in nursing home (NH) and community settings from 2007 to 2010. The study results suggest that continued efforts are warranted to improve glucose-lowering medication management and simplify treatment regimens in the NH; that the relative importance of CER questions regarding specific glucose-lowering treatments may differ according to the care setting; and that CER studies of glucose-lowering treatments in older adults must address the combination use of medications, especially in NH residents.
AHRQ-funded; HS022998.
Citation: Zullo AR, Dore DD, Gutman R .
National glucose-lowering treatment complexity is greater in nursing home residents than community-dwelling adults.
J Am Geriatr Soc 2016 Nov;64(11):e233-e35. doi: 10.1111/jgs.14485.
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Keywords: Care Management, Chronic Conditions, Diabetes, Elderly, Medication, Nursing Homes
Berry SD, Lee Y, Zullo AR
Incidence of hip fracture in U.S. nursing homes.
The researchers described the incidence rate (IR) of hip fracture according to age, sex, and race in a nationwide sample of long-stay nursing home residents. They found that the mean age was 84 years, 74.5% were women, 83.9% were white, and 12.0% were black. The overall IR of hip fracture was 2.3/100 person years, which was similar in men and women across age groups. The IR of hip fracture was highest in Native Americans aged 85 years or older, in whites, and during the first 100 days of institutionalization, while the.IRs of hip fracture were lowest in blacks.
AHRQ-funded; HS022998.
Citation: Berry SD, Lee Y, Zullo AR .
Incidence of hip fracture in U.S. nursing homes.
J Gerontol A Biol Sci Med Sci 2016 Sep;71(9):1230-4. doi: 10.1093/gerona/glw034.
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Keywords: Elderly, Injuries and Wounds, Long-Term Care, Nursing Homes, Racial and Ethnic Minorities
Abrahamson K, Davila H, Rehkamp N
Is there a business case for nursing home quality improvement?
The objective of this study was to investigate the economic or business perspective surrounding QI participation by exploring nursing home leader perceptions regarding market-based motivations for improvements, or a business case for engaging in a quality improvement project.
AHRQ-funded; HS018464.
Citation: Abrahamson K, Davila H, Rehkamp N .
Is there a business case for nursing home quality improvement?
Nurs Econ 2016 Sep-Oct;34(5):224-9, 35..
Keywords: Long-Term Care, Nursing Homes, Quality Improvement
Bali V, Chatterjee S, Johnson ML
Comparative risk of hip fractures in elderly nursing home patients with depression using paroxetine and other selective serotonin reuptake inhibitors.
The researchers evaluated comparative safety of paroxetine and other selective serotonin reuptake inhibitors (SSRIs) for the risk of hip fractures. They found no differential risk of hip fractures between paroxetine and other SSRIs.
AHRQ-funded; HS021264.
Citation: Bali V, Chatterjee S, Johnson ML .
Comparative risk of hip fractures in elderly nursing home patients with depression using paroxetine and other selective serotonin reuptake inhibitors.
J Comp Eff Res 2016 Aug;5(5):461-73. doi: 10.2217/cer-2016-0009.
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Keywords: Medication, Elderly, Injuries and Wounds, Nursing Homes, Patient Safety
Alexander GL, Madsen RW, Miller E
A national report of nursing home information technology adoption and quality measures.
The purpose of this article is to describe a national model being used as a guiding framework to assess trends in nursing home IT adoption, called IT sophistication, and quality measures. Through this model, the authors answer the following research question: Do relationships exist between nursing home IT sophistication and quality measures?
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen RW, Miller E .
A national report of nursing home information technology adoption and quality measures.
J Nurs Care Qual 2016 Jul-Sep;31(3):201-6. doi: 10.1097/ncq.0000000000000187.
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Keywords: Nursing Homes, Health Information Technology (HIT), Quality Measures
Zullo AR, Dore DD, Daiello L
National trends in treatment initiation for nursing home residents with diabetes mellitus, 2008 to 2010.
The authors studied trends in initiation of glucose-lowering medications in a national cohort of nursing home residents. They found that, between 2008 and 2010, there were substantial decreases in the use of oral glucose-lowering agents and corresponding increases in the use of insulin among long-term residents of US nursing homes.
AHRQ-funded; HS022998.
Citation: Zullo AR, Dore DD, Daiello L .
National trends in treatment initiation for nursing home residents with diabetes mellitus, 2008 to 2010.
J Am Med Dir Assoc 2016 Jul;17(7):602-8. doi: 10.1016/j.jamda.2016.02.023.
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Keywords: Diabetes, Elderly, Long-Term Care, Medication, Nursing Homes
Chatterjee S, Bali V, Carnahan RM
Anticholinergic medication use and risk of dementia among elderly nursing home residents with depression.
The purpose of this study was to examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression. The study concluded that use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia.
AHRQ-funded; HS021264.
Citation: Chatterjee S, Bali V, Carnahan RM .
Anticholinergic medication use and risk of dementia among elderly nursing home residents with depression.
Am J Geriatr Psychiatry 2016 Jun;24(6):485-95. doi: 10.1016/j.jagp.2015.12.011..
Keywords: Adverse Drug Events (ADE), Dementia, Elderly, Medication, Nursing Homes